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ELECTBICAL.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS ()\t Nt.R lt( ,tn.R l)fr.r \k\lur\
<br />t hcrchy alirh und.r p.nally ol rrjury (hd I m crcnPr ,hnr lN ContrctoN Liensc rlw lnr th. tirll,sins '.aon (scc 70.11.5
<br />Bxn.cs a Pro&sio! Cd.i.): Ary Ciry ot Colnry which rcqums t Pcmn b conidd nlr.r. inrpn'v. Jcmnch or tpair dv
<br />(rudurc, Forro irs s{mc. atso rcquirs rhc amlicmi lor$.hIEmir rd lika s+nc{ srarcNnr rhxt hcor she n liccntd puruot
<br />b rh. pNvisions ol lh. Conrracktr s LBnsc'l Lav (Chafl* 9, CommcRin3 *irh Sdctbn 1000 oi Divilion J olrhc Buriics dnd
<br />Pru,c$ trDs Co'jc) or rh h.orshc neicnPr ihcftttom rd rhc blsn lbtrh. d uc8.d crc mPl ioo. Anv vnrlarion ol Secrbn 70ll'5 bv 8trv
<br />applird tur r p.mir subrech lhc apphca.r ro , oivil Fn.ll, oi nor mtr th.n live hunJftd Jollds (S500)
<br />l-a!ownctot(hcProltlly.ornycmlloltsw(hwase\asrhcts,lc(.mFNatirn.*illd)lh.*o,4irh.nndurchrti
<br />d.nl.d o. otlihl lbr slc rSe.7O44. Busirc$ 3n,l Pn,ltsn,ni Ci,c -t h. Ornm.nx s l-un* tnw rk)cs nor aPlilv b an owncr of
<br />rhc l^,tcdy wl$ buil'lr or iqr)hi dEB)n. x] *ho ddr nEh M* hims.ll or ltn.ll or r hou8h lns or her own cmplovcer,
<br />pNd;J rh{ .!.h ,n'ln)wEnls m nor inr. n{ or olicGl to, elc. Il. howt{r' th. huiung or i,r'F)vcmr n sli v hin onc rr
<br />ot com0krdn, lhc O*rcr Buin r will ha{ tht tDnjcn of t'n,vins thd ltr or drc ,li l nor build or r\x)vc ft loFdv lor llE Purlrt* or
<br />L ir .wncr oi t h. ptup.ny. in gclusivcly dntacrD8 wnh lic.ni.J contr&tor ro onntucl rrf, nolccl lst' 7o!1. Busincs
<br />aBl ,\I't6*n codc: I hc Conr.etx-s L(.nse L.w tjNs nor rlrly k, o*ner nt ltupcnv who $u ilds .r mPmvcs lhcrcon
<br />and who uodrach tor ru(h p.!ic.F wirh I G,tur.n,(t li.rnrcn pusnmr ro thc conlEcntr s l-ic.n$ tjw)
<br />-l
<br />rnc\cmpi und.! Sc.tro.-, B & P.a.16rrh'\ rcrvin
<br />IVORKER.S' CONIITENSATIoN
<br />DEC!,ABAIION
<br />I h.tohy alfnD undci pcndryolh_rjry otrc ol lhc lnlbwmg 'l(ld.rions:
<br />-l
<br />hivc .nl wrll mi.lain a Ccnrrdrc or Conscnl ro Scll ln{rrc hr wo*eE' .t,mt'!nsrtn,n. as pnrvdcd tor bv Sectk'n l?rl0
<br />'1
<br />rh'
<br />utff Gxlc, torrhc !.rti,mucc olthc work tdr Phrh rhc P.m isrnrcJ.
<br />-l
<br />luvc lnn willmai rinwotkr'.on$-nsalb!in\t mc.rsrcqurc'lhySt.rionl7(loolrhcl-.txriC'!c.lorth'p'rinn'"Lcor
<br />rh. w.!k lorwhilihrht p.i,nir is issuol. M y ,orkc6' cdmp.nsd nn in\u!aN.c,Ecr. Fnicvntrnh.rN:
<br />lrcnivrhrt in rhe F..rlirnB nec of I hc workI *hicn rhr p.rm[ rs issucd. ! \hdllnot cnPlovlnyl.!s'n inanvmmncr
<br />o as ro hc.{nrc iuhjc.r t' rhc workcs drmpcnsdn,n hws ol Crlihnri!. d +c lhll iil slouLl tEonf, suhFl hrhc
<br />workcn conrFnslrion lnrvs$ns ol Sccri.n .\7(]O of rlt t$or Cotlc. t shil. tunhw h comPly wirh (ho$ lovNnrns '
<br />WARNING F.ilurc r. $cuB worlcN q)nrp.nsdnon covcr.sc is unhsrul ed sh l subFcr rn cNPlovcr b (iniml lxmllis and
<br />.ivn fircs up ft) onc tundrd lhousaa, noll6 (stoo,filo), ,n add n,n 6 lh. .on oi uomnch\aron. Jama8cs a\ pntvihn fi}' rtu
<br />s..rn,n rU'6 ulrhc tihn c".i. hrcrc{ 'i rrotry'( f..\
<br />LICEISEiD-CONIIACEIB
<br />DECI.dBAIION
<br />I hcEby arumx.dcr ncMlry ol Frjury rhat I m li*nsd lnder rov$aon olChaflcr t (L\Jnmncing wilh Sc.rirn lo(x)) orDivt nl
<br />ot rhc Bnsincss ud Pnl..$mn! Co.lc. srl dy liccn{ r n! tull fde,Iri.iIel.
<br />CONSTIUCTION LENDINC ACENCI
<br />I hcEb, atirm und.r Fn.ly oi pctjury lhal rh.E is a 4.sld.lion tcoiirC i8cn.y fo! thc !.rfomncc of rhe hrk fot vhich rhl\ Fmn (
<br />n\ucd (S.., l09l. Civ. C ).
<br />Lc c:'s Nrm:
<br />I-.n,l.r\ Adrlcs _
<br />APPLICANT DECLARATION
<br />I hnd,y aJtim undcr Nnah, ot Ftjury orc ol lhc Iollowins dccLranonr:
<br />Dcnknirbn Pc.nik-Aih.(os Nolir'icdbn F.dci,l Rcguhb.s{Tnk 40 Pan6)
<br />Rcquircd l*(( of Notif.ali,n
<br />-l
<br />c.diryrlr lhc fclcu I rcsoLr io.\ rcsmlina ashc(oc (.rovrl -. frrl amlicabh ro lhn PNjer
<br />t.Tnrlyrlui I hNc mrd rhis applic.rnr,,ri sl{c lhar lhc ahrE inn malon rcomcl I lsG lo cofrPlv wilh ,ll Cirv 3nd Counlv
<br />oRlin.fr$;d Sralc L,*i El,rin8 n' burldins cu{ddbn. !tu1 hcrcty aur hor@. r.Fcscnr,lils orrhii citv lnJ Cou.tvlo cnle! uF}n rrE
<br />ahrv. nrn(ioNl prupeny litr in{l.crion pur!x&s.
<br />,\rDlicsnt 0r A!cnl Siqn"lu
<br />Pemllk nnm. 'prinl'l
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lite Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh xl
<br />Ceilinqs (T-Bar Rouoh)I'd Lt'li I
<br />lt/leter Release u -\7
<br />A
<br />Rough k.Y-
<br />Service [Vleter
<br />FINAL Y'21o"1"$,\l uil \
<br />Notes, Remarks, Etc.V
<br />Pole Bases
<br />/n\
<br />l-,tn1
<br />o .1"n
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<br />V\Y
<br />-ExPtr.s:
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