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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE OWNEN BUILDER DELC RATION
<br />I hcrcby ltnrn undcr p.nolry of Frjury lnol I am cienpr lmn riE C.nrrncbn t-ic.n{ bq for thc lollo*in8 ,ca{,n (Scc 70:l l 5
<br />Busincs\ aftl Prole$ion Codc): Any Ciry or G,unry whi.h mquircs r Fnnii to ofl\lrucr- alrcr. inprovc, &nolhh or EP.n My
<br />s .rurc. priorro ih hsua.... also rcqutcs lhc olplicant for such pcmil ro flca risncd cmm rhnr h.orshc i.liccnscd turqanl
<br />lo rn povhio.. of rlE Conrracrois Licened tnw (Chaprd 9. cofrmn.ine wirh Scction ?ux) ot Divnion I .r rh. Busincs and
<br />Prea€$nrnr Cudc) or rh{ h.orsh. ic.rcn rh.earo,nrnd rhc b,sis for lhc n,le-ecd cicmpri.n An,violarionoaS.crion7o.115hyany
<br />.ppli.!d ror dle.nrir subF-rsthc applicrnr to ucivilpcnrllyofnol nFrcrMn fivu hu.drcd dolla^ ($5fi))
<br />_1. a\ Dsncr ol rhc lmrcny, (tr my cnplor.c\ wnh w,B.r as rhcn $t conrFnsar ion- will do |tc sork and rh. {turxft i1 nor
<br />iNdrdcd or ofrcrcd lor elc I SN.7044- Busincs\ and Pmlc$ions Codc 'l'hc Conh&t,\ Liccnsc hw dacs ml 0ptly h m oBmr ot
<br />rtc pnlEny who ttrilds o, i'qrekr rh.mtr .Jrl wh) dds ikh sun hn$clt or h.scll or lhnugh hh or hcr o*n c Dloyc.s,
<br />nmvidcd rhar su.h inDmvcmnk iE (r ir cnlctl or onard ior {lc ll t *crs, rhc t ildinE or nlFnruEnr k $H sirhin .R )tor
<br />olcoq)krion. rhc Owmr Buildc! will hlve rhe lldcn ofpmvins lhd hc or shc did nor btrikl or itrpft,ve rtE PmFny fo. rhc purlneol
<br />l. N o*ncr ot rhc lmpcny. 0'n erclu\ircly conrracl ins sil h licenscd .onrracnn\ b ..nsd.r rhl troid (Scc ?0{.r. Bu\in$\
<br />lod Ptr,icshn Codc: The C.nh&kr'r l-ic.trsc Lrw doc! not nprly ro 0nowtrcr olp.opcny *h(, builds ur inpr.v.s rhcrcor.
<br />ud etu .onM.lsforsu(hrmlccrsunhaG,rtmcro(, lie.*dl)Uis,snr hrhccoftn.roi\ Li.ctrs trw)
<br />tan.rc'n.rutr,lcr Sdton .B &PC l,{rhh'. " '
<br />]!lJ-8-[.u8rl9ur!t!"tr!)!
<br />t)t.t( LAk,\lr()N
<br />I h.rcby,mnnundcr n nnlryof rrjulyorc oIrhc r'ollowin8 dalarlrt'.s:
<br />Irh{ (i.J..li rl.( J\1l."rtr cc.r rhr w.rk h_ rlLh rh( Frrn'
<br />Xl\r(.n.1$iltr"inLitrqo'k r.r'n'F.n.x'.,ntr\u'J' .,.
<br />rh. $, 'l ," yrbn l- ,hr |c.'trir i. i*unl M) w,rkl.'r, nlrn,i i,
<br />,,-,". r4clFre_
<br />r.quircd bySc.lion 3700otlhc Llbor Codc, ror rhc Frromtnc. oa
<br />)n insurmc cmicr an lnlicy numher ei
<br />z
<br />IccniIlhalinlhcpcrri,irMnccofrhcworkn{shichrhi!!.riniri\is\uc.IrhallnorcnrployrrryNroninaoynruncr
<br />\r !\ ki hcq,nt$hi(rhrhc worlq( c..ycnu n,n hw\ .r Cahtunrin. ,nd +e lhalill \houkl hccom \ubFcr b rlf,
<br />rorkcrs.omrcnrlrionpovi\i,'nrofSdn,n.l7(x)otrhclrtxrCdc.lshxll.ionhwnhconlly*ithrhocpmvnn,ns
<br />WARNIN(|: FJlur. b *ur.*.rkcrj.on\rnsion covctuBc is unhwl'lll. !ln] shall \utrlrr rn. plo$r to mniMl P.mhics lnd
<br />.ivil fincs up b um hundrcd lhousand dollirs ($l(x).ux,). in ondii.n ro llE co{.r.onvx.\.rion. d0ntr8cs 3r trovidcd lor rhe
<br />\..,.,, rr,{;,, .r.,r", (,,J, , k,..,
<br />,..: t/,1rs
<br />D&CI.ABAIION
<br />I n.Eby ortrh und$ pcnally ofrcrjury lhd I am liensn udd pmvisi.n olChrprd 9l.on.Emine {ilh Setion 70fl)) otDiltt,t l
<br />ot rhc Busifts und Pbr.*ions Codc. 0Jrd ny lhcn* h in tull forcc un cftccl
<br />C 20 CryA /?/7aaE_
<br />CONEIAIJI]I!)NIENDIIG.AGIN.II,
<br />I hcrcbyrllir uMfFmllyolpcrluryIhorlhcrcisrcnn(ruclionbndinga!.tuylnrrhclEornn.cofrhcsotkiorshichrhnlcrniri\
<br />nsucd (S.{ .lO97.Civ. C ).
<br />Lcn&i\ Nam
<br />-
<br />ABrIICANLDECI.ABAIION
<br />t h.,rhy Im und.r F.ahy or Frjury unc ol rhc followi.S delaralnrtrs:
<br />Dcmolirion Pcrmik Asbcsbs Norilic ion Fedcrrl Rdgohrions (Tn!c 40. Pd6)
<br />-Rcquncd
<br />Lcrrcrof Norifi cdion
<br />I rrnifyrhrrrhcfcdc'al'rBUh{i,,nycgrrdnrs rr![no\ rc Dvnirc tror it'fl.rhlc l,) rl,ir Irtcfr
<br />I c.dilyrh,t I hrvc i.nd rhs.fdiorion
<br />oftliMtrcs and sr.i. tiws rclnrirt ro buildt
<br />rh)rc m.rioncd lii,pcdy for in\Fcrion Nr
<br />sn storc lhar thc atnvc informrn,n h coBr I alIft lo
<br />rE conslruclion. $d hcrcbyaurhoria rcpre*nr.rika orrW-AlDlionl trr AA. tSix ahft./r+/@ts
<br />.onply wnh allCilyond Counly
<br />hnc y. kl c.u/y ro cn,7/DF,n rrE
<br />* C/3,t<
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service [tr]eter
<br />FINAL f\?,8ltg l,ra&(,E)
<br />Notes, Remarks, Etc
<br />ID/SIG.COtI/IMENTS
<br />I hrvc dklsrllrrirriir r (tnifcrlcoiCo0scnllo Selllnsurc hr w.rlcr\'comfcnsnrnnr. r\ tln,vrlcd nt by Sedi,r l7(x).lrhc
<br />u,,,,..-^,,,,,,*,,11) 4 ffiGC 7d/ u.,,',".
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