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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCAR-ArlON
<br />I hcrcby .ffirn undd Fnnlry of pcrjury rhd I m cxcmfl frorn lhc Conta.los Licen* k' ior lhc follo*ins E!$n (Sfc.70:11.5
<br />Busincss .nd Prclcssion Codc) Any Ciry or Counly rhich rcquircs 0 Fmil lo onsrtucl. allcr. inprovc. dcftlkh or rcldir rdy
<br />ntocrurc. pri{nto irs hsum- al{ rcqun€\ rhc Epplhunr lor ru.h Frmir h fib a riSmd {d.mm rhd h. o. rl.{ is liccnscd IuBUrd r -
<br />to thc povnions ofrh. Conrmcroas Liccnrd ljw (Chaprcr 9. Conmncins wirh Sccti.n 7O0O oi Divisbn:l ol rhc Bxsincs and
<br />PF,f.\sion\ Code) or (har lt or rh. is.ftdfl rh.r.fronrd rhc blsis f.tr rhc rlLg.dcx.nplion Any violalionofsdhn 7Oll5 byany -
<br />rrpli.!.r lnrapcnnit suhjLrlslhc lrpliont lo !civilpcnillyoinol mrc than fivc hundrcddolhs($500)
<br />-l-
<br />as owrcr oi lhc prepcny, (n ry cmrloyes wilh *!scs ar lhcir rch onrpcnsrbn, will do rhc work ,id rF. {trrurc ir nur
<br />inrdnd.d or ollcrd for $lc (5(.7044. ausin is dnd Pmfc*ions Cod.: Thc Conrndols Ltcnsc tj{ dm\ ml lpdylo !nowrcr of
<br />rhc fmpcny *ho hoildsor nlpmvcs rltBn. ud sho &E\ such srl himsclfor hds.ifoi ihbu8h his o. h.t o*trcmploy.es.
<br />pn,vidcd lhrr sDch inprovcnrnh e mt inrcM.d or oficrcd for sdh lt nowcrcr. lhc building or impmknrnr h s,U wirhi on+u
<br />olcon1|)kri)n.
<br />'tf,
<br />O!tur BliHd will hr i& budc. or porin8 rhar tr or \hc dit ml boili or inDrolr $. F)trny lhr llr purlnc ot
<br />,. ,s osk, of rhc |^)Fry, ,trr cxclusivcly .onr.crnrg wirh li.cn$d conrldoF ro consrruc lE pnFl (Sec 7Or4, Bu\inc$
<br />and llDfcsionCodc'lhcConlracr{tr'sl"iccnset,avdo$norlpilyroa.osndro,pioptdrwh.buildsoiinlprovcsrhcrmn.
<br />rnd who conlra.rsfor su.h l,oids pirh ( com.Jdonr) lic.n\.d Nrsu,n' b thc on m.toas Liccn* L2w)
<br />}:4trf,}:S.UANIINSA:II!}N
<br />DECLIN.AIDN
<br />I hcrcby a,ltni undcr pcnalrtofpdrury dtu.frhc inlbwi'r! dcclffrrion\:
<br />I hn\r Md sill uinrin, CcdiLlrcofCo.\cnr ro Sclf.tnsurc lor wo*crs'.r)mpctrsurion. !s Drovacd for t y S(rn,n :lll$ ot rh.
<br />utxn Codc. nn rhc ,crfortune ot rh. tor* f.r whi.h thc rdir i\ tsu.d.
<br />I hrlr r s'llt nnrin qo'kcra.r rf.t\rri(nr niur .c. r\ rcqtrd blScditr.lTlX)ol rhc l;lh.rCodc. trrh. |xnnnun ol
<br />rh^ro.[l,{whtrl.rh*FrnnrrsrrucdMysn.kns.,{npctrsr.irsu'.'cc\n'crardFl{ynurnt{ruc
<br />,^,,,., , Sla* e N e-ir oyn- / Iut, ce.
<br />n,.rJ\ui.,{, ' 4r1x - 06? - i-c'31 'on/,'"-.,o /8
<br />-l
<br />ccnily rhar in rhc pcr,nr@Nc ofrhe sork rd {hich rhis pcrhir ii i\\md. I sh0llnor.ntk,, a., lE^otr ir lny mtrmr
<br />$ * u bc.o.r. \rbFcr t, rhcwo*.n cunr.trs,rn)n hsr.rcrliloiri.. dnda!rccth iiI should $€onE subjd lollr
<br />wo c ..nD.n\ i.n pturhirnr of Sdrion :17{D of rhc tjbor Cr c.I slurll. fnnhwith c.nDly wirh lhos prcvhions
<br />lv^kNlNc Failurc ro Ecure workcm ompctrsrlion .orcr.8c is unlowtul- and \hall \ubJcd un.mrk,)tr t, dirnntrl p.Mlrici aM
<br />.ivil fincr u, ro .rc hundrcd thousatrd doulrs ($loo.Un). in addirion io thc cost of c"mtcn$rion. drroges as ptuvidcd f(tr rh.';::::yrtlL',:
<br />,r,n r,{
<br />I hdrchy.mnnunddr pnrhy orpcrjurylhor I a liccns.d und.r omvision ofCh0,rls 9 (commh-'in8 qirh Sccli.,n 7ffD) orDi!i\io.l
<br />o, lhc Businc$ od Polcrsionr Codc. 3nd ny lic.n\c t io tull f{e ,nd tffccr
<br />r?7?e = raUp4a-c"^*b&--€2Zi-
<br />CA iIf,IJCII()II.EII,IIXGAGENCT
<br />I hcrcby lltirm undcr pcnalry oI pcrj!ry r har rhcrc t a mnsrtocrion tc.ding agrm, for th. FrfomEftc or $. worl for wti:h lhis lEmil is
<br />issucd (Scc.1097, Civ. C.).
<br />APPI !(]ANT DECLARAT(}N
<br />I lrnby lnnunddr prfulry olpcrjury oN orlh. n,lb$'n8 d..ludions
<br />Dcrnolirion Fcnnir\ A\$cno\ Norificrrn,n F.dcrdl R*rlarion\ Tlirl.40, Pad6)
<br />Rcqxncd trn.r ol Norifi.rrnnr
<br />-l
<br />ccnilyrhll thc fedcrulrc8ulalions reBedin8 a\tEft\ rcmlul!r ton applicrblt t, rhh phj.yl.
<br />l1_l an ify ! ha! I tu( rc!'j rhh qTlf,urion ,id ddc rhir rhc ltnvc infor@ri.o ir .omr I rga ro comply *ith 0ll City and Counly
<br />6ifr.ms and Shr L$. rcUrrns k, bu,lllfs con\rto(1Fn. and hercby drhorizc rcpresnrdriv.i .r rhii Cnyand Counly lo cnts uIFn lhc
<br />rlxnc rni,r{lfrrl).rrv1.r in\tccri,,r
<br />Atpli$nt trr Axrnl siBnsrur. ts
<br />I'cnnit.r B rlpri r:r(oy' u.--, t//, t
<br />a/z/e
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sians (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq /'1
<br />Under Slab / Floor 1"2-(g x.v{-I4
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)/A
<br />Walls (Bough)1-4"t,r x"v$al
<br />Ceilings (Hard & Soflit Rouqh qd
<br />Ceilinos (T-Bar Rouqh)
<br />lvleter Release
<br />Rouoh
<br />Service lVleter /f
<br />FINAL il -lKri XJLi)
<br />Notes, Remarks, Etc."1v
<br />-+
<br />Pole Bases
<br />lrn,r\!n,, untl.r St.ro .lr & l'( l(r rlL^,u!tr'
<br />I)rl( (\rmr
<br />I
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