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ELECTRICAL.INSPECTOR RECOBD
<br />APPROVALS DATE IDiSIG.COMMENTS
<br />I. rr oancrolthc pro[lcrly, or nrycnrlloyccs wilh *agc( rs rhcir sh .onrPcn\arn,n, wilt do rh. *orl urd ltE (nrluN h nol
<br />inrcnid orofcrcd,or slc (Se 7(N.t. Btsitu:s and lrrcfcssions C()d.: Th. Conttrois Liicnsc Llw doc\ noi qrp], h Mo$dcr.f
<br />rhctmFny shr huikh or irvn'rc\ rhm$n, rftl *h) d{r\ !rl, rod( hinrrdlfor hci\clfor ihtoDgi hk ot hcr o*nc'nnkly.ci.
<br />Drovnhd lhd such i'n!rctcrxft0rmr inrcMcdorofc'ld lhrsalc ll h.*ctr. rhchuildirgorin{n.vcmnr isdd+irhi onc Far
<br />ofconrkri.n. rh. Ow cr Auiud *rll hrvr rlf, hudcn of F)vin8 rhd hc or shc rii, mt h,ikl or i,\roE rh. pn,Fny nn rhc rurF,{ of
<br />_l.arorn$ofrhc!rupcny,rncrclhrvclycotur.rnrgsirhlicutr*d.onrdcktrsloonslruclrhctn,ic.l(S(7llt4,Bu.inc$
<br />rl Pn,f.ssrr Codc Th.Cotrlracrors Liccnsc L{s (nrcs nor rtplyro rtrotrntr.fprot t wh. build\ or ir.prclcs lhcrcon.
<br />rnd who conrmck ror su.hri&.rswrh. cbnrrucrorls) lkcn*d purnhnr ro rhc Cnnrraclols l-kcns. tiw).
<br />I a'n.x.nrpr un .r S.di,
<br />]IaB(EBlIaMfliNS/U[]N
<br />tlECttxAIIaN
<br />I hrdhy drfirnund$ l.nrlrt orp.rjuryo.c.lrhc nnhpiri8 l..lnmtiotrs
<br />I havc{d *illnuinrsinr Ccflifi.arc.l Coi*d n, Sctlli\ud litrsorkcF comtcnsarion. as povidedfi,hySdlionl7U)ofrh.
<br />lj6or (id., tur rhc Fnbnmmc ofrhc N.rk tur whi.h rh. p&mir i\ icsucd
<br />lh.!condwillnminloinworkcrsconrpcnrltioniNurancc.osrcquitcJhySccrn,n:r70Oof(h.L0hoiCodc.l()rrhcptrfonnrccol
<br />rrE worktbrwhichthk p.iorit is isss! My$orkcs .omncneliqr i'tsurstrcc..ni$ ond Flicy nu,nhct ne:
<br />-l
<br />c.nity rhll n, rh. Ilofn'utr.. ofrhc work tu whirh thn Fnnir i\ i\\ucd. I drll nor cmploy 3try ncrnr i', rny nrnrcr
<br />s, ,\ t, h.o r sxhicr ri rhc sorkcr' .onrFn\nrio,r l.* .f C.lifdnir. in<l iSE llur if I sl$old hL(Dr {hlcd ro lhc
<br />sorkm .onllc \rri(,r pmvi\n,N ol sc.r iLnr 1700 ol lhc trlxtr C,nlc. I n$ll. rihh\ iri .onrdy wirh rh.s flovisios
<br />WARNIN(; F,ilur. ro surc *orkcrs'co.D.nsdi(in.o\crr8. is utrlnwrul. !0d lhtrll slhjc.r ar' c'nPkJr.r b dnniml Pctrrhil md
<br />civil iincs ut ro on. hundrcd rhousa d dollrs (SI(Xl.0lX)). in.ddiiion ro rnc con ofcomp.nsdnn. drm8.s !s Droviled ior lnc
<br />serio 10T6 llhc hh.r Codc. inlcrc( !.d ltrormy'r r'e\
<br />l)Htc: /\DDli(rnl:
<br />LMlMllNlltl.uBDr(l BltlllN
<br />,n rtu lluri',rs rnll\ol.\r' L\(i{r. rllnr} r.tr! i\ i'i rr ll rri.. xrLl .l ..r
<br />CONSIEUCIIANIENDINC.ACEBCI
<br />IhcEhy.ffirmunderpenllryofpcrjurythutlhcrcL\,coniru.rionkndine.e..ylorrhcPc,foirnrmcofrh.so fotwhi.hihit Fnnn h
<br />issucd (S.c.1097. Civ C ).
<br />AfIL&ANLIIECL/$AfIoN
<br />I hcE$y allirm urder Fnolty oi i,€rjlry onc oflhc folhwio8 dccl.rdri.is:
<br />Dcmliri.nPfin rsAsb.sosNoiincarion FcdcBl Rcnularions(Iirlc41).Pon6)
<br />Rcqutcrl t ncr of NoifEorion
<br />_lccniiyrhii rhc fc{lcrrlreguhrion\ rq&li',A ashldo\ r.R,vrl arc nor lPpli.iblc tu rhis fm]ccl
<br />-lccnifythnr
<br />I h^r..ad rhtapl,li.dn ,nd far. rhd rh.trt \r infornrrion n corcd I nSre h cohpl, wirh all cny ,nd County
<br />ordinlnccs und Siarc l"aws rclriing h building coD{ru.ri.n. rd h.rchyaurhdizc rqEscnrdilci ofliis Cir, Dnd C.unryr. cnrcr upon ihc
<br />atn,vc nf,nliorcn popcrly n, i'1sF.rion lurF)sca
<br />]\pDlicnnl or AEcnl SiInature
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />"/t:
<br />tt2iH 6
<br />Rouqh 4Z''i * <,,.'Y-\.evF.9
<br />Service Ir/eter
<br />FINAL t1 _.{L(n ,r4 )------------vNotes, Remarks, Etc
<br />Communications Cable
<br />Air Conditioners
<br />OWNER BUILI'ER DELCARAI'ION
<br />I hcrcby afinn undcr pcnslly ol'pciury thll I am crcmpl lron lh. Conk,ctin l-i.cns bw lor Ihc follorine rclv,n rscc 7l-rl t
<br />Businc$ ad l,rofc$ion Code): Any Ciry u Co! y whi.h Eqxncs I Firni to consrrucl- slle!. imp!ov.. dcn)li*h or rl.n iny
<br />srrucrlrc. pri,r ro irr irsu,n....l$ rcquncs lh. arllic0 rbr surn [E.nrir lo fiL! sirn.d darcftnr rhd hco. shc n liccnscd Nrsulnr
<br />ro rhc prolisions ofrhc Conrdcrocs Lic.nscd tiw (chnflfi 9. ComnrrcinB wirh Scclion ?O(n or Di$liotr :r ofrhc Businc$ $nd
<br />Pofcsions Codc) or th.l lEorshc tcrrmpl rhclcrror and lhc$o\iq fttr rhc slltgcd cxcq)ridr. AnrviolationofSarion 70:ll5 hyin,
<br />q,plicanr fn ! ncnnihul,jN( rh. appli.anr h a.i!ilpcndlryornor morcrhin fivc hundrcddollar ($5{x,).
<br />CMEr:-
<br />Liccnsc chss:-Liftnrc Nun rr:
<br />-
<br />D.lc. (onrmclorl)lri
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