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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER DUILDER TIELCARATION
<br />I hcrcby rffinn u.dn ,cbrhy or F4ury lhar I 'fr .xc6pr fmm rh. 6.ra.ro6 Li.cn* Luw f(tr (he rollowing rcffotr (S(.7o.11.J.
<br />Blsinc$ ond Pmrc$ion Codc) Any Ciry or Coutrly Rhi.h rdtunes r pcrn ro connrud. allcr. imp.ovc. lcmnlnh o. Eprt any
<br />nru.tur.. pdor b nr is\utuce. al$ Equici rhc lpdter tu sucn rEmir lo filc a sisncd {areft rlr h. or sh. ir lic.sed l)uRu0nr
<br />ro rhc p.vhi.ns olltr Conrnclois Licen*'l Law (Chapts 9, Comnrncin8 wirh Scclion ?flx) otDivtion :l oflhc Burinc\i lid
<br />Pn,rcs\ionsCodc)ortharlrorshcascxcdprrhcreironandlheb€sisn]rrhcallcgcdcicnurion.Anrvn,hrn,iofsftrbnT0-ll5byatry,
<br />aptlic,rl ln a pcflnil subj.c* rhc altlic,trr r. a civil Fndlryofnot nnrc rha. fivc hundrcd d.lhr\ ($500).
<br />-1.
<br />!( o$ncr of thc protBny. or ry .nrrlores wnh wdgcc r\ thcir $k o D. \arnr. will do rhc w.lk arld fi. nf,durc t ml
<br />inr.nkn or orlcrcd for qlc (Ss.?01,{. BDim$ ond Proltssions codc: l hc Conrrdois Li.cnsc ljw dcs ml orply ro o ovner o,
<br />lhcpn,F y who huild( or in{'ov$ rlEMn. and who docs skh *\)* him*lf.r hcr\clf or rhruuBh hh o. hct orn cmployccs.
<br />nmvnhd rhd su.h imlr)wnrnh m mr inrcdcd n oltcrcd lir srlc Ii. h.*cBr. rhj tnrildir8 or imnrownE is old wirhin om Jrr
<br />oa.o.{kridi. rh. owoe, BuiEc, will hnv. rh. b8hn oiT,ovins rh.r h. or snc did nor bdtr or itrll,mk rh. FJFny r.r rh. purl[r or
<br />l. rsos,f,rolrhcpmpcnr- rn,.rclusilclrcontrri',8 $irh li.cn\cnconrr.ttr\bcon{tucrrhc fn,Jcrr(Se 7(}l-1, Ru!trcss
<br />md hni\\ir. Codcr'lhc Cotrtrcrtr \ Li.ctrsc L.w d..r ioi ap|ly k, trtr Dqtrcr oflnoFny $h(r buikl\ or irpmvc\ rhc'otr.
<br />rnd wlm cotrtlcrs ror such l,r,+cls sirhxCorrflcr ls)liccn\cn pu^uinrhrhcConrrctr's l.iccr. us)
<br />lrtrrr\.n,nr u ntur Sc.rn,
<br />Dot.-- osn.r-
<br />woRK;Rsr aar^rtFiairl(rN
<br />PECI.ABAIIQN
<br />I hcE6, amrm undd peolry of Fjtrry orc or ihc rou6*irt d(ldaiions:
<br />-l
<br />hrv€ ond will roinroin . Ccrtificrlc of Co.sctrl lo Scr. hsuE for *ork6 smFnetion. .s lmvidcd for by SNtion 1700 ol rhc
<br />hbor Conc, for fie p.rfomnc. oi rhc wor* r.r qhich lhc pemir ii hslcd.
<br />[t r'ur" una *' rr *,,", *o,krs compcNllon i.rummc. a! Enxir.d by sErion ]?0o or rh. tibor oodc. ror lhc p€rfmmc ol
<br />lhc wort f.r which rnis Fmi is irsd- My wo.k*' .onrp.ns{i,rr insurarcc cMicr id Flicy numh.r mi
<br />I
<br />I 'Lo-l- t,
<br />-l
<br />ccnilylnal ir thc Fnnrnk.ccollhc qort Inr qhicnlhk p.irnil k issucd.l nhlloor cnrnloy0ny pc6.n in anynunncr
<br />$ ash h.o'ft \uhjccr r,,rh.*orkc^ conlpc rlrn lurs oa Caliit,ni!, n d lsE hri if l sh.uld h..d'tu subjNr b rl'.
<br />wdrkcn .onrFnsari{ F,vi\ionsofScciionl?OOol rh.ltrh,Oxlc- I shall. fonh*irhco'nply wirhrho$ F,vhioN..
<br />IVARNINC lrailurc lo {curc sorkcr( conpcn$ion c.\croAc N utrhwtul- nnn $all \uhjd arr cnlpbycr lo oimt8lrimlrics and
<br />civil finc\ up ro onc hun,lrcn rhou\lnd dollar (i100.()(x)). in oddirnnr lo rhc co( oa.otrDcn\aln,n. ds usc\ r\ pn)vid.d ror rhc
<br />sccriinr lo?a olrhd l,rhr ({ c. idcr.{ rnrlxr
<br />E-tt-t{encgr /1,01h
<br />I hcrchy rfnmnndcr pcmltyofpcrjury thrt I nm licctrr.d !trdcr provision olCh.ptr 9(commncinE wilh SNli'n 7(xx)) oIDilkion.l
<br />ol thc Busiilcssrnd Ptulcssiols Codc. nM myli$n* is in full forc. M'l.frr.r
<br />,.,-..,.,..f /a r )o C36 1...,^", 7 6€o
<br />,h,c 6 ^Lx-tJ ,^^N4ytr,'^,7rl
<br />CI)ISIBUCIION.LENDING.AIiIN.SI
<br />I h.rchyufinnuder FrrlryofpcrJuryihat rncrc iriconsrrucrion L insascncyiirrrhcpEntrmlnccofrhcw.rkaorwhichrhiipcnnirh
<br />hsucd (Scc 3097. Civ C ).
<br />arfllc Nfl)Ellaaaua!
<br />I hc,c$y allim undcr Nn0lry otr.rjury one ollhc lollo$ing dcclamrionr
<br />Dcnxrition Pcnnire stE{os NorifEdinn ftdcrrlRcFUl ion\ (Tirl. -10. Pd6)
<br />-llcquircd
<br />t llcrol Nolilical ion
<br />_l €rriiyrh.t lhc tcdc ftl re8ular io n s rc sardin8 Nlsroscn$lrlnrc mt amlic$lcro rhh pmjc.r
<br />lccnirrhar I hrvc rc rhnlntltrri,,n and nrrc rh thc $avc irtuiDdion isc.'rccr l rgm hcomply*irhallC iryrid Cou ry
<br />onlinan.cs tr.rl Shrc tn$ rclilins lo huiklin8 cotrsl byrurhorizc rcprcsctrhrivcs olrlris Ciry Jnd CdunrI b circr uJni rrf,
<br />rlh\c nr. [(n]..1 p!ft)r'1\' ktr nl
<br />,\ppli.r ror,\Ar r Six ru
<br />le.ncef lotl t -st'ta
<br />Site-Work
<br />Underground
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilin gs (Hard & Solf it Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service lrleter
<br />FINAL 7vfl7,'f -'*tql)
<br />Notes, Remarks, Etc.
<br />ID/SIG.
<br />Pole Bases
<br />Under Slab / Floor
<br />txtrJca. \JJ,.$
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