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ELECTRICAL-INSPECTOR HECORD
<br />APPHOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />Ivleter Release
<br />Rouqh
<br />Service Meter
<br />{J^^Qrt 9,> )FINAL I >l t4-tv
<br />Notes, Remarks, Etc.un
<br />OWNET AUILDER DELCARATION
<br />I hcrcl,y afiirh und6 pnally ol F.riury lhal I 0m cxcnfl tmm rhc ContdoF Lianr ljw ror rhc rolhwir8 rcap. (S.c.70.11.5
<br />Bu\in.ss ..ld Proltsion Codc): Any Ciry or counry which rcquir.s a pcrni! b .on{ru.t. .lrcr. imPovc. thmlish .r E:lEir atrv
<br />srdciurc. prfiro irs issx0rc..0ko rcquircs rhc apflklnr lor slch Fnr lo filcasisnql slalcftnr rhar h..rshc t lltcnscd pn6xmr
<br />ro lhc tmvisions of lhc Conr&ror's Li.cned bw (ChlPlct 9, Commctiis wirh Scctiotr 7OO0 oa Divnion I orlhc Businc$ !n,
<br />ProfessionsCodc)orrhlrh.orshciscxcmpllnercfrcmandrhchasnrorrh.rllcscdcxcnll,rion.Anyvi.larionolSdionL]l5hr,.v
<br />applicanr td r Flmn \ubjc.lsthc dtplicant lo acivilpcnuxrorh.r mrclhon fivc hundrql douars {$50o)
<br />-1.
<br />as owner ol rhc rroFny. or nry cmtloles with wases as rh.t $lc onP.nsrha. wil! do rtc wo* 0,ld llE (nxlurc is mr
<br />inrcdcd or onircd for slc (SE.?(N4, Bnri@a. md Pmf.$iohs Codq Thc Contacror's Ltcnsc kw d.trs nor +ply to d ownq ol
<br />rtc poFny who builds r inpmlB tlrcmtr. md who d.es sch w& hiosclfo. hcrclfor rhrough hh ot her own cmrlovs..
<br />providcd rhrt such imporntnN m mt inrcndcd or oficrcd fo! slc, ll. howcKi thc buildins or impoEft hsldNirhinoncF
<br />orlnnyhriJn. rh owmr auitq sill hat rhc bod.i ortmviig thd lE oi shc did t hrild or in{,ow lnc !mFn, for itr puqDs of
<br />I. * o*n*ofrhc tm!,my. ancrch\ivclyconka.ring wirh lkcn$\d.o raci(ns t,.oniru.t ItE Pmrc.r (Scc 7044. Bi(in.$
<br />md l,rDEs\ion Codc: Thc Conra.rols Liccnsc L,.w dos nor applyro M osnct offioP.ny who buiids or inlptorcs 'h.rsn.rid qho .on rN li)r s'ch nn,rcc* sirhl ((s) liccnscd pusuanr ro rh. Conrktol s Lic€ne hw).
<br />B & P C. for rhis ,.!$n.I an crcnrpr undcr Sccri,,n
<br />{'o-c^e\a. f-o
<br />llllL8r u!\
<br />I hcrchyamr utrdcr pcnrllyolF-rjuy
<br />-l
<br />haw lDd wiu @n rin a Ccniftarc ot G'nsnr t, SclH nruc rd workcn .omFo\arn,n. N fovided ror hv S6rn r .1700 of I hc
<br />tjhor Codc. lor rhe lsfomftc or rh. work nx which lhc pcrmir i\ issucd
<br />I hrvc rnd will,nli|rrnr workcri conp.nsdriotr insurrrcc. as required hySc.rn,nl?moflh. LlhorG)d.. for rh. pcrlhmEncc ol
<br />rhc sork lbl whichtht pcrn is isskd. Myworkcn .onlEnsalion in\rranN.aratud P.licynumh.rdl
<br />-ExpiEs
<br />WARNINC: Faihrc t, $curc sorlc^ .ompcnillion .o!cri8c i\ unlaqtul. rnd rhrll sthj..r an cmPk,rcr lo dminnl l.Mlric\ md
<br />clvil fincs up lo orc hondr.d rhoxsond dollnn (S ).(ixr. in din ro rhc co{ {)fconrpcn\ari.n. d.nr8cs as F)vidcd lar rhc
<br />Scdtu 10?6 or rh.lltrtrCodc. nrcrc( Md !n
<br />e\r.\ogez-
<br />I2r!1"!B llar
<br />I h.rrhy rlnnr rndcr pcfulryol Nrjuy r rr vhion olCharrer I (conntn.in! sirh Scdion 70(x)) olDivniotr:l
<br />CONSTRI(:TIoN I FNDIN(: AGEN(]V
<br />I hcrcby aflir'n xnd.i F,allyofpcrjury rhur lhdre h r.onsrrudion hndinS ascky forrh. pcrtor.r,ncc ofthc sork r.r which rnk Pcrmit is
<br />issucd 1Se. 309?. Civ. C ).
<br />AITUCAIIDECLAEAIION
<br />I lutby alInn undc! pcnrlly of Frjury onc of thc followine dccirrotionsl
<br />Dcff)lnion PcrnirsArb.{os Notificarion Fedcral R.eularions (Tilc 40. Pan6)
<br />Rcquircd Lcllcr of Notiarcarion
<br />-l
<br />ccn,l} rhqr{h. kJ-!1ft$larrcn\ rcBJrdins a.tE{ \mm\rld. n.rJnflr$lctn rhn ftur'l
<br />, , ",L,n,/*-" ** ,n^ *"ric n,n rftr {sh' ,hlhc rb.\c ,nrh,nuunn F, nrl I rFN ,o comrr) *
<br />-d,i,*".,)i{shttj"srchunptnhildins..i{nrh,.flth.rchyaurhoria,.pl...nrJrtrc\^rrhi\{irydnd
<br />oh.rc mn,'ykh{.n i) lor itr\rsrnnrutro*!
<br />n,o**,lo*-i.*rr,*, G.crOetq \-p.:- -," I
<br />**r**\",nr,( A rt'..;dq. L,oPez-
<br />Counly ro cnlcr uFn ltE
<br />fs,1\9
<br />Under Slab / Floor
<br />I.cnily rhdt ir rhe D.rlonmncc ofrh. work for which rhis pcirnil is tsucd, I shrll trol cnrploy trny Pc!$n in anv $onncr
<br />$ a\ro hcqnm suhicd ro rh. workcB ompctrBrion h*s orCrliromi...nd urce rhar il I \lt,old tro'm subF-l brhe
<br />sorl.r' .omp..qrn,n l)ftrvisions ol Scclion :1700 of rhc tihtr Ctdc. I sh.ll. tunh*irh .ohnly wirh rhoe lmrnions
<br />ol rhc Du{irr$ and hor'csions codc- and my licens h in tullli,rc and clfc.t.
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