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ELECTRICAL.INSPECTOR HECORD
<br />APPROVALS DATE ()lYNlrt Blr .I)t,:R t)tit,cllRA l]()N
<br />I hcrhy affinn undcr F.mlry or FrFrr rhat I m ck'nll Inrn rhc ContBcr()E Liaor tjw ror rhc totkrwinE reean (Scc703t 5
<br />Busincis ,.d Prrfc$ion Codc): r\ny Cn, or Counry which r.qunc\ I Fm r lo corsl[cr. shcr. iq)rcvc. &mtilh or rcpat any
<br />\rrucrur.. rfit. irs isslan.e. lho requircs rh. applicsnr ror such,f,rnlirro filc, signcd {arcnrcnr rhor tEorsnc G lhctrsd punlanr
<br />Io rhc pn,visions of rhc Conr.ctors Li.n\..1 L!* (Ch0/cr 9. ct,hmn.inE wirh Se.rion 7fiD or oivkbn I of rhc U8incs rnd
<br />l\ofcssioos cod.) or rhur tEorshc iscxcnpl lh&.rn,mand rhcbasis for lhc 0thg.d cxcnption. Anyviot ionofScction703r.thtrny
<br />arplicanl lorap.mn suhjmG rhe arlplicant h acivilp.nalrr.f.or nrrcrnan fivc hundbddoum (5500).
<br />*1. rs owncr or rhc pmFnt, or nry cmplorc.i wirh w!g.s 0s rhcn $k dnnFnsltt'fl. will do rlE work lrrt tlr {ndm Ls rt,t
<br />inicxled nr otrcrcd ror Mlc (Sa ?Or4. Busil.$ dd Prutc$ions Codc: Thc 6nra.r.r's Lkcns tjs docs nor Erdy ro an o*ncr or
<br />rhc pRrpcd, wln huilds or impmwsrh.m., ad who des skh son hiisclaor hcrslfor rhmush iis r hn own.npl{'JEc\.
<br />trovidcd rhrr su.h ihpDEntnt m nor ir ckicd or ontrc{ fo st. It hrMv.r, rhc huiHin8 or in{roEmnr is std Rirh om rofconllcrion, rhe (^Lncr lruikls witthrv. rh. hldcn ofIrolin8 rhar h. or rhc did nor huitd or inDroE lnc Fn,Fdy for rtr puq-sot
<br />-1.
<br />i\ o*rrr or dr propcny. nn cxclurivclr .onr,cring wilh licctr*d co kr.(,^ h co.{dc hc roj6r tsq 70{-1. Bunnc$
<br />and ft,fcsshtr Codc ThcConra.ktriL,iccnseLnpdorsiorllpplyroanosncrolpmpc ywhobuitds.rin1povdsrh.rcon.
<br />xnd who.o.h.knnsuchpolcdssnhtrConrkrn(rtie.sdpurundhrh.C.ntucroast_k.tr{t_ae)
<br />-lamcxcnpr
<br />undd s&rk)._,3 &PC lorrhhrcas,n
<br />D.ler o*n .:
<br />!i'oRKxRs. c.(xnPEI\SATI(r,\
<br />PTCI.ASAIIO!
<br />I hcr€6y rr'turnhd.r Fnalry oi p.rjury onc olthc lolk,qing dcclrlrions
<br />I have urxl will truirrii. { C.nificxrc oa Cotrs.t to Sclflnsurc for *orkcni com!.ns0rion.$ Fovidcd ntr hySeri(,i:t?(x)otthc
<br />titx, Codc. for lhc lErromu.cc oa ihe suk lor qhkh rhc I.roi h nsued.
<br />I hrlc and willnminhin sork.rs c.nD. srlion i$uhn.c. rs rcquiddbySccrionllTOOofrhchborG)dc,fttrrhcpcrf.rroncent
<br />rhc sort for whi.h lhisFrnrn ish\ucd Nt,wo cs mDp.nsrnnr in\urnnrcrtricr aM di.y nunrn rm:
<br />-lccniDrl
<br />nr rhcrcrn,Enccotrhc Bork ror shi.h rhn rnnit t issucd,I \h.tl nor c'npk,t lny pcron intrnymanncr
<br />erAt,brrorEsubrer'.rhcsorkr*'.ompcnsaliotrlass.rcalir. ia. udnsrccrhd it I should bc..mc sxhrl{r h rhc
<br />workcF conpcnerion pbvi\n,nt olsccrnrn:lT0Oofrh. trtxtr Codc.lshdl. fonh!irh.o,rdy wirh rhu* pi.vtions
<br />WARNING: Faihrc ro scurc $orkcr'.onrr. rarion covcmsc is utrli$rxt. d sh, subj.cr {n cnDtorlr r. aininrtt'cMLric\ rid
<br />.lvil l'irs trt, h om hnftlr.d rhou\rtrd doll r\ rll(X).lrx)r
<br />S..ri$ 1016flrhr t-nhtrC.nc. inrcrcn iM i oii.y s ri.r
<br />I hcrcnyar6rnundcr l)cnllr! olr(rrury rhar I rnr liens.d u vnn,i otChrprcr 9 iconumrEitrE uirh Sc.rn,n 7m0) ofDjvni{,n l
<br />of rhc llu\incsnnd Pi(,f.ssi{nr Codc. and nry liccn$ h in trllfo.ellldcfl(l
<br />I herchy amfln uid0r Fnalry or p.rjury rhar rhcrc n n snitu rion lcodins ascncy aor th. Frronmn.c orrhc *ork tor whkn rhis rErnn rs
<br />i\sk'd (S.. .10q7. Civ ( )
<br />APPI I{]ANA DECL{IIAT(IN
<br />I hsrtd llfm u ndcr lEnalry o, pcrjry on. olrhc rduowing decttralions:
<br />Dcmlirion Pcrmih'Astr{os Norincsrion tucral Rc8ulalions (TirL 40. P{n6)
<br />R.quircn Lcrrcr ol Noifi.oriotr
<br />l..dityrhar rlE fslcro I rcSuh r ions tuArding rshcstos rcnhvdl *. nor lFttkahlc b rnh prorc.r
<br />-l
<br />ccniiyth,r I h.!c rc thi\ lDnli.,lion {ar. rharrhe alnvc inlorndiotr i\.or&1. I nsm ro c.nDly wirh rllCiryond GJunry
<br />,trrlfx (c\nndSrrl.lrslrIrirCnibuidi aurhtriz.rcrc{nr,rivcsoilhh(ilyatrdCounlylocnrnuF rhc
<br />lhovr nr incd p.o!.ny lor ms
<br />ApDli.rnl or A(ml Sien{tu
<br />Pennil.r n.n( lDrintt:
<br />^X'
<br />l-r,11a
<br />Site-Work
<br />Pole Bases
<br />Li ht Standards
<br />AS Pool Fountains
<br />Life Salety /Low Volta ge
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondin / Groundin / UFER
<br />Transformers
<br />Sub-Panels
<br />Roof To E UI ent
<br />Facto Wired Unit
<br />Walls Rou h
<br />Ceilin S Hard & Soff il Rou h
<br />Rou h t15 | 't-,
<br />U,Ytl-+C,tl';.2)0l
<br />FINAL lp b rg.'q^zc\4rr
<br />Notes. Remarks Etc I TN
<br />ID/SIG.COMMENTS
<br />Underqround
<br />Siqns (monument)
<br />Torqueinq
<br />Air Conditioners
<br />Walls (Conduit)
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Service lvleter ,- |
<br />iddiridr ro rhc .o{ .f.o rlf,nsdion. &,rogcs a\ pro(idcd br rhc
<br />trftic' ( Addcs. _
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