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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS 0WNER DUTLDER DEI,CARATIoN
<br />I herchy affifln und.r p.nalry.r rErrtry th{ Ln crempt fm'n rhc Conr!.r,^ t,icctr{ La* in rh. tou.{ing rdd$n (scc.70l5
<br />Bunncss r l Prolc$ion Codc) Ai, Ciry or County whi.h rcquncs ( ,crnil ro mn{fl.r, atrcr. inrprovc_ dcnnnh ur torJtr Jny
<br />irucrlrc, I'lio. ro ns issuancc. aho rcqutcs rh. +plianr ior suchlxmir b fit. a \igrcd srlrcmnr rh tr.r shc ir ti.cnrd puruMr rro rhc pmvnn F olrhc Conlrrctols Licciscd t,aw (Ch0!rcr 9. Conntuncins $ith Se.rio. Tuxr olDilisnri I oalic Fnsirc$ 0nd
<br />Pmtc$ions Codc) or rhI hcorrhc n crcnpt rh.r.rtum 4d rhcMsh tbr rhc tr cgcd .r.nprion. Any viotnrion or sdion 7ot I 5 b, (ny
<br />aptli.rnrnn!pclnrnsubjc.hrh..ppli.anloacivitp.nalryot.ormrcrhlnrivchundrcddd rnlS50O)
<br />-1,
<br />!r owtur or rhc popcny. or my cnltllorrc\ eirh wr8cs $ rhcir $tc d,nr.osation_ *itt do rhc m r.drtr {Nllru is mt
<br />n cndol or oilcicd for el. (S( 7ol.l- Businc$ snd ftorc\siotrs Cdc: Thc Conkfi,\ t-i.cn* tj* des rer optty h r owtur oa
<br />rhc Impciy who boild\ or ilnnmrcs ltrNr,nl *ho d*s sEh por* hnns.tfor hor*tfor rhmugh hir nr hcr own cnDhyc*.
<br />providtd rhit such iml$rcnrnB oE e hrc eJo.ollc{d fi,uk If. tnsewi rhe buildiry o! iqm\rmnr ir $H wirhi,, u,r r{otmnl,lcrion. th. owncr Buitlcr sill harc lnc burdcn orltrnlins rh he or shc dil nur hriH or iqmw rhc pmFny for rh. pury,s of
<br />l- s\owncr.rrhc ptupcdy. au crclusivcly..nrs.rinc Nirh liccnsd cotrra.k,F r, consruc nc !mj..l tscc 71r,14_ Bu!trcs
<br />and Pnfcsiri c:(dc: Thc Conkacrols Lic.nse l-nw des nor dfrlv kJ r. o*ncr oi propcny sho builds or inpr.v6 rh.reon.,nd eho cnnimch ror su.h pfrrccls wilh I Conra.r4r) liccnsd rusuanr ro rhc Conrkrn s Li.cnsc Law)
<br />I lorcicmrruM.r Sc.rnrn ,8.&P.C lnr rhis rc.son
<br />llat.:_ - O{rcr
<br />woRxFis' (l{rNrpFN.sATI()N
<br />DECI {RAI(TN
<br />I hcrcby rrfird undcr p€nalty of p.rjury oft ofrhc lhllowirA dekr[ions
<br />I hrv. nrxl will mt oinrCcnnicrrcofConscnrroSctf"tNurclarsortc^ omp.trsdi.n. rs pn,vidcd fitrtyS(rion 37(X) trhc
<br />Lrbor Codc, for lhc rcrrormrm. ofrbc ror* lor which ihc ncrnrir h h\ucd.
<br />I h*e and sillm.int.in *ork.rs .onrpcnsarim insurnncc, as rquircd byScdid 37([ofrhc ljtxn Codc. lbr rh.
<br />€,hf -,. rdrior in\unNcuricru F,lic,tu'nhcr cl
<br />atnqzrr
<br />_l.cairyrhtrrin rhc !dlofln0mcorrh. sork rir $hichrhis pcnnn is i\surd.I sholl nol codoy 0iy !c*oi i,r any unncr
<br />* tr ro bccom suhrL{r h rhc *orksi conrFn\lriotr l,w\ of C.liraflrii. and rEEc rhar ir I \k,rld bccom suhjccr ro ..
<br />sorl.n.onDctrs.rnrnF,lisn,tr\oIS(riotr3rmofrh.lihrrC{!lc.Irh.ll.fonhLvirhontl,sirhrhocprcvnion(..
<br />IVARNIN(;: lilurc nr ccurc qork$ .rnnp.n! irr .or.rrg. i\ untr\iir!. rtrd shn suhlc.r i,r cnpkD.! r).rinrimt p.tr hs md
<br />.^il litrc\ un ro onc huftrcd rho!\xtrrl (lol[r\ 1$t00(xx)), rn b rhc con ofcoml).n\rrn,n. dx'ngcs !s trovidcd ntr rhc
<br />SLrri( 1076 of rhe l-nlnr Codc. incrc{ riJ r(or %o*- ? -zztt:/ / n
<br />l)lr(l,AR,\ Ito\
<br />I hcrcbt 0fatrm undcr Fn!|ry oa p€rju y lhar I aD lie.En undcr pmvirionofch+r$ 9 (cohmminB wnh Sclk. 7(xD) or Divnion 3
<br />of thc Busimss and PmLssfuns Cod.. ard my li.cnsc h i. tull to.i a,rlcflal.
<br />Zo
<br />I hcrcb, nfli'n undcr Fnaltroftcrjury lhnrrh.r. is a con\ln.tiotr Lnding rt.my r.tr rhc pcrfonn.ncc irhcMtrk r.r $hichihi\ Frmilisi(suL\ttse -1097_ civ c ).
<br />APPLICANT DFI:I AqATTON
<br />I ltnby olilr'n u'der pcnrlty oipcr]nr] onc orrhc lollo$ini dc.tdornlN:
<br />D.mlnbn P€rmirs.Asbcjos Norirr.uraon Fcderal Rcgul.riois (Tittc 40. Pin6)
<br />-Rdqoircd
<br />krrerof Nolifi cdion
<br />_l ccnif, rhli rhe lcdcml E8ul.t ions ESrdins $besros rsnmvul m n r qdkdl,k ro lhn fmjer.
<br />-l
<br />cdify lhar I hdrc rcad this appli.alion ard {arc rhd thc,bow inro@!ioo iscorer.I agm losmptysirhalt Ciryart Counlyo'Ji nrcsnrtd Slrrc l-rsa r.i{n'.rtr. r'kl hcrrhyntrrhor/crtrcw Jrivc\ol rhis (-iryrtrd (tudtk,cdrr
<br />rl$ve trEnti.trc fn,pcdylnr iN
<br />,ltIli(.nr nr,\x r Si,!nrrtrrr '.,"J e o'/?
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />S Pool, Fountains
<br />Life Safety /Low Volta ge
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Buildin g
<br />Under Slab / Floor
<br />Bondin / Groundi / UFER
<br />Transformers
<br />Sub-Panels
<br />Facto Wired Unit
<br />Walls (Conduit)
<br />Ceili S Hard & Soffit Rou h
<br />Ceilin S T-Bar Rou h
<br />FINAL
<br />Notes, Remarks , Elc
<br />Liqht Standards
<br />Siqns (monument)
<br />Torqueinq
<br />Air Conditioners
<br />Rool Top Equipment
<br />Walls (Rouqh)
<br />It/leter Release
<br />Rouoh
<br />Service Meter
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