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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUILI,ER DELCARATIoN
<br />I hcrcby ar6.,n rndor pc.,hy 0r Frjury rhd I @€xcmpr fion rhc Co"r,rroF t.rens ljw turne followi.s rcN,n (s*?o:ll5
<br />Businc$ .nd Prufcssion Codc): A., Cily or Coumt whi.h r.qxiB a !$mir h ..ndrucr. alrcr, improw. dcnBlish or rcprt any
<br />drudur.. prin b il\ nsuana. Dl$ rquncs rh. !pplic{.| lor such rErmil lo lik a si8ned nlhmnr rh{t lE ot rh. n licoa'd puruul
<br />h rhc Eovnions ol ltE Co.rractols Liccnrcd L.w (Chnplcr 9, CommcminS wnh Sccliotr ?0(x) ol Divnion I oflhe Busincs and
<br />Pmr.ssbns cdc) or rhrt hc or sh. h .rcmpr rhcdron dl lnc l{{is id rhc allcgcd cxcqnn]n. Aiy violarion 6f Sario. 70.1 I 5 hy rny
<br />aprlicanl l{,r o pcrnil rubj..ls trE frlicanl to rcivilpc.rlryofB'r mftrhM ll!. hxndrd dolhs ( 3500).
<br />-1,
<br />!\ owtrq of ttu lrollcny. (n nry .nDloyres with srscs as r hcn soh cotrrEnsnrion. will do rtrc nuk ond th. stur@ i nor
<br />i cndcd or oltar.d n sh (Se 704{, Auein.sq dnd Pmfc*i.ns C,dd: -l hr Conta.nr\ Licn* bw dds frn atdy ro an o{mr of
<br />rhc pmFdy whr huitCs or inlpm*\ rhcmn. di *h. dms $ch sorl himsclaor hcr{llor rhmuBh hk or h.r owi tmphyccs.
<br />providcd thur sucn inDnwEnls m mr inlcD.ld or ofld.d for $lc. lt howcver. llE buildiry or iflpmKnEnt h sld wnhin nnc jror
<br />of.omphri,n.rh.OunrBnikldwillh.Bdrh!.nottmvingrhdltors\cdidmrbliuorinlloltUcl,sFdyf.rrhl,uqr$of
<br />P**r,:llr, *g*,;Iilitr:1#'gr:::.:rx fi iJ,: ,,l,T:::ffi;l[ilr #ifi :ir,lfi i:::;:
<br />,nd who $nta.k irtr such rojccN wirh a CnnrEcb.(9 liccnscn punlanr ro rhc Conrach s Liftn\c Lnw).
<br />I xmcr.n,pr und.r Sccr
<br />,",", .r-{'-t k .-..,1
<br />DICLAIAUqX
<br />I tur.ny atrtm undcr Fnalry or pcrjury onc olrhc rblbwnr8 dcch.{lions:
<br />I harr drl will msinrrhnccnificdr.ofc.ns.nrb s.llln\urc lbr w.rk6a conllcn\arion, ar foridcd f.r byscclion]7oOoirlrc
<br />libor Culc. for lh€ pcrformaflcc otlh. so* lnr which rhc pcrnil i\ issucd.
<br />rh. *ork f{r whichrhi\ pfinrn i\ isu.d My*orlc^ con,lcDsrri.n ii\urrncc crdcr id F,lirynumhcr ec:
<br />l$n}nr, 'n, *,n" *.n,nun!c nrrhc trork ror whrh rhir r.rnir is issucd.l shnll nor c,hploy 0ny pc'son h n.y monncr
<br />4l Kta ta\om suhArh rhc *o*.r' cotr{xn$r nn hw\ of C.librnin. lnd ose lhd if I slsuld tEor subrcLl ro rlE
<br />workefi compcnsario. t'Dvhion!ofSction 3'700 oflhc tihor Codc.I shall.,bnhuilh comply with rhoc pmvisio.r
<br />WARNING !_rilure ro s..^u!c utric .onr!n\di.n .olcrarc is unln*$l. ind shall \uhlcrr Jtr cnvloyo t, oinli'rl Fnrhi.\ rnd
<br />civil fincs ut lo otrc hundrcd lhousa(l d.lldrs ($l(x).ux)), in nddil I', rlN co\r ol .onrpctr\rlion. rmalc\ \ !(,vtrlcd fttr rhd
<br />If,bor Cod. inrc,rd r''d rn.rm! \ le\Q-Lt n,,,n*,,K6'
<br />D!:CI.A}AIION
<br />I hcrcby llnrm undcr Fnah, orrriury lhal I m lilTnsl und$ olvision ofCh!flcr 9 (smftrci
<br />of ihc aurims ard Profcssions Cod., ori nry li.cns. is h rull rr,.{ rl cnirt.
<br />h Sccri(in 7(xX)),,lDirni(r l
<br />,Ecns Numbcr
<br />-
<br />CONSAiUCTtoN LENDING ACENCY
<br />I hrichy llfinn undcr rEnallrolpcrju.yrhul rltrc is o con\rrudion bndins l8cmy tu rhc Ilcrlontuncc olrhc wort i, Nh.h lhis lrflnn i\
<br />hsued (s( 1097,civ. c ).
<br />APPI ICANT DNCLARdTI(TN
<br />I h.r.lry .fm undcr ,..ally of lEr]try orc ol lh. followi.B deLrurio.s:
<br />D.'nolalion Pcrnnr Asb.sroi Norifi.atio. F.dcol Re$lor ions (Tirle rl0. Pd6)
<br />-Rcquir.d
<br />Ltlcr of Notiil.arir.
<br />ffi ffi ;ffi #ffi ffi ,;;;-'l;;-#**,,,,,,,,,,,,*,*",,,'*,,-
<br />rtx\c nrnri,)nrd pml.ny f{n in\F-cri,)n
<br />\t>a
<br />Al,pllc,nr or A8crl Slsn,lue
<br />Pemlle nomc (prini): X \Pu\ l<
<br />.<r-L-tg
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage (
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool To p Equipment (
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />^\
<br />Rough r-t5-)klr-rx)
<br />Service l\Ieter U Y.
<br />FINAL (-16-t ,\vJid)
<br />Notes, Remarks, Etc.\7
<br />**
<br />Meter Release
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