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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER AUILDFJR DELCARATToN
<br />I hercl,y rrfirnr un(lcr pcnalr, or Nrjury lhul I. crcnrnr iion rhc co r.ctom Liccn* lj$ ior thc lollo*in8 rcasn (Scc.?031.5
<br />Butinr\s Md Profcshn Cndc) n, Ciry or Counr, qhi.h rcluirc\ a Fnir ro mndtuci. alrcr. inl,rore- dcqnnh or rpan nny
<br />slDclurc. prirtr to irs is\ua..c, aln) rcquncs rh. ryllkanr for \rch Nrhir k,lll.a ngncd srtcmm rhd hrorshc is h.cDscd !ursu{}
<br />tJ rhc pn'vnn,ns olrhc Co.tlctn \ Liccn\cd Los lChrDtc! 9. Cnrnmtrcire wilh Sccrt,n ?0OO of Divisi{,i -l or rhc Busi'ics rnd
<br />ProfcssdN Cod.) or rhar tr .r rhc ilcrcnpr rhcrclronrand rhc hasn l$ rhc allcgtd crc.rprt,n AnyliolarionofSccri.n 7IJ.ll,5 by drt
<br />lmlicrnt ior.l.rn suhjdsrhc affli.rtrr k, r.ivillcnalrtoftror
<br />'norc
<br />rhnn fivc hxrdrd dollds($5(Xl)
<br />l. as o*ner orlhc proDcnr- or m!cmpblccs wirh waBcs as lncn nnc comrcn{lion- *illdo rhe *orfi md rhe {rl@ k to,r
<br />ir c,xLd or orci.d for sl. ( S.r 7044. Busin.s ,nd Profc\\io,s C{xlc Th. Conkrftr's Liccnrc U* dmr nor {ply tu nn owftr uf
<br />ih.lmFny wio boil.ls or inlpnivcs lhcmn. anl who d,rs such v)* hnnrclf.r htr*ll.r rhrcu8h his or hcr o*n cnrrL)ccs-
<br />prorldcd rh such nnfovcnrnN !rc nor inrcndcd dofidRal lir elc ll li,scwr. rhc hu iUnB or i'Jlr.wnur h sk] uirh .nc ]ur
<br />of.onrtrcliun. rhc ()wnf Buiud willhah rhc brrdcn ol pn,ving rhd hc or shc did tror huild or imlfl)w rhc In,Fny for rh. pu4r{ of
<br />I. A oqnr or rh. F)pcny. r'ncx.lusivclycontn.ring wirh liccnscd contactnsk,con{ cr rhrpn*cilScc 101,r.3un..$
<br />llxl lhac\\bn C.dc lhcCotrlrrtofs Liccnsc Lawdocs nol rpplt n' .n owNr ol pror'( ywho burldsor irnprotrs rhcrcon.
<br />.id who conta$ n)r such |tr(I(h wirh ! O,nrruct)n \) liccnscd turuor t, rhc G ractr\ I-iccnsc liw)
<br />;:-:z/[Il aL)
<br />I herehy lffirnundcr ll.mlly of pcrjury onc of rhc followin8 d.chr inns
<br />Ih:vcaJ willnuinrrin aCcdiarar. o{Conrnr ro Sclllnsurc ior workcn conv,cnsario.. as F)ridedlorb,Srcrion:1700ofrhc
<br />lrbor C.rlc. ior rhc |crlonuncc ai th. sork forwhich th. pcrmir i\ issucd
<br />I hdvc rid will uinbin *orkcrs co rt* \riirnr insdrrncc. as r.quncd hvSccrnrn.r?(norrhc tjhorGrdc. ntrrhc ttrrfunrtrr..f
<br />rhc *uk ntr shi.h rhis pcirnir ir k$cd Myw.rlcs .. ,Fn\ri(,n i'ruBnc. .rtricr rld F'li{ numhd m:
<br />lcrniiyrhar irrhc ncriorurncc oilhe work rirr $hi.hrhisE.nil is ssucd,I \h.llrolcnDl"ydtryncryr in rDy nr ncr
<br />*, a{ ki lr.o'ft \uhj(.t h rhd workcr'.on,Irnsrri{rn hs\ ol cJlilnaril and aSrc. rhrr ifl sbuld hccom \uh]..r b rhc
<br />$.rkch' $npcnsrrn'i pmlnion\ or Sernn, l?(D oi lhc Latnr C{xI.. I \h!11. tun [silh compl, *ith rho* F,vni.n\
<br />WARNINC: t{ilurc lo $curc aortcN cohp.ns ion colcfllc i\ unl,srul. Jnd nrll suhjrcr .ri cnrpk'ycr to ninrin.l Ftrllri.s Md
<br />ciril riars up to onc hudrcd rhousand dollan (SIoo,(xD), in rdd bn ro rhc.os or$lnrrns,rion. d0nr8cs rr lmvacd ntr rhc
<br />::':':'''ry'J78:ppritsnrX-
<br />I herchynilnmundcrpcDrllyol pcrjurylhllI { liccnsd und$ rovi\ion olChaplcr 9 (otrnrcncin8 uith
<br />of rhc tlusimsr0nd Pmf.$ion\ Codc,.nd nrr lr.nsc i\ i,r fullfor.r d clL.r
<br />Liccnrc Nu hct
<br />COXSIf,UCUOXIENDIITGACENII
<br />I hcrcby diirm undcr lxMlry of !.rlury rhar rh.E h a .o.(ru.riJn lc.dine agcncy for rhc Frfo'lMc. .f rh. *ork for whth this Fflnir is
<br />i*u.d (se 1097,ci!. c )
<br />kdci\ Ad.lre$:
<br />-
<br />AIPUCANIIISCLAaAIIUT
<br />I lrEr)y dmm und.r rcnatry oa p.riury orc olrhc follosinB dalar ionr
<br />Dcmlirion Pcrnih-Asbcsros Notilicrlion Fedcral Rcsuh'ions (Tnb &. Pan6)
<br />-Rcqlircd
<br />lf, tlcr ot Norifrarion
<br />l.rnllirh rhc lcdcralrclrhri{)n\ rcSrdi'rg r\}tno\r.morrlrrc mr anflicJhlc t'i,n\ pn,jrr
<br />-l.enily
<br />lhnr I tuvc rcod rhh opplicolio.ond slat.lhir ihc rnovc nrlonnalion is.orrccl. l l8ls lo cor
<br />oflliMnccs!trd SiorctawsEl in8 to huildin8 construcltun.0ixl lErcbyaurhori- rcprc*ntarivcs olrhn
<br />lbovc rEdidrcd protl.ny for irrp.crion
<br />lppliconl or scnl siAn$lurc )l-ta
<br />r,"-rir"" n*rc rp.inrr, (€"O r\jL A
<br />nriny*nh oll Ciryand Counl,
<br />CiryJndrcounry ll cnrs unntr rhc
<br />"LLLlis
<br />Site-Work
<br />U nderground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dam pers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouq h)
<br />lQeilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough
<br />Service lVleter
<br />FINAL lo/u/lA #,1 tu-'hb)vu vNotesRemarksEtC
<br />APPROVALS
<br />Air Conditioners
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