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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDTR DOLCARATION
<br />I hcEby lltrrn undcr pcnrlly of pcrjury lhir I am excn{'l iom rhc Conlmlon Ltensc Law lor rhc followi.S rcasn (sN7o:11.5
<br />Busincss .dl Prorcssbn Cdc): Any Cit, or Counly ehich rcquircs ! ocrmi n, coi{rucr- alrcr, inDrovc. dcmlnh-or rcprn !ny,
<br />(rucrurc. ll'in to its hsuaN. lls equnci rhc anplicanr lu such pcrnir lo fllc a sigmd srarcmnr lhor lE or she is liccnscd puts'rnl
<br />ro rhc lmvisio.s ofth. Conhctols Licenscd Llw (Ch.prcr 9. Conmemins wirh Sccrin 70(x) of Divhion I oflh. Busin.ss,nd
<br />Pmtusbls C.ne) or rhar hc orsh. n ciconr rhcrclrom d rhe hu\h lor rhc all.scd .x.npiidn. Anyvnn(rioiofs€tion'70115hy!try
<br />aprli.rnr larapcmir subtccN ihc ,mlicani ro acivilpcmlryorn.r nrrcth livc hundrcddollar (3500).
<br />-1.tr\owtrcrollhcDr.pcnr.orn,ycnlPloErswilhsrEc\.sthcirv,lcunnpcnssrion.willd.rh.work.Mrhcstrnrciinnri' .ft]cd or .flidd lai elc rs(.7()ll..l. Busnr$ and ProL(io \ Ci)dcr Thc C.ntmntr'r l ,iccnsc l-ow doc\ not amly ro an o*ncr ol'
<br />rhcpmrcny +ln' huilds or in{mrr\ rhcmn, md sho doc\ {.h wo* him{ltor hci\clfor (hbugh his or h$ o*ncmployrcs,
<br />pbvnbd rh[ such n\m\rtrrft rrc mt inrc cdnot!rcdlbrsllc ll ho*ocr. rlrc buikli',! or nnpnxt rnrhkndqnhir',nc yc
<br />o{.rnwhri'n. rhr Oqtur Buildcr will hrvr rlf, burdcn of F*iig rh r lt or stu dii m! b{ilil or inpmvc rhc pDI'sly aor rhc IrF{ ol
<br />l.as.wmrolrkp p.ny,,tr1dr.lu\ivclt.ortmrnrgsirhlicci\.dcokd.tAtucotr{rucrrtrItroj.rr(S€7(!t,Bu$ncs
<br />and Enltssi{ Codc lhccontrlck, s Liccnsc L.* docs noll.Ilyr. rnowncrolrn)p.ny*ho builds.rnnptuvcs rlBcon.
<br />rnd *ho conrru( tor u.h rrcj(B wnh a Conrnct,rl, liccn*d prnurnr h rhc Contr.ror's t-i.cnsc hwr.
<br />x1:#O{ner
<br />traBrlirNrrg^ltlNsallaN
<br />DEII.A.BAIION
<br />rtof I[rirrro..of rh. lnllo*nig cclar i,,ns
<br />-l
<br />h.vca qillnuinrain a Cc.rifrarc orconsnr ro Scll ln\urc aor lorkc6 co@cnsdn,!.{s !rcrilc{ lor byScclionl?00ollhc
<br />tjhor c-odc. lor lhc lc oiim.cc ol lhc work for w[ i.h lhi pcnnir is ksucd
<br />!ir w.rkcrr.onlPcn\rridr i'xuzncc. rs rc,tuirctl hyScrrn'n.ll(x)otrhd l-nhorCo,lc. tu lhcpdli'rnDnc..l
<br />lhis |Eiinir i\ i\n, My so'[c'i con,t.nsi
<br />tcdh
<br />Q-LC6qGal 303 r(-t -l Y
<br />I.cdily ihdr i,r rhc p.rformmc oI thc work tur *hich thn !.i.nit is n\ucd, I lhnll n.i cmploy rny ncr$n in dy 'ntnmrs s r,, bc(trrE subJ$r lo r hc *ortcn' conu.n\d ion hs! nt Crlifitui!, rn{l ,gM rhar ir I sbuld h.com sub]cd ro rhc
<br />sorkcB co'lpcns0rionpovisirnsofSdrn l?(nofrhc IrkrCodc.I \ll1ll. fodlNirh comply Bilh thos [ovisions..
<br />W RNINC: Frilur. k, rcurc workm( ..trDcns,' tn covch!. ir unlawful. dd \h0ll suhjcct nrr cmpklycr k' qirlinxl p.i,kh\ Md
<br />:Itl,:1;;l,iilT.LT*::llTil:11'tllil:,:iTlll'''Jd nnrn hc s'i{ 'rlmp'Na'n ddrur $ pn']eidcd nn hc
<br />Y,.,8-3-( f ^,,,*,, €nl*v- f1,eerc-lir/ "*,"."-*ffi*I hcEbyalttnundcr pcndlyofrcrjurrrh6r I um liccnrd lndcr Drovi\io ot Chaprdr 9 (.onrftnc irB wilh SNtton ?O0O) or Diliio! .1
<br />or rhcBusinc* Md Proltssions Codc..nd alyliccn$ is in iull force.rn criccr
<br />cte /ctC '/ 73,"8-3-ta ov
<br />CAISIBICIIONIDIDIIG.ASINCI
<br />I heEty alfiir.undcr pcnaltyofFrj!ryrhar rhse ir 3 connrudhn lcndins a!.fty ror rh. pcrlornumc oI lhc work for *iichlhis pcmi G
<br />issucd (s.c .109?. Civ C.).
<br />knJ.''\ Ntrnr
<br />AITLICANLIDCIAAAIION
<br />I he$y fmundcr lcmlly oiFryury orc oflic followinr dElamrions:
<br />Dcnolihon Pc nilsAsbc{os Norilicalio. ladcrll R.aulalio.s (l itlc.l()- Pnn6)
<br />Rcquncd Gncr olNdiii.llhn
<br />I c.nilirhri rtu ridrrrlrcgrLr N
<br />rgrm b conlny sirh rllCiryrnd Counly
<br />ivc\ ofrh \ Cliry riil Couniy k, rtrrci uF rtr
<br />0\nnxc0nl 6nYu €<€Q-rqoa
<br />Dsle:elt t
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouqh
<br />Service lt/eter
<br />lblfllr\,e[.)(#6
<br />Notes, Remarks, Etc.
<br />Under Slab / Floor
<br />FINAL
<br />L.ndc." Addr.*
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