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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDEi DI'LCAR.T'f ION
<br />I hcrchy r,nr uktcr pcmxy or Frury rhd I nn .rcmpl fsnn rhc Conrrlclos' l,iccn\c La* ,hr lhc lollogins rclqnr 156.- 7011 5
<br />Buli'rcs lnd Profcsio. Codc): Any Ciry or couirt ehich rcqrncs a pcrfrir x, .onnrucr. ahs. in[r,c, dcnoinh or rclln rny
<br />{flcrxri prin k' irs iss!trrcc. al$ rnuircs thc 0ppltmi lor su.h Frn ro llLa \iencd {,kmfl rhd h.o, shc i\ li.e[*d pur\uanr
<br />r. lhc pmlisions of rh. Cotrin.r.fs Li.c.{d ljw (Chaptcr 9- Co rnEncirs wirh Scction 7O(x) oI Divnion ] oI thc lrusincs oid
<br />Pnfcsions Codc I or lh.r trorshc iscxcmpr rhcrcrromand rl[h,sG rurhc rllcscd dr.nl,i.n Aiyvnn(n)nolSccri,)n70]l5bytrny
<br />atpli.anr rd r p(n'i! srbjct rte applicanr ro acivilpcn.lryolnor nnrcrhan fivc hundrcd dollnm ($5m)
<br />I. rs oBrcr oi lic nmpcny. or my cmploFcs w [h wagd $ rlrir {]L ..nFnsari(,n. qill do rhr {ink ,nd rhe n*rk is tror
<br />dcMcd or .lr.rcd lar slc ( Ss.'.?O44- Btrsirc$ !!d Prolcshns Cod. l hc C.nkrttr-s l-iccnsc bw dms nor lptly r. m o* ncr ot
<br />rhc pmpcny Bh. build\ or muovcs rtrrs . u lahod(rsskh*olt hnnsclfor hcrklturihn,ogh hisorhcr.str. rllovccs,
<br />Frtided dur such inrnr,{mnk {c rot inrcdd.rotl'cBi lor *rlc.ll th$cv!r. rh. hurldiry or iryrorcnE.r is hll*irhin.iE }rr
<br />ol.onrpEli{u thc Owner BuiULr willlrvc llr bordcn ol l,r.!in8 dd hc or dr dtl nor htrild or irylfu rhc rrcIany f.. ihc plrax,r ot
<br />L a\ nsncrolrhc nmpcny. unrcxclu\ivcly co.tndnrS sirh li.cnscd conkr.ttrstu.on{dcr thc ti(lNr (S...704rr. Bus'k,r
<br />aRl Pmlcsin G)d.r Th. codkrcn* s t.i..n\.lis doc\ n.rulrply to.tr o*Nr ofl,ropcnyuno huilds or ihffovcs rhsruor.
<br />and *ho conr.acrsforsu€hlmjcclswithrContm.r)(s) li.cn*d Nnumr h rh. Contr,ctn s Li..n\c ltrw)
<br />MBtrE8[tAUtrN,r[tO!
<br />DICI/AA.IION
<br />I hcrl'y {rl'tm undcr lEfllllyol Dcriuryorc ofrhc,alhsirx d.chhrion\:
<br />-l
<br />lEvc B<ill roint?h ! Ccnificqlc of Conscnl toSclalnsxtu for workcrJ.r'np.nern,n. as pbviddd fd byS..rhn,lT0O ofthd
<br />hn r Codc.lor thc rcrformMcc oflhc worr
<br />'irwhi.hIhc
<br />pc,hir n nskd.
<br />rhc wo nrwhichrhi\ Pcmir i\ ilsrd My q co,rlcnsarn,n nsurarc.rdicr rnl tx)licy nu'nh.r rc
<br />rt 9/ t,
<br />-lcc
<br />ily rhir i. rhc Irrronhtuc otrh. wo* rn which rhis Fnnir h nsucd.I +trlltr,r cmpkry any pcnotr in any monrcr
<br />{, N r. bccom suhjcct to lhc vorkcr( comtcNrlion laws ol cdlir(min.,nd agm rhir irI should hc.onr {hj.cr t, rh.
<br />*ortc6 conlE.sarionlmvisionsofsstion3700ofrhcl-atrC.dc.lshdl,fod[sirlr.or y wilh rhosc tmvhions .
<br />WAkNING: FJilurc ro $urc worklr conrpctrsdi,nr corer+c i\ ufhtrlu
<br />.ivil lincs up ro orc hundrcd lhous*nd dollars ($l(
<br />l. 0ft1 shall suhjc.l an cnl|)lorer lo oiniml Fn,llts rnd
<br />th..os ofc.nD.nsdbn. drro!.s rs provtcd lor rhcQz-
<br />D I \k \ ll()\
<br />I hcEby !finn unld FmlryorFrjurt ihri I ur liansd undcr pruvkiotr ol Chopr.r 9 lommencins wirh Sccrion 7m0) olDivishn 3
<br />or rhe au\incs bnd Profcsiors Codc, and my licctrsc is in rullrom d*ratltr.
<br />77qa= q
<br />-z?-7o-/8
<br />COISIBUqIIQN.LEN.DIXC-AGENII
<br />I hcehy rmnn und.r pcndly ol pcrjury thal rhR is n onriru.tirn Lnding lg.m! f.r rh. p&tomftc ot th. *.ik ror shi.h rhi{ Frmir h
<br />issued lScc. 1097. Civ. C.).
<br />APIIICANIDECIIBAIIO!
<br />I h."cny affinn u nd.r pcnelry or Dcrjury oe 6l rhc follosins dahr.t ions
<br />Dcmhn,n Pclnns Asbcsros Nolificllkrn Fedcrol Rcgulolions (Tnh40, Pan6)
<br />-Rcquired
<br />kncrof Norifi carion
<br />ogre lo .onDly wnh ,ll Cny ind Connly
<br />ri\rs ol rhir Ciiy aod Counry
<br />'o
<br />..ro upon rh€
<br />-l
<br />ccnilyth,t lhc Ldcmt rcguliri.ns rclrdiis a$estos rcmul orc not aldtahlc rot
<br />I ccniry thrr I harc rcod rhs,nnlkdri.n ain irtc rh.' rh. rh v. 'nk,mrion '...ffir I:i*:ffiw";ru--^2-7 o-tr
<br />Site-Work
<br />Unde rground
<br />Pole Bases
<br />Light Standards
<br />S Pool, Fountains
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin / Groundi / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels I
<br />Air Conditioners
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilin gs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service lvleter
<br />FINAL
<br />Remarks, Etc
<br />Sions (monument)
<br />Roof Top Equipment
<br />Meter Release
<br />Notes,
<br />-l
<br />IncicnU undcrsNion_. a &PC r{trrhi\rc!$n
<br />Dale: ()ln.r:
<br />I.n'lc'', dJlc!
<br />I
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