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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DI]I,CANATION
<br />I h.rcby afhrn uidc, n nalry of Frjury rh,' I m cxcdpr f&m rhc C.ntn los Lian* Lw for rhc lbllowinB rEsa (Sa.70:11 .5
<br />ausin.\s mil Prof.s\io. Cod.): A.y Cny or Coumy whi.h rcqun fmfi lo o.{rud. olrn. nnprovc. dcmlhh or Epan m,
<br />docrtrrc. Eior ro irs issuancc- 'l$ rcqui8 r hc applkan ior such llen.ir ro fiL d siSn d rdcmnr rhr hc or sh. k lie.scd ,rurs.nr
<br />ro rhe pmvnions ofthc Conrractois t,iccnsed Lav (Chlprcr 9. Commncins wilh Secrion 7lD0 ol Divnion I ofrh. Busi.css dnd
<br />Pmfc$ions Code) or lhat hc or shc n cxcfipl rhercfromand thc brsis for thc lllescd cxcnption Any vhlilio. oiSdion 7011 5 by,ny
<br />/rpr])! rirJncnn uhrcr.rl" anrli.rnrru rcrrl,Fnrl,yn, nor m'( rhrn rr. hdnJa'd 'l.llr! '(ruo,.'4.
<br />"**. "rr;" r'-o:ny. or mycmnh,rcr wirh wlgcs as rhct v'lc conu.nsarion. willd{, rtt *or* d rlf, smtuB is ml
<br />inrc'xl.d or oiled tor sL (Sd 7044, ausincs 0nd Profcssiohs Cdlcr Th. Conrrdor's Liccn* urw docs not apply lo rn 6*ncr oa
<br />rhc IreFdy *h. hoilds or in{mrcs 6ccrn. arxl wh. dm sEn rort hiosell or hcrslr or lhi.rgh his d hct o*n .nploycc\.
<br />pnrvidlal rhdr such inpnMrEnisa rur inlcndcdorolIcrcn forelc.ll k)Evcr. rtr bliuin8 o, inlllotNnr is $Li *nhino* )ur
<br />of..n{,Lri'i. rh. O$ rcr Brikic! will hnv. rhc bordcn of pioving rhd tu or rhc did ml huid or iq,mw fi. Imfsry for lhc luqiE of
<br />l, N.wD&ol rh. ln'Nny. rtrrcx.ltrsivcly
<br />rtr.l ltdirssir C.dr 'lhc Contrrr'\ l-iccn\o
<br />ond who sntBcs ior such roi.rls wirfi
<br />DECI.AMIIO!
<br />I hcrchy,,fi.nundcr pcnalryolFrjuryonc ollhc iollowin8 d.rla6lions:
<br />I hrvc r d willnlaiinain rccdii.dcorConscfl r. sclf li\ur! l.r wdkcd .ofi)cnsari()n. u\,n)vidud ftrbysocrn,n:17(x)orrhc
<br />l;fin Codc. n, rhc f.rtormrncc oirhc wo ln which rht pcnnir isis\trrd
<br />I h!v..nd eillnaiinain workciJ.omr.nsation iNutun....r rl\uncd by Sdion:l?(Xl ollhc litlor C.d.. for rh. P.rfonutrc of
<br />lh. work torwhahthist mn is nscd. Myworkcrl com!.nsolion inslmrccclrhr and Flic, nlnh(r m:
<br />#**i ;*.***xlur'r**r, r,.,.,,,,'
<br />col,,,,yiny|trson in rnynuncr
<br />shotrnt hccoi{ \uhjccr kr rlr
<br />wolksJ cotrrtctrs.riotr ,rcvhions olScclion 3?00 oi thc Lihor Codc,I shall. lonhwnh 6frp1, {nh rho* tbvnions.
<br />IVARNING Frilurc ro *.urc workcrs mmnc.sar
<br />civil lin.\ u, b o hundrd rhou$nd dollds (
<br />;J:]JI,+H: :
<br />I hcrhr,flirmu.dcr p.nrliyoip.rjur] lhll ! um licensl undcr pmvisbn olChaprer9(connftncing wirh sccrion ?0OO) ofDivisioa l
<br />of rh. Businc$ lnd Pmrcsd,ns C.dc. dd my li.cne is in full foN ,rxl cffer.
<br />Lic.n*CLs: Liansc Nunftr
<br />(:oNSTRI'(ITrcN I TNDIN(i A(iENCI
<br />Ih.rhy dll]rN unddr Fnrlryoipdjnry 'h.l 'hcrc
<br />n a comrruclion k inSrscncylnrrhc0qlara!('ccorrhcwor*forwhichrhisPctmirh
<br />'$ucd(Sqc .lor?. Ci!. C )
<br />AXTLI(ANLDICLABAIPN
<br />I *!*hy rllntrr d n{l.r l.drlry of F.jrrt onc ol rhc lollowing dc.lnr r i(rN
<br />l)ctrrnii(r l,cnnirs A$.sro\ Norili.rri(n, ttdcnl Rcauldion\ ( l iilc t0. r'xn6)
<br />-Rcquircn
<br />brrcr oi Norifi calion
<br />n I +rd bd,nlply wnh 0ll City rad Counry
<br />!h.vc nrtrrnnlL.ll |tJltrd!
<br />Ett ,t Dez:
<br />""'"*,'"'lfnI')
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains a,--/
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER I j D
<br />Translormers ul
<br />Torqueino
<br />Sub-Panels
<br />Arr Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Rough b ;D)
<br />Service Meter t*)a;',/D^
<br />FINAL ,,brJ
<br />Notes, Remarks, Etc uf
<br />L->
<br />COMMENTS
<br />Site-Work
<br />l^tt ^r*l-
<br />Meter Release
<br />")trta 4
<br />ftl9l'tl I Y>_/
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