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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT'ILDER DF:LCART\TION
<br />I turchy Nlfrrn undcr pcnnlry ol prjury rhar I o cxery)r lnn lh. Conrr.k,^ Lkcne ljw tor rhc loltoqins B$on (s(.?0lt5
<br />Burincss and Pmrcsbn Codc): An, Cily or Counry which rcquircs a rE.mir k, sn{rucr. alro. improvc. d.mlth or rcInn rny
<br />slflcrxi., Illior lo irs issur.cc. aho ftquics rhcrptlic0nl ror srh ricrnir lr' filc ! sisncd sralcmnl rh,r hcor1h. t liccnrd pusu r
<br />ro rhc provisions oritb Conrlldofs LiccNe{ Ijw (Chaprcr g. CommncinS with Sccrion 70U) or Divhion I ot rhc Busines 0M
<br />Pbrc*inns Codc) o! th.r h. or.hc is qcnrpr thcrcfr.m ed rh. Min for rhc rltcs.d crcnnion Any viotdrio.oaSccrtrnT0:I5 byany
<br />applicnnr aor a pc.rnn subl.rk lhc ap!,licanr ro!civilpc.llllornor methd fivc hundrcd doltatr tssoo).
<br />L ,\ owrc. oi lhc fo!.riy. .i ny cnrrn,)Es with *,ec\ r rh.t wlc compcns irnr,w ldorh.qork drhc(ururchmr
<br />inrctrdcrl or oitcrcd aor slc lS(.704-1.8urircs and ttofesi.ns Cdl.: Thc Coftr.h s I icens Llw des mr lr,ply ro atr o$nfot
<br />rhr Impcdy *ho hilds or irlnows rhson. and who des su.h qorl him\.!t or hcn.lior rhmu8h hn or h$ dwn.mpbyccl.
<br />providcd rh.r su.h iBEormdc @ ml lntcndcd or oncnxl lbr srlc.li hN.tcr. rhchuiuingor in ovcmnr i nkl n,irhi,, utru ,urof.oryLrbn. rhc Owncr Buitl$ will hdvc rh. bndcn of prcvir8 rhd h. or \hr dil nor buiu or inqrmlc lh. pmFiy r.r rh. ,urp\c ot
<br />I.dsowncroilhc!rcpcnr,rn.x.lx\ivcllconrrodin8withti.di*dconrra.kr\h.afflrucrrtEtn,jccr(Sc.701-,1.8urn.\\
<br />aril Pnlesbtr Codcr Th.ConrrDctr's l,iccnsc L0qdocsnor ryplyro atro!trc.oftmN yshi)huitdsorimprovcsrhcrLstr.
<br />lnd who mnrocls lir such lroj.rN eirh , c.nrm.to(s ) lt{n*d IoFMr b rh€ conrlacrols Liccn{ ljw).
<br />-l
<br />mt.xcn,IruDdcr Scdiu-. B. & PC turrhi\rcxv,n
<br />D.le: OpE..
<br />WOR(ER$ COITP,]NSATX)N
<br />ItECt AtAnA!
<br />I hcrchy nlhrd u dr pcmltyolll.rjuryonc orrhc roltowins dc.tararions
<br />-l
<br />hrv. &idwill nEinroir o (tnificat. ol Cons.r roSclltnsurc ror sorkcn .onrcn\arion.as Eovidcd ror byScdion u?(xl orrhc
<br />l-'trtr Codc. lor the pcrfonnlncc ot rhc w.r[ ror which thc p.nnir is irxcd
<br />_lhavcandwilln main work.6 con{'ensarion nNrucc. !s rcquimd 6ysc.rion t7u) otrh. tjhorC.dc_ ror rhc I'criormrmc of
<br />ldtrh/.hrhNn(m tr Fqnl. Mytrorkr'!.iitrqrn\ Fn rnsur0nc. cM r.r dn n lqnurnt{rm
<br />s,&a L<- ,(arwr
<br />DC /a L.-1 .t3
<br />I cenllylhar ir thc pcrrornEn.c olrhc work for which rht Frmil n hsucd, I shill tror.,npk,t any F^o. io !n, manrcr
<br />s nsr. tEcom \uhjcd to thc so*cn .onDensarion l.ss ofcdlir.rnia. and +tu rhar if I sfiould h€onr ubi..r ro fi.
<br />wo*o ( onDensurion provhi.ns of Sor t'n .1700 of rhc Latrr Crrc. I shall. fonhBnh cnnDly * irh rhos p$vnions
<br />WARNNG: Flilurc ro Kue workcs ..nlansation ovcm8. i\ unh*ful dd \hall srhF.r an cnDlolcr r' siminrtr.nrtri.\ snd
<br />civil tlncs rp ro onc hlndrcd thousand dollrn (1100.000)- i[ 0ddnion h rhc.os of cofrpcnsorion. dantrx.s as nrovidcd lil rh.
<br />\c(uon lU,6rr rhc Lbn' Cndc. inrcrc!ond dr.m!11..,
<br />,.,", '7.[t .(6 n,,,."..
<br />DICI,Af,.AIIAN
<br />I hcrchy allim uM.r p.nallyorpcrjlryrhal I !n licctrerl undcr povishn otChaprs 9t$'nmncing $ith Sccrhn 70OO) ofDivision 3
<br />ol rhe Bnsitursn.d Profc$io.r Cod.. atu my li.cnr h in tullloNard.fier
<br />CLc s6lrt9 |
<br />,",. "'i.tl.l-6
<br />(I)NSTTUCTI(TN LB*NIN(: ACFN(IV
<br />I hEby artrm rndM Fnixy of p€dlry lhar lhcm k a c.n{ocl i'n lcndinS !8.Ky ior lh. Frromtuc of rh. hrt for which lhn Ismir is
<br />nsucd (S.c. 1007.Ci! C.).
<br />APP! ICANT DICLARdTIoN
<br />I h.Ei'y arirnn under Fnalry olI]. juryonc or rh. r(,ltorins dcctardio.s
<br />D.mlirion Pcmils,Asbcslos Noriarcarion Fedcnl Rcsutarions (Tirlc 40. pmo
<br />-R.quncd
<br />lxuc, olNoriliork.
<br />-,.cniiydu
<br />rhc fcJcral rcgullrlotrs rcsirnnrg a\hcnos rcnn,ul rc tror dt,fti.rbt. ro rhi\Imjccr
<br />I.cnifyrhd I hnrc rcadrhr rrpli. ionnnd(atcrl th. brc iifornuriotr nconccr lrerc.r..o.rrtywirhrltCirysndCounry
<br />odinri.cr Lnd Slorc La*s nhl inS robuildin! consrrucrion..nl h.r.bya horizcrgresctrlirires ofrhnCiyed(i nryro cnrcrrl)onrhc
<br />firlc lrctrlioncd propcdy tur
<br />,1pplicnnr or /\Ecnr Sixnntur(L
<br />w14^-tr4A
<br />\\l:l
<br />Sile-Work
<br />Underground
<br />Pole Bases
<br />Li ht Standards
<br />S as, Pool Fountains
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Da ers
<br />Communications Cable
<br />Building
<br />Bondin / Groundrn / UFER
<br />Transformers
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To p Equipment
<br />Facto Wired Unit
<br />Walls Conduit
<br />Ceilin S Hard & Soffit Ro h
<br />Meter Release
<br />/^
<br />Rou h 7-!'7-/tr P,Y/)(Y
<br />Service I\4eter L/
<br />FINAL Tlto^rc,.JzU
<br />Notes Bemarks, Etc t
<br />Sions (monument)
<br />Under Slab / Floor
<br />Torqueino
<br />Walls (Rouqh)
<br />Ceilinqs (T-Bar Rouoh)
<br />V--9^4
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