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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS l)\rNtaI ll( ll l)llli Lll,( \Rr\ I I()N
<br />I hc.chy liitn lnder Fnrlry of lerJury rhlr I m .x.mpr fron lh. Conlrrkn Li...sc tiw f.r rtt follo*in8 rclsa IS( 70:11 5
<br />Busines{ dd Prorcsion Codc): A.y Ciry or Counly which rcqunc\ , trnnil ro onsr .i. drd. inPmvc d.molish or q'!t !n,
<br />itucrxrc, rior ro its hsuance, oho mquncs lhcnpolicanl lbr \&h lrnnit Io filc r sis.td sl,lcmnt lhal hcorrhc n ticcnscd l]lrsunr
<br />I.lhc nnlnioni of rh. C{)ntocroi\ l-ic.nsd be (Ch./cr 9. Co.meMinB wilh Sccrn'n 7000.r Division .l ofrh nu\in's 'nd
<br />Pnrrc\sbnsCodc) or rhar hcor.h. hcxcnPl lficrcfrom ond rhc b'si\ toift 0llcScdc\cnflion Anvviol.rionorScrion?0ll t hr riv
<br />rmlicrnr fn r pcrmir .ubrc.s th. amltanr b a civil rnrlry of mr mrc rhsn llvc hundrcd dollss (!50o)
<br />I. ns owncr otrhc nori.dy. or my cnrloyes wiih waS.sas rhcn st c.mp.ns,tiotr. will d. lhe ,olk drd rtE (nrl@ i\ fr'
<br />inrcri.i or oficftd fdr $lc I Ss ?Cr4{. Bn\incss .nd Prcfcssions Codq Th. Contlctoi r Lic.hs. bw dcs nor nPply rD rd owm! of
<br />rhc pmpcny who builds or ingoB rhcron. aod who d@s tuch M,* himselfor hcMlf or rhmugh his or hcr own ttnnlovcc\.
<br />pflrvilcd rh.r s(h nq'Frrrns m toi inr.dcd ot ofi.ed for slc ll tx$tw. rhc h{ildioa or ir{mvcmnr is bll wirhi. oft }ta
<br />of conFIdri,n. rhc otxnn guildcr eill ltrh rh. trrdcn of [.ving rh, lt or shc did nor huild or imFrvc lnc DmIqlv lor rhc lurysc of
<br />L rsotrNroflhc nmpLny. r'ncxclusivclyconrrscrinE siih li...{'l .ontrrttrs h consrucl lhc pmJccr (SN. 7Or4. Bu\inc$
<br />xr lhf.a\i Codcr'I'hc Conlracrois Lirctrsc tiv tlocs nol q)Ilyn' trno*rcrolpfuP€ny*ho builds or imnr,lcs rhcrcon.
<br />,trd *ho c.nrra.h t{n \ucfi pfl)j.1...h *ilh a G, tu.hnl)li.ctrsd pusurnr brhcC.nrodois Lkctr* Ilw).
<br />lr rcxcnr|, trnicr S..ri,)n .B &l)(-r({rhi{drnn,
<br />Osner
<br />lro8trDf,$.loutllsAua!
<br />DICI,jIBAIION
<br />Ih.rcbyofli.niundcrp.nahyolpctju,yoncorrh.n,l[,sin8dNl arnt$:
<br />I h6vc ond will minlain u Ccdin.arc or Coa*nr lo S€lal nsxrc ror rcrkcn mdp.nution. rs pmvAcd a{tr bv Salion :1700 of rh'
<br />kbor Codc. for lhc pslormmc o[lh. work for wfiich lhc pcrdi i{ hsucd
<br />I hovc rtrd will mioraio sorkds coop€nsart,n in.uraNc, as Bquncn b, sdiotr 3?00 of lhc llbor Codc. lbr rhc n'rr.lmne o'
<br />rhc work for whkh rhn p.nnir is G$sd. M y qor*n .omp.nsl ion insurane c{dic. a Dolic, nlnb.r N:
<br />l.cnrryrh.rir1lh.pcrtu.Mn.c.lthcworkforwhichrhi\!. nir is i\sucd.l shdlltror cmplovany P.6on inrnv 'nanmrs 6hb!(rE $t'jer ro rlE $o*s\' conr.nsarn,n htrs ol Crlilbrrir- and,Ercc rhal ill \hotld ltcoft \uhlccr ro rrt
<br />$orks I conFrs,r i(,n Pmvniotrs of Serion l7m or rhc trbor Codc. I \hrll. lonhwirh .innplv wirh rhoe Pnrvhi{'N
<br />IVARNIN(;: Fdilurc t, E.urc *olkcs .o.rD+nsarion mrEgc '
<br />!n cmploYfi ro riminol Fmha! and
<br />b on. hundrcd rhotr\rtrd dollar\ l$l(D.Olt)), in ri,)r. ,lrtrrgc\ r! I'nrvi,ic ntr rhc
<br />SNri(,n.1076 ofrhc Lntor Cql.. inrcrciitrd romr's fesa:3:1(
<br />I hcrc$y lrlirD u cr |{nrlr! ol rcrju.y rhd I in lttn{'d utrd$ I1rov ol Chllplc! I (connft.cnr8 wiih Ssrir 70m) ol l)irtion.l
<br />oi rhc aunftss ind Prolcssi{nN Codc.0 trryli.cns i1i'r fulln)
<br />,"" a-?-(f
<br />I hcEny rmflnlndcr Fn,lryoI |].rjury rhd lhd. is d.on{ruclion
<br />hsu.d (Scc. 3O9?. Civ. C )
<br />gctrcy Ior lhc E rlo Dnc. olrhc *orL for uhich rhis ncrmir i\
<br />AELIIANI.DECIIBAIIO!
<br />I lrnhy altinn undcr pcnahy.fp.rjury onc oilhc f.lh,wing dccl0r,rions:
<br />D€tulirn,n Pcrmns'Asbcslos Norincdrion Fcdcru I Rcsular n,ns (T ir lc 40. Pun6)
<br />-Requncd
<br />Ldcr of Noliftu'bn
<br />l.crrily rhrl rfu ridcrrl rctuhri(ins i'igr({no!'r n,viLr. n,t rl,t,l.rhL\'ri rhis l(E.r
<br />-l.cnifyrhd
<br />I lDlc rc.drhi\ ppli.nrio i"Lnndidr isro'rcd lreraioconrplywilh0llCilyandCourri
<br />ordinan.cs dtrd Shrc tjws rchrinE lurhornxrcpd* .rivcsoflhhCiry,ndCountyl{,cn'6u|1)nllt
<br />onovc nEnrn,ncd rn,lcfly lbr inspcc
<br />\DDli(nnt or Ax.nr SiHmrum-
<br />,*.r**.",r".,, \Ul CP'-L\L{;F)
<br />,,",1-A(
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Saletv /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soff it Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />lVleter Release
<br />Rouqh lo 7\I,t9 bt '5D 6e vaA(;)
<br />Service lvleter
<br />FINAL t 1t t9 ul/d/4 /
<br />TNotes, Remarks, Etc.
<br />ID/SIG.
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<br />l.n,lc''\ Nrmc
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