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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER DUII,DEN DET-CARATloN
<br />I h6€by amrm und6 r,coahy of Fdjury Od I an.r.6fl 6orn th. (ontrrcloG Liccnse l,$ fnnt rolk\rins r.a$n (S(70ll5
<br />Bri66s and Prof*ion Cod.): 4., Ciry o. Counly shich ..qurd . Frnir ro .onstlcr. alr6. irnp,ov.. ddnolish ,tr cptn My
<br />slrucru.. prior lo irs issuac., abo r.qun6 rh. appli.d fo. such pdmil to ille a sisncd nal46l rhal h. or sh. ii licds.d puuuel
<br />ro rh. pmvisioE oarhc Conlrocrois Lic.Bcd lrw (Chafl( 9, co,nm.n.in* wilh Setion 7000 ol t)ivnu I oanE Busin6 Dd
<br />Pofsions Codcl o, thal hcorshc ncxdfl rha.from and th. bssb for thc .llcscd .xoprin Any\id.rionolselionT0ll5bytnt
<br />.pplta foratmnsubj.arh.applica.tloacivilpcMhrofnotmorclhdfivchund.ddollds{lsoo)
<br />l. s osnq offi. prcpcny. ornycmplor6 wilh qar6 s lhdr sl..omFn alion. \vill do lh€ trlrk ud lhc sluhe n nur
<br />inrqy.Ld oroll6.d aorsl.(sc 7044, Btrliddand Pr.fBioB Cod. lhcContradoisLroGl.r'&*noramlyroanoMaof
<br />lh. pop.ny $ho tr & o! i,rFor6 thd6n. ild sho d,6 su.h *ol( hi,ns.lfor h6*lfor IhmtAh his or hs o\n cmlnry.6.
<br />prorid.d rhal ruch imprevoot3 &c Nr idddalftofioal6i sk li hos'd6. lhc hildins or improvcntn is snd\ri'hinon. ya
<br />of con Ltio., $. ()*n6 Build.r will hd. lh. hr&n oaFor ins lhd hc or $c dd (l build or inro\t rh. prnFdy lor rh. puqtr$ ol
<br />I. sosnd ofrh. proFly. en.rclusiv.lycontradins sirh licd.d conhcloaro coNttrcl lh. plljd (S(. 7041. Auni6
<br />od ftof.sion Codc: Thc Contrackn\ Li..ns. Law do6 .or apply ro m osnd o I !n opolr Nho builds o. i'ht(\.s Ih.' on.
<br />and sho co tuE lor $.h p.ojdts *nh a Contmcro(s) lic€ns.d puGuanr l. rh. c.dra.nn s l-icek l-as )
<br />I m .r.mpt undd Selio
<br />.uoarcattaulllsAtlat
<br />IECIASAIIOB
<br />I hd.by amm und6 p.mlty ol psjury on. oflh. follorvin! dftldarnrB
<br />, hr!. nd { ill mimain . C.nific.l. ot CoBnt io S.lf'tNuE for rvortd Nnpddion, as ,6\ id.d aor by S€tnnr I70u oflh.
<br />Llbor Cod.. lor lhc pqfoman.. of lh. *oft for q hich rh. Fnnn t isu.d
<br />I havc and $ill m.inroin *ork6 .oht .etn,n i6uranc.. 6 r.quir.d by Sd ion I700 oal h. Lfllx)r Code. for lhe p(tunnoc. of
<br />lhc uor k for whkh lhis Fn.il is is.d. My vorrd co'npa3trion insur.... ceid e polic, ntrn,bd rc:
<br />! rlJ <:co \'., soq' P LF CC-r"^QAlr1
<br />PoricyNdnbd, ' \lw c-? 1685q\F.p,,.,,. !q\drze\1
<br />I c.nilyihar i. rh. Flirm.n.. oarh. *or[ aor which rhis pq mir is issucd. I shall nor onpn,y an] pd$n i anr nrinnd
<br />$ s lo b.coDc subjar ro rhc $!rlG! .ompderion Ia$ ! o I Caliromia. md .88 thot ia l should b€.omc n'hjd k, rrE
<br />\od6 co'npcnsolion povrions ofS..lion.1700ofrh. trtn ( od..l sh.ll. fonhwith conDly with lho* r,o\isi{nB
<br />WARNINC: Iriilur. to KuE wortsa compdsaion cov@r. ,s u.lawlul. .nd shall subjd 0n anDloyer to orninal p6.hd dd
<br />civi! fin.s up ro onc hundrcd rhouend dollds (S100.000), in rddition to lhc cost ofco'lp€nstion. da'nascs as li\ id.d ao. th.
<br />Sdion 1076 of thc libor Cod.. intGr Md altom.yi aG
<br />- \o\\j \zotc c..,.). \os€ \..r< r,\E] (
<br />trc[tsEtrtoMxa(jlaa
<br />DICIAIAIION
<br />I h6.bt amfln und.r p6ahy of Frjury lhal I m li6sd undd [ovisioo ofchaptaI (.o,nnrkinB sith Scclion ?Oo0) orl)ivisi.n I
<br />oa $c Businas Md Proa6lioa cod.. ad m, licN is in full forcc tud cflal.
<br />c--rq LicruNumb.r: ' qq tsq an
<br />o". ' tO\fj\Zo\<o co'r-",o. ). Sose F.jsrtter (-
<br />colsralcuolrEN,)lNclcElr.Y
<br />t hftby rmrd undd pcn.lty o f pojury rh!| rhd. ir r codrudion ladin{ agocy for Ihc pFlonnanc. o r th. $'ork lor $hi.h thi! Fnt b
<br />isucd lS(.109?. Ci! C ).
<br />AIfll(;A [Dlcl.AAAIIg!
<br />I holtry orm und6 paalty of Fjury on. of lhc folloving d<l&d iod3
<br />D.molirion P6rnits-Asb6los Norification Fcdcr.l Rcsulalio6 (tirlc 40. Pa16)
<br />R.qun.d Lell6 ol Nolific.lion
<br />I c.rrify rhar Inc fcdral rcsular ions r.s&dins ab6lo3 ronoval a. noi rpplicrbl. tu lhb p olEI
<br />5 F r ..rrry rr,nr r r,0,. ,.oo rt o oppr,.a i ,n rh..h)1c nrfofln.rion iscond. I rgrelo co'nply\irh all(,ry r d(ounry
<br />ordinancE ed Slate Ld\$ chring ro h.r.6r. horiz. rcrrs dn6 of lhis Cily.nd ( ounrr- t,.md qFd $.
<br />abovc r.drioncd proFny aor
<br />Appliccnr or A*enr Si*n{rure:F
<br />Prflnire nrn'e (prinr)>3c:e tJ\lJ\€5 (
<br />,"," . ,o\ rr\z orb
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit){aP
<br />Walls (Rough)a8.. i .t
<br />Ceilings (Hard & Soffit Rouqh ftlt\'/4/1"
<br />Ceilings (T-Bar Rough)4t)
<br />Meter Release
<br />Rough
<br />Service Meter L .ry4//
<br />FINAL Crt4 / tt ftryt t ',6"-4,a.-*
<br />Notes, Remarks, Etc 0//
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