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ELECTHICAL-INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS OWIIER BUILDER DELC RATION
<br />I h.mby rlfirn undd !..rhy ol !.iury rhlt I am cxcnrfl norn thc Conlncron l,ic.nsc tis r.r rhc rollovirr8 tcusn (Scc.7oll5
<br />Businc$ dM Prof.sion Codc): Any Cirt or Counry whici rcqutcs r Prnir kJ on{d.t. dlrcr, nn!ruvc, &ft'lirh .r rNn Jny
<br />srrudurc, prior to ns issuance. lho lcqlires rhctrpplicMr tU ruchrnnirlo lllc, siSncd strtcnEnl lh tEorrhe i! li..n{d tuNumr
<br />ro rhc tmvisnris orrh. conta.r" s Li..trscd taw (Ch,!lcr 9. Commncins wilh sc.rior 70Oo .r DivGion I of rhc Au\inc\\ lnd
<br />Pturcsrn,n{ Codc) or lhlr h.orshc iscicnpr lhcrclromlnd lhc h!si\ lbrrhc LBcdcrcDprion AnyviohrionolsccrhnT0ll5bymy
<br />rtplicsniftr!pcnnitslhje*rhcappli.{trrloicivilpctrrhyofnolmorcrhlnirehun&eddolltrn(S5m)
<br />-1.
<br />0s owncr of lhc pmpcrl,. ,n my .mpk,yeer wilh w4.\ as lh.n $h comPctrsd ion, will do lhe tdk r i rh. {nthn is mt
<br />iirctoLd or 6ft rcd for sdl. (Se ?(}4,1. Busincs and Pd'essions CoJc 'fhc Conkn ktr\ Lkcns t w &es nor aPply t, m orftr of
<br />rh.rFlrny who $uilds or inl9nhr rtrmn. *xl who des such wl( hi,.selfor her{lforrhniu8h his or hcr own cq)n,yc6.
<br />Frvi'lc.l rhd ru.h iqrovcmnh m ml inlcn tn or ofrcEd nns! It hotthr,(h. brilliry or in{tm'lmnr is eld wirhin onc $r
<br />oI cor'I)krion. rhc Osncr Blildcr will har of, hod.n or rovin8 tlla hc or shc dt nol build or inDmh thc pmFrly for tr 0ulpoe ol
<br />Lr\owicrorrhcEorcny,nn.r.lusivclyconlra.rirswilhli.cnscdco tr.ttr ocotrsnrdih.Pm,ccr(Scc 70,{r. Bu\ir'.s
<br />rnd fti{i:ssbn Codc Thc Conrnctr's Licch$c Ltrwdo.s nor.ppl}r. nn ounct ol poF(y sho hoildsor inrFovcs lhcrcon.
<br />rtrd wh. co m.h tu such nmjccls *irh ! Conhcto(s) licenscd puNJnr h rhc Conta.roa s Lkcnic tn* )
<br />lrd-r.itr trrd.' jc.rtr{r .tl &Pa l, hi.r'rid
<br />Dsre: Osmr:
<br />tloB(!&trautlNsalltl!
<br />LIA;lrl&LIJ0!
<br />I h.rcby rrfirnu d.r r Mhy ol Nrlury orc ol rhc ,hllow ins dcchmli,rN:
<br />l hrlc atul willnrirair rCcriilralc ol'Conscnt lo Sclilnsurc lor wortc conPcnsdnnr.nsti{)vidcdlbrbySarion.lT(X)ofiltr
<br />ljhor Codc. for lh. Dcrfoouie or rhc w.ik f.r whichrrE lcrnlil t istrcd.
<br />I havc.nd will nmi nirBorkcricomtnralioninsuBtrcc.rsrcquircdbySc.iidrlTtDolthctjbotCodc.ftnrhcp&trnBrccof
<br />lhc wort ror whi.h rhisNnnil is hsBn. My*orkcn conrEn\rrn,n nNurr,trc.,nicr n policy numhcr uc:
<br />l1lccn'ryrh,rinrhcnc mnlc fihctr,trkruNhrhrhisrc r is issucl, I \hall nor cilpkJt 4., lf,ron i. any nun.r/w,"r.nco,m.utr.rrornc"nrlc'(c,,trrTr\s'nnhsln,CJlil,lniJatul,Srcst\Jtill.houldhr.n,mshrc.rr.rh.
<br />\ ortcn' con\Ens0r ion Dovhions of Ssiirn .l7m of rhc ljtbr c.d.. I shrll. lhn hwilh cofl{'1, wirh Iho* ,rovisn,.s
<br />WARNINC: Iaihrrc to $cu'c work.^
<br />civil firc\ up to orc hundrcd thouund
<br />Sccrion 1076olrhc uho. Codc. inr.'c!
<br />""'", 1/zr-/tL
<br />onlprn\]iion corcri8r,\ u htrtul. un shrll n,hEcr rtr cn,pl())tr t, dnnitrrl Fnrlrirs rad
<br />in add t'n Io rlrc.o{ ofcoq*n\dn,n. da E!.s r( providcd nn rhc
<br />Yq(
<br />DECIABAEO!
<br />I hcEbyamrm undcr pendhy or p.rjury thol I snr li€cnst unds Imvision olChafld 9(.ommin8 with Sation ?000) ofDiY(ion l
<br />oa rhc Business lnd PmltFsio.r Gi.. rM ny liccn* k in tuU fom s,n cfccl. .
<br />L
<br />,,","?7u'1r I)ec \a 'otq I ttO v\
<br />AITLI{:ANI.DECI,ABAIIQN
<br />I hd.6t lmm und.r l,..allt of pc.jur, orc of rhe aolloei.B d<ldurionr:
<br />Dcmti.n Pcrmirs Aslxsos NorifEalion FcdcEl Rc3ulolions (Tillc40. Pa,r6)
<br />_R.qri6d b(o.t llorifEllion
<br />l..nrlyrhnr rhc rcdural r.ruhrn)ns ngrlin! r\lx{o('r r,vrlirc tror,l|)tlsrblr r. rhislntrci
<br />rh. ahovc irlormirion i\c.nftr.I rEcc h conrtly wilh lllCirydid coutrry
<br />n. and hcrcl'y aurhor;c rcl)rc*nturilcs ofrhis Ciry und Counrr ro c .r trF,n rlE
<br />_.lccnilirhn' I l$v. rcrd rInrppli.rrior dnrrcrhrr
<br />v<(<
<br />,,,," t@16
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqhl Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />It/leter Release A
<br />Rouqh 7-20"tr kllrl0)
<br />Service lvleter U
<br />FINAL tt'-9-tK x.wrt\
<br />Notes, Remarks, Etc
<br />Transformers
<br />I
<br />I;AIIIB!]CITONIENIIIIG.&GENCI
<br />I hcrby afltrm undcocnally of p€rjury rha' rhcrc i. ! .on{ru.rion lcndinS a8ctrcy for rhc lrrrlorn@e or thc wor* lor which this r.tmi! i\
<br />isrucd(sd 1097, cit. c ).
<br />tJndd'! \ame
<br />-
<br />L.rJr''. AdJrc$ _
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