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ELECTBICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCABATION <br />I hcrcbr .fllrn und.r Fralry .r Frjury rhd Ln cr.npr t6n 'h. <br />Co rNbE Liccn{ h* lbr lhc iolloqitrB rcastr (Scc.7ol l 5 <br />Ausinc$ aflt Prolcsion Codc): Any Cily or County whi.n rcquiEs ! IEir.il lo conslflcl. ahs. irymt. den'li\h or EFir !n, <br />srtodurc, prntr to irs issusnce. llso rcqliEs lhcappli.anr for suchFflnil k, filco sis.cd (arcmnr rhar hc.rshc b li.cns.d puhumr <br />Io Ih. pmvhion\ ofuhc Contoclor's Li.cDscd ljw (chrrrcr 9. Conm.rci.E wnh Sccrion Tuxl of Divnion :l or rhc Busines ud <br />PDfcsions Co'lc)or lhar hcorrhe teicqi lhcrefrorrnd lh. bosn for Ihc rllcscdcic.,{,lion Anyliohrionorsc.riunT0ll.5by.ny <br />,rpli.ant f.r a p.r6it \ubjek rh. Nppli.xmro,civilpcnllryolnortuftrh.rivchundr.ddolltrs(5500). <br />-1. <br />os owrcrollhc pmltnr, or mycmplolccs rilh wa8cs as lhlt slc conpcnsdion. silldo rhc wort adl rhc {turm i\ mr <br />i'nd &d or.ftcrcd lor \olc ( S( 7014. Busincs dnd h)fcsionr Codc Th. Contd.r's Liccnr bw docs nor lptly h !n owncr of <br />rhc pmlEny wb hoilds or in{reB rrr@n, a.d who d.Es such w.t iinsclf or hcrclf or rhion3h his ur h.r o*n cmrloytcs, <br />ptuvided rhar su.h inptuk.rnB m mr i, cndcd or.r.md tu *n . Il hoscrcr. lhr bdildinB .r nrymlcmnr h srd wirh in onc rr <br />.f@nnhrion. tnc Owacr Bui[cr will lErc rnc h{rdo ol rmvins thar hc or shc dn n.! hlild or irDmr rhc pmFny for rtr puqns or <br />l. rr .*tur or rhc rbl.ny, am cr.losivcly conra.rine wirh li.cn{d co.rrbs ro snsroct rh. loirt ( Sa ?O1.,1. Bu$m$ <br />!'xl E fc$ion Codc l hc Gntacrol s Liccnsc t,ow docs not ol)Ply ro nn owncr ol p()l'eny *ho i,uilds or imtovci rhcrcotr. <br />rnd sho.onrhcrrf(rsrchpn,J..r\wirhaconrEcrodrltcn*dflBuanrbrhcco.ra.blsLtcnsebB). <br />traaxE&r:rl)uffNtallo! <br />DECI.Af,AJIION <br />I hclcby{filirnundcrn nohrof pciur}oncofrhctullowinBdcclrllions: <br />-l <br />lrvcatrd*illmi d.aCcnificalcotC.nsnrloScll.lnsurclorwo.kcrs corFnsrlion. as povid.d ror h, s..rion.1700 ofrhc <br />tibor C-odc, rirr rhc FlfDmkc of th. *ork for whhh rhc l.rn r is issucd <br />_lhr\c rnd sillnrii ah rorkcF conrpcnsJrtun insumrEc. rs rcquircd hlSrdion l7tuofrhc L*orCodc.lar rhc lcrliinnrN.ol <br />rh. s( ld whl.h rh s pcnnir i\ iskd nlvsukc'r tr i'truran.. .nrhr r*l ,.li.y umb.r ec: <br />l.cdifyrhrr i'rrhc NrfoflNtrccol rhc sork nx rhis rcnnir is tsucd. I rhall nol cnDloyany per$n ii rny manncr <br />$ rs to bccnrc subj$l l.lhc sorker'co Fonibn lars oiculifnnii- ond a8rcc rh,r irI llbuld lE om {bj.d ro rhc <br />workcricoorlr.nssrbnprovhion\olScctnnrl7(xlofrhcLihtrCodc.lshall.tdhwirh.on!r,sirhlbs[ovisions <br />WARNIN(;: Fnihrc n) {cor. $.rk rs .o rFns rtr'n.(\tft!c i\ uolNrul r.d \hdll suhjccr rn cnlllo)ar lo rnrinrl lf,tulrics r d <br />.ivil fincs xp b onc hxndrcd rhou$nd dol <br />S..ti.tr 1076 of rh. I at$r a.rlc inr.r.sr md <br />r dddition k, rhc con ofcotrrpcns0lion. da'na!6 b$ F)vidcd lor rhc <br />M}tNSl.I) C{)N1 RA( tt)R <br />DlcI,.t&rQ! <br />I hcrcby ai,nm undcr rEnalry.lFrjury ihd I m lienst undc. [ovisio. olChapre 9 (snrm,ri.8 wilh Salion ?000) ofDilGioo.] <br />of lhc Busincs and Pofcsions Codc, ud nryliccnrc t intull lorcc mdcffNr <br />a <br />CONSIf,I]CIION.LENDING.AIiINII <br />I h.reby rriirm uidcr Fmlry or pcrju.y thrl th.c ir a onsru.rion lending rBcmy for lh. p.rfornEmc of rh. wo.k lor shich rnir Frd t <br />hsncd (Sc.309?. Civ. C.) <br />A.PEIICAII.I)ECL/$A.II0N <br />I hoth, afim' undcr p.nrlryofpcrjury onc.rrhc r.llowing deldarionsi <br />Dcmlilion PcrmiG-AstEslos Notification Fcdcral Rcguhlions (Tilb 40, Pan6) <br />-Rcqutcd <br />Lcllcrof Nolifrc ion <br />I.cnifyrhd rh. lidchl Egulari s rB$dirt nsb.so\ rcnn)vJ ,r. nornppli.$lc k) $ntrol.ct. <br />-l <br />ccniiyrhrr I hrvc rcldrhh arrplicltion d (rre rhrrrhcotnlc inl'onurion hcon.cr larrcctl.onrlywirhnllCily3ndCounry <br />ordimmcs and Sralc Lrws Elllin8 tr huilding con{tuciion. und hcrcby auriori/f, rctr.$nr,ircs ofrhh Cny.nd Countylo cnler ulon rhc <br />'*4//e <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondino / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soflit Rouoh <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />.A <br />Rouqh g-7s-lK .8.14-Ji) <br />Service Meter x{ <br />FINAL ffi >Jd]lL\ <br />Notes, Remarks, Etc t <br />I rcrcntPr ondcr Sc.rnn, .ll &PC nrihismNnr <br />Dtrre <br />E//?/r Q <br />Lrrler \ Addrcs <br />i:"Y;xW <br />--f------