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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEt,CARAT'ION
<br />I hcrchy ffrm uMcr pcnalry ('f Frrury rhd t a,h cx.'npr lhn rh. G,irrcron' Liccns. tjw lor rhc lollosin8 rcisotr (SN.7011.5
<br />Burincs\ and Profc$ion Codc): Any Cily or Counly shich rcquncs 0 pcflnir to cnn(rud. !hcr. nnprovc, d.molish o. rcprt 3try
<br />dfl.rnrc. prior b ih t.unc.. a\o rcqutcs rhc applicoi for such Frmir b filc, si8trcd {rrc'ftnr rhar hcor rh. is liccn*d pur\urtrr
<br />nr lhc provhions of lhc Conrrackn\ I-iccn*d L.w (Chaplcr 9, ConnncmirS wirh Scclion ?mo of Division I ofrll Businesr and
<br />Profc\si(n* Ctulc) or rhrr hc.r\lrc hcftnpr rhcrcfromsnd rhc husi\ tnr r[c rllcgd cfun9rn,n Any vknnion ofSNrirn ]0:ll 5 by.ny
<br />oDfhca n)rr!.irnirsubjc.rslhc.Fflicanlioacivilpcn,llyorn.rntr.rhanrivchundrcddolhrc($500)
<br />l. as ownrr oilhc pmrcny. or n,ycnployccs wirh wr8$ r\ rncir sok conrFnsllion. willdo rhc worl and rhe etuluc n nur
<br />inlcnd.d or ollrrcd l{tr elc (Se.7(}1t. Bu\i'*s and Pnftsshns Cdtc: Thc G)ntrcM r Licctrsc hw docs nol rtply ro rn owmrol
<br />thcpDFny sh. tuikls or inrlIows lncEnr. a' whodmssuch$orlhih\clforhcsdlforrhn,uBhhisorhcrown.nDloyec\.
<br />tlnrv idcd rh.r nEh irnpmlcrEtrIs m mr nrcnLd or oftLnd for silc ll howcrcr. $. hurtliry or ialrmrenEnl is skl wirhin nc trrr
<br />.t co'rplcri.n. rh O{ rr Brildr rill hrh rhc bxrdcn ol poving rhrr hc or \hc dn ml build or itrllltr^r lll. pn,pclly f{n rht !!qi{ or
<br />l. rs.shriofihc |fl,Fnv. d cx.lusnrly.. krcring wirh licch\cdcnitr.rr^i,.on(tu.rrhc pn*.r(SLr.7(}14- Busir'ci\
<br />rtu hllc$tu Codc: Thc Conrrcl{tr s l,iccnlc Llw doc\ mr nDrlv ro m owmr oiprcp.ny !h{) buirds or imDrovcs rh.r..n.
<br />nd sho la,drtucr\ tur \uch pn,l.crs wirh x Conrack l s) liccn\cd Nrsoinr r' rhc Cbtrt{tr'\ Licctrs tiw )
<br />-lrncxcnr
<br />trtrdcrScc|otr .a &PC ltrrhirrc.\on
<br />D.le: o*n€r:
<br />IYqB(EA!:CAU[!!IAIA!
<br />IUI;LABAIIA!
<br />I hcrcby alrirnhdcr Fmlr, oaFrJur, onc ofrhc lollowirr dccldralii'ns:
<br />Ihavc,nleillrMinrdi.rCditi.rr.ofC.n\cnrn,Sclaln\urcf,trs.ikcs co tDcnsartun, rs frevidcdlbrb,Scction-17(n)orrh.
<br />lihor Codc.lor rhc Frformlncc ofrhc oork torshich rhc pclnril h hsucd
<br />-@* " ,"a *
<br />'rr
<br />.,^." *, trtcF' u nrnqr nn rn\urrn.c, ar roquind by sccl ion 3?u) of lhc labor Codc. io! rhc pcrfonMEc oI
<br />-rh.su'\hrwhtrhhFncm{"rocJMy\,{lc'a.omFnlurtr,lin\xmp..,r*.d'Jnl*,num&racF*ccs L*KE-
<br />@ *
<br />-lccniiylhirnrlrcrrioflnatrcc.lrhcsorkfortrhich'hisNrnni(h\uc.lrhallNlcnrrl.yrnyj--nonirnynrnturn, t, hc&nrc suhjcd lo rhe sorl.r' .omFn\i n,n hns ofcnlir'oroir. rrd rarcc rhrrirI \,n,trld bccotu subjc.r k' rtt
<br />sorkcrl conrncnslrinr pnisiotrs of S.cr ion .17(X, ol rh( I -r C.d.- I ihall.lanhwirhconlly sirhrk)$ pii,v$hn1..
<br />WARNING: F.ilur. ro wu.. workc6 conrp.nntrion svc.rBc i\ unl.wlul. md shrll s,hjc.r irr cmploy.r h ni'ninrl Ir rlric\ rtrJ
<br />l.omFn\rrion. drnrA.\ r\ f(,vid.d Lr rh.
<br />DIICIAIAIION
<br />I hcrcbydffirFondcr pchahyoiFrJUry rhd I rm lien{rr undcr povni{,n ofChapt.r 9 (.onrm.cin! with Sction ?U{)) ofDivhion 1
<br />ol' lhe ausi.*s Prcfe$ions Codc. and mylicctr* k nr fullLrcc and cficct
<br />ez-Q -1,_G_'*",i7tt/* .""'K*\
<br />!:OISIBIEIION.LIiNJ]IACICINCI
<br />Iicrcbyrfinnondcr pcnrlrtol l,crjuy rhlr lhcrc hnconnruclion lcndins oscncy for lnc pc orroncc orrhc work rd whi.h rhis Pcrnrit is
<br />issucd rsc. l{Ir7. Civ. C.l.
<br />Lf,ndcrs Nanr:
<br />-
<br />AI]&rcANLDECIAAAIIQ!
<br />I llnby altirnr utrdcr pctrrlryoipcrury oDc ol Ihc lollownrs dcclamrions:
<br />Ixmlirion Pcnnirl^sh.nos Notiflcrlion ltdcr(l RcSuI ns (lillc.l1). Pan6)
<br />Rcqnntd lrrcrolNoilfic.liotr
<br />-l
<br />ccnilylhrrlhc fcdcml rc8ulrlions rsardinE oshcnos rcnmvtrlarc nor aprlktrhlc lo rhn pmjecr
<br />lccnirrrhai lhrvc rcad rhi\rpplicrri{r nl{rrcrhl nrcnh,v. iotu,rnrri{trr isc.trccr lxsrNbdDplywirhrll(iryn dc.utrrt
<br />l{lins c.n\lrcrion. rtrd hcrchyrulhxnc rcDr.\cndnrs ofrht Cirv Jntl Cuunr! t, (nr( uu,n rlt
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<br />".," 2bry'9/ TVOzzt
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communicalions Cable
<br />Building
<br />Bondinq / Groundino / 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 />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lvleter
<br />FINAL /D/4//t-27zao*/D.--
<br />Notes, Remarks, Etc.
<br />Pole Bases
<br />Under Slab / Floor
<br />Ivleter Release
<br />U/;;7,8^
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