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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DET.CAR,ITION <br />I h.rcby ,lfrn undcr F.ahy ol tcljury rhlr t d cxct{,r from rhc C.nrhdos Ltcns tiw ror $. follo*ins rc0$n (S( ?0:l l 5 <br />Businc$ ffil Pofcssion code): Any ciry or coutrly wnich rcqui r lEmrir lo coondcl llter imrovc. d.lmlnh nr marn rnv <br />srrucrlrc, I'ktrb irs hsuamc. !l$ rcquncslhc arpli.'il for ruchPflnir ro filc trsiencd (otcmnr rhor tror shc is liccn*d puNa . <br />to ihc pnvnio.s ol rh. Co mcrois Liccnscd Low (Chorlct 9. C;mfr.rcins wirh S..rion 7mO ol Dili\tun I oi rh. Brsincs and' <br />Pmfc$bis Codc) or lhlr hc orsh. isrxcmpr lheEliomddlhc h,sk for lhc lllce.d lxemflion AnvvioblbnolSccri'n70ll5 bvanv <br />nprlic!trIfor spcn r{bjccklhc lpllicamioacivilpcnrllyofnornsicrh.nfivcfilndftddollrs($5OO) <br />-t. <br />!\ .wn.. of lhc lrotEnr. or my cqtloles wirh waScs ,s rhcn Ft codo.ncdnnl. wjll do rhc wrt and lhc dndE h mr <br />i^tqldl or oficrcd foi sle ( se.ro.l4. Busimr dnd Prof.sions Codq Th€ Conractoi s Lic..k rjv doer ml aml, kr an owncr or <br />th. Dmrtny $ho h.il& or i,!ms rlF)n, Nrd wts dcs sch srt himcll o. he r.lt or rhmueh hh or ttr own cnuk'v'ci <br />provid.tl rhnt such imlmktunGNnoi inrcd.d orotTcr.{ fttrsh.ll howcw, rh. truiuiog o, itrFmwmnr h$ll wirhin orc }fs <br />;a.ooDkrion. ft. Ovn:r Bu dr vill haE the tDtdcn or lft,ving rhlr hc or sh€ did nor build or tnpmv. rhc ,mpcnv ror rhc ,u'pose ol <br />l. !s owocr or rhe popcny, amciclu\ilclyconr,crins silh liccn€d.oftrroF lo onsru.1lhc Fojccr (se.7l!4 B!\in'( <br />a.il Polisir codc ih; C;nrracror s Licctrsc Lrv dds @r .pPly ro atr oen.r or rmpcrl v vho huilds or imtrolcs rhctco'' <br />.nd eho onrracrs ror such pmj.crs wnh aConr.dons) ltcn$d plRunl ro lhc Conrdors Liccnsc l2w) <br />I rn.r.nrpru dcr sc.ri.n-.ll &|( id rhi\ rci(,n <br />Drte <br />- <br />woRl(t(is' coMPEMsa-aN-- <br />IIECIASAIIAN <br />I hcrcby lmrn under pcnahy of pdjury om of lnc followins dcclmlions <br />I havc ald will mi.rdin a ccnifEarc of Con* to S.lf lnsurc lor w6tkss' conD.nsr ion. ss Prcvidcd for bv SNtion:1700 orrtE <br />L2b.r codc. for lhc l,erfo@ns ol the md( lor whkh th. pmn is issncd6.vc rnd willnui'rhin wo.kc6 comp.n\ i.n insurancc. !s tcqun d hvSccltr.r7iDoirhc Llhorcodc,lorrhc Pstomlm" or <br />rhc ruk i, *hich rhis lEnnir ir i\Myworkcrl comncn\rrion nnurMcccrnicr s' Nli.ynum6.rdc: <br />t-/_/+do 7 </7dZ <br />-l.dnilirh <br />inrhcpcrfoilrrn.collheworkforshkhrhisJ,eirninisucd.Ishrll..rc'ntloyanvPe6onininym mr <br />$ $ b bccom \ubjcd iu thc $oi(cr .a,frl.trsrnrn hs\ oiCrlii(mir. n.d r8rc. rhd irl sh.uld t{'ont subjtcl h lhc <br />so*c^ coml]enlrlion pmvtiotrs ol Scdnr .l7u) of lhc ljtry Codc,l \hrll fonhwiih conrdv wilt lhor lovisions <br />WAIrNINC frilurc ro $.urc worlcB .unr,].ns ion covcrasr i\ utrl,stul. aDd nr ll $rhjc.l rn cilno$r n) 6iNi'r l Fmhics 3nd <br />civillinc\upk)onchundrcdrhou\anddollrsiJl($.(xx)r'inrddirionrorh..odolcompln\rriohdrnDgcs"\lnivid'dlbrrhc <br />S(r tr'n 1076 of rhc LltEr aodc- m.rcst dnd <br />D5.: z/qy'6 t,l( u\stil) (oN I IL\c l()R <br />IE.EIAsAIION <br />lhcrclryalfirmundciNndlyolll{ljurylhall.arlienedun{lctlmlisionolcnaplg9(comflErcin!wilhscctionTmo).fl)ivilion]1 <br />ol lhc Businc$ and Prora$ions C.dc, dd ny li.cns t in rull ior.c fn cfial <br />7a <br />CONSTRT](:T(tN LENDINC A(:ENCI <br />t hcrhydrnrnrundcrl]enllrrolpcijurylhlr lncrc iq,snirucliotr lcndingaS.n.yhrlheP$rormncc ollhc work ior which rhis rcan n <br />hsucdlSN lm7. Civ. C ). <br />tf,tul.r\ Nrrnc <br />Irtrdc.s AJdrc.' <br />AELUANLDSCIABAU9N <br />IhcN$rrmnnundcrp.nrlty.lFrrxryotrcollhcloUowin!d(l dions: <br />Dcn$liri l,cDirs Asb.stos Noliiicrin,n Fcdctdl Rcauralions aliilc 40- P!n6) <br />Rc,Nir.,l I orr$.t Norlli.rri(n, <br />I c.rlilylh0r ihc fcdcrnl rcsr l.r ions rcaardins rshcdos rcdDvalare nor llPli.nhlc lo rhh toj.cr <br />I .enili r hlr I h c rc.d thi applicaiioi md salc lh.l rlrc ak,rc inr(rnml ion i! com.r I .8tot ro <br />odirirtrc.s r SllretissEl,ritrsl(ihuilding..nstrucrion. xlhcrebyrurhortcrcPrc!.nrdrivcsofr <br />.onlply wirh rll Cirytrid Coumy <br />rhovc n,ciri,rrcd nroFny f(tr inr|[.r *H__ <br />,\pfli(dt or i lent SiANI trrt <br />P.mi1.c nrmrlprint):laz <br />I <br />Underoround <br />Lioht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Lile Satety /Low Voltage <br />Fire Alarm i Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilinos (Hard & Soflil Rough <br />Ceilinqs (T-Bar Rouqh) <br />Ivleter Release <br />Rouoh <br />Service lvleter <br />FINAL V/4lrf i i,ru)orJ.l ,2ywTIfl \-/ <br />Site-Work <br />Pole Bases <br />6C^7?:z