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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEI,CAiATION
<br />I hcrcby aflnm undcr lcmlly of pcriury dr I m.xcmnr r$n rh. contn kJn Liccnk Lrw ro. th. follosing rc.str (Se.7o.ll.J
<br />Businc$ and Pror'esion Codc): Any Cily or Counly whf,h rcqun s 0 ltirnil ro conslrucl. axcr, nnprove. dcmoh,r or rcIqn any
<br />nrudur. pridr. ns isuamc. iho requircs rhe upplicrDr lbr such Frmil t,,lilc{ sisncd (arcmnr rhat hcorshe n liccn\cd tuBurni
<br />ro lnc ,nrvi\ions ofrh€ Conrracrois Licensd ti- (Ch,flcr 9. Conmcrcir8 wirh Scctiotr 7000 of Divnion I of rhc lJusines ond
<br />Pmtcssion\ c.ds)orrhar h.orrhc il ci.npr rhcrcfron ond rhc hlsn for rhc lllc8cd crcrni,rion. Anyliolart,nofsccrion 7l).115 byan,
<br />.pplicntrr for I pc.mir subj.ats rhc applionr ro a .ivil Fnrlry or toI mr. rhd fiv. hx.dicd dollrq (3500)
<br />L ds owrcr ofihc perrny. .t ry cmplorccs sirh s a8cs !s lhcn dc co ucns ion- sill do lhc w(nk lrd rhc natu( ir tror
<br />intcndcd or olttrcd (tr elc (Scc 7014. Busirr$ a d Piofcssi,nr Cftlc lhcConkactx\I-iccn{liwdkstror,ptlyloano*ncr.l
<br />rhc pft,pcny wl.i hilds or iqrrowi lhcBrn. and wno des flch wo't himrll ar hcr*lf or rhmu8h hn or her osn cnrployccs-
<br />trcvid.d rhar such impmvemnrs c ior inrcndL{ or oficEd for slc. li trwcv... rhc huildiry or itrr,rownrcnr h sll eilhin om yt,'
<br />of.. Dbrbi, rhc osn rBtriklcrwillharc rlE hrdor oa prcvnB tl}1r hcor\hcdil h huiu or nlltmw rhc ptuFry fo. rtf, purpoc of
<br />-1.u!owncroirhcpn,l)cny.amcxclusivcly.onr.din8snhli.cns...tr.r.$hconnddrh.pmrcc!lSN.?(}1,1.Buw$uld Phfc*i,n Codc: Thc Conrmcnr's Licensc l-owdoes nor amlylo nnowncroftoncnywho hlildsor imlrorc\ rhcron-
<br />,nd who conlnds for xuch proFcrs wirt a Cotrhckr(9 liccns&l !tr uam k,rhe C'onr.crols Liccnsc bw).
<br />I ancxcn'fl undcr Sccti.n_. B. & P.C foi rhh rclson.
<br />O*ner
<br />llof,trE&t:g)ltf[lta.UoN
<br />IIEIIAEIIII]N
<br />I hcrcby r,nrmrnd.r pcnrlryofFrjrryonc olrhc folk,wins dcclaftlions
<br />lh.rcrnduilltuintainrCcniiicarcofcoi*ntroSclflNurcf(trrorlcr!co'nnn\rrion-a\IovideirnhySetionl?O0ofrfic
<br />lrhtr A{c- lor rhc pcrforroncc olrhc {ork tu which rhc Fnnir h is}ucd
<br />rhL $ork lnrshichrhis p.rn'ir i\ i\sucd Mywtrkcrr conDcn\!ri.n i'*urrnc. crtricrxndfinicy nu hcr rc:
<br />_l(cnr!rhnr rltclrrloi,ttri.c ofih( sork f(tr (hich rhnJ^-nnir h i\\ucJ.I\hrllnor cn'doyrnypc^odi atry rrnicr
<br />$ a\(, bcm f, srhicr k, rh. sorkcs'conlpcn$rion hs\or'crlitun,ir Md rsE.rhor iil shoukl hc.om suhjccr brh.
<br />$orkci\ .. lpcn\arn'npn)vi\n)Nofs(rnnr:1701)ofrh.lrhfcod..lshatl.nrnh$irhc.nj,lywirhrhofrro(isidrs
<br />WARNINCT Failurc ro mu6 wor*.rs ofrp.nsarion colcEgc t unlawfrrl, dnri rhnll subixr an .'ryloycr ro 6imi,al Fmllics ard
<br />civil lincs u, to onc hu.d.cd rhou$nd dou6 (S100.0m)- in addni.o ro rh..o{ of.onp.ns6rion. dr'mg.r as Fmvidcd for lhc
<br />Sccti).1076 ofrh. Lahor Cd., intcrcs rJxl anomyk fc.s
<br />D.r.:. _-. _ _ _ {ppllonlr
<br />r .rcENsEp aaN"rR^dii-
<br />DECI,Af,AIIOX
<br />I hcEhy olfirm undcr FnrllyofFrjurylhal l0m li@n$n u.dfi !6vhion ofchoplcr 9 (mmmNinS eilh Scclhtr 7000) ofDivision 3
<br />of lhc Busircs ond Pofcssions Codc. &d m, liccns is i. fnll lore aJld clT(r.
<br />CANIIAI&IIIINIENPIIIIIiENET
<br />I hercty Bfirn undc! rEn ty ol perjuly lhol rhcrc n a construclion lendinS aBcmy for rlE performmc of thc *ork ior whkh rhir Ntn ir
<br />ksucd (Scc.3097. Civ. C ).
<br />AIS.TANLDECIAMTAN
<br />I tmb) Imunds pcnally ofrcrlury orc oflhc followinS dRhrolions:
<br />Dcmolirion Pcnnils-Asbc{os Noriicdion Frdcrol Rcguhtn,s Girlc !t0. Pd6)
<br />-Rcquircd
<br />lltr$of NolifErbn
<br />, rcniliihrrrhclc(lc'rlr.gulxri,,tr\ rcEndi'rBx\hnn\ rcnynrlrr. n.r rnfli.rbl. ni rhi\ nni.cr
<br />I.dilyrhrr l hrvc rctrd rhnrpllicrrion!ft1nrrcih r dr rhN! inlanndion ir.on&1 I r3r.! t, co lnly wirhallCiryaiJ (loutrry
<br />o'dirricc\ nitl Srnic lis\ rcl ingb tu iktins ron(rcrion. and hcrchy3urhori/r'cprc\cnr ircsi,frhnCiyandCounrykrctr(u|r)nrhr
<br />,h,vc 'nrDinnrd pmpc yi,n irsp..rion 0u4ns\
<br />.\pDli(!nl or ,{,renr Signnrure
<br />l,€rnril€ nnnr hrinl )l
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin g/Grounding/UFER 3/, u le f-?lnrf7>- /62
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Condilioners
<br />Bool Top Equipment
<br />Factory Wired Unit
<br />alls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Bouoh
<br />Cerlings (T-Bar Rough)
<br />Ivleter Release
<br />Rou gh I elltolrl @141efi I tt)
<br />filiali)lvw(',l-t4
<br />FINAL ilihl*riahfi1 t / n-'-
<br />Notes, Remarks , Etc.
<br />Service Meter
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