|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.rchy aflnn nndfi ,.ndry or p.rjury th,t I m cxcflpr lmnr lh. Conracro6 Li.cne L:w loi rhc followi.S Ecsi (5(.?031.5.
<br />Bu$ncss and Prolc$ion Codc) Any Cily or County uhkh rcquits r tsrfrii ro snirucr. all.r. iq,rovc. &mlnh or rctln ony
<br />nrucluc.priortonr issuaxe. also Equircs rh.4,plkanr r.r ru.h Fnnil lo 6lca si8ncd slarcmnl thrt lEor shc is liceiEd r!!^oani
<br />ro rh. fmvi\ions or lh. Conlricrors Liccnrd Liw (Chaplcr 9, Comftmins wirh S.crion 7000 ol Divnion 3 of lhc AusiRss rnd
<br />Pmrisions Code) or rhll tr or shc is cx€mpr thcrcliom and rlr tusi. tur rhc rlLgcd cxcmprion. Any viohtirnofScclion 7011.5 byany
<br />{Dlicanr for a pcrmn slbjet rhc aprlicrnr ro r .ivil pc6,lry of mr mre lhon five hundrcd dours 1$500).
<br />_1, as owmr olrhc pmpcny,,r mrcmpk,yccs uirh wigcs as rhctr olc cory,.nslion. will do rlE lork od rlr stndm is mr
<br />inrcnd.d or otttrcd ro. eL (SN.r0.14, Busim$ and Prclc$ions Codc ah. Conracrors Liccnsc kw docs nor lpply lo an owmr oa
<br />rhc Im,p.d, who ttrilds or inDDrcs thcNn- dxl who &Es $cb m* hinNlf or h.rslfor rhhuah his or h.r osn cmrlolecs,
<br />prolidcd rhar sn h irymvcmna s Dr inrcd.d d olIcrd tor sh lt lnucwr. dr ttikiing or irpovrEd is $b vnhin orc ]tu
<br />of con{,Ltioc drc Ovncr Builde! eill har rlt blrd.n of Flving $d k or shc dil mt hiild or itrprcvD l}t rhFr, for ft pnqr,s of
<br />_1. a\ owrcr of rhc pmp.nr. am cr.lusively contr.ring wirh liccn*d conra.tod Io onnrud rhc prcjNr (Sd 704.,1. 8u\ik\'
<br />rtrd Piiixsaitr Codc: rhc Contrrctol ! l-i.cnsc Lru dft\ not lplly ro d ou.f of prop.ny who builds or imProvcs rhcron.
<br />and who .onrn r r.r such pbjccB wnh 0 Conbrcbnr lienrd p!6unl rorhcG,nrncrors Ltcnsc bw).
<br />I uncxd.rB u.d$scrior
<br />-l
<br />have ad sill minraiD a Ccdilicarc or Concm r. Sclr-ldurc ror workc* comp.nstiotr, as [ovidcd for by Sdion ]700 ot (h.
<br />Lrhr Codc. lor rhc Frforrome oi rhc *ort rir which rh. Frmir ir isucd.
<br />-l
<br />hrvc in'l will'nrintrin sorkcr' coryrn\arnrn insurancs, rs rtluncd by Sc(rion 1700ofrhc L.hor Codc, tor lhc p.rrormBncc or
<br />lhc work for whnh tht pcrmir is i\s'rd. My workcr' .o rr..sdio, i.surm. cuE lxl poli:y numbcr oc
<br />Expncs:
<br />I c.niry rhd ,n rhc rcrloflun.c ol rhc f,ort lor rhichlhh p.rmil i\ i\sucd.l shallnor cn l,o, an! P.son in lny Enner
<br />s sto b.ronE subicr ro rhc mrlss $mpcnsrhn lass orcalir.hi and a8rcc thlt ifl should tErom slbF.l ro rh.
<br />*orkcs'conrp.nsorionprolisionrolScctioo3T00orrhtlrb.rCdlc,lsh!u.fonhwith.on{'lywilhlh,€prolisn,ns
<br />WARNINC r'lilurc ro {curc $orkcr' conpcnrrnnr c.vt sc
<br />.iL'l tinc\ ut r, i r. hunJ'c,l rh.,u\rnJ J"l'J'r ,$l(x).u{" i'r
<br />Scdi,,n:1076 olrhc L:lrn C,xlc. "ncrc{ rnd in.nrt's fccs
<br />{,blcur rn .nui,rs b cnni'rl lEulrf,s aid
<br />)n,r^-n\rrn,n. dn B!.\ ns F)v'dcd ntr rhc
<br />41L-7'p11
<br />Illlr &l.t.112I
<br />I hcrehy amrm!.dcr pcElryofp..juiyrhd I rn lianerl und.r povnion ofCharter 9 (ommtins eirh serio.7000) orDivision l
<br />ol thc Businc$ ond Pmfcs\nrnr Cod., ari my liccns i\ r tull fot c alrd cft(1.
<br />.,**""**, C-Llf z--?()
<br />Dll >ta
<br />0 L1-""r,,"'",L1U<4r-- J
<br />l.cdiry rh.l rhc fcdcrllrc8ulations Esrdina oshc(o! Efrrvtr] e. tut lprl.$L ro Ibis prcj(t.
<br />IccnifyrhrrIhavcE rhn +plicsr ion rxt (arc thd th. otnrc inlbmlion is comr Irgrero.onplywnh.[CnrandCounly
<br />ordimnccsr d SrrrcLrss rclnriryro bui
<br />rh,vc
<br />'mtrri{,ncd |m,Drny lnr i"srr.rnnr
<br />nstrucrion. aaj hcrcbyrurh,nzc repdsnuriv$ ofrhisCily{nd Countylo e quFnlhc
<br />A|,|llic!nl.r AxotSixnnlu
<br />tLt,--q 1d"4YL
<br />*,.,41?'7,bzl
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service ltrleter tl --2
<br />FINAL U,l)r btulru %x
<br />INotes, Remarks, Etc
<br />UOBKDIILS.IIIIENIAIION
<br />DECI"dTAIION
<br />I hcrchy llfirn under prnrXyofFrluryom ofrh. folb*in8 dcclr.rions:
<br />CQNSIBUI]UA|{.LEIDING.AGDNCI
<br />Ih.rcbt.ltirnundcrp.ndryofp€rjuryrhllth€rcna.onsr.tirnLndirg!8crcylorrhcFraormrceofthc*orlf.awhnhrhigpdmtis
<br />tsucd (sN. 3097. C,v. C.)
<br />lxnd0 ' Nrm
<br />-
<br />L.nd.' \ Addrc(
<br />-
<br />ATEUgANLDECI.AMIIQN
<br />lhsrby rfim rndfi pcnrhy ofp.rjury om olrhc followinS drchEtions:
<br />Dcmoliriotr Pcrmia-Asbdlos Notification rfderrl RcBulat ions Ont 40. Pd6)
<br />Rcquncd L,rrc. or Norirtdion
<br />Communications Cable
|