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ELECTRICAL.INSPECTOR RECORD
<br />COMMENTSAPPROVALSDATEID/SIG.
<br />Under round
<br />Pole Bases
<br />Li hl Standards
<br />S FountainsASPool
<br />Si ns monument
<br />Life Salet /Low Volta e
<br />rSFire Alarm / Dam
<br />Under Slab / Floor
<br />/ Groundin / UFERBondin
<br />Translormers
<br />To uein
<br />Air Conditioners
<br />Rool To UI ment
<br />Factor Wired Unit
<br />Walls Conduit
<br />Rou h
<br />Ceili S Hard & Soff it Bou h
<br />Ceilin hST-Bar Rou
<br />lVleter Release
<br />Rou h
<br />Service IVleter
<br />FINAL
<br />Notes Remarks Etc
<br />OIYNIiR BIIILDER DEI,CAK.\T('N
<br />I h.rch, altum undcr pcoahy o{ lcqtrry rhal I e .x.mpr i m rhe Conki.los l-acns. L^w lor rlt rouowins 'e'-' l57orl 5
<br />Burnc$ ad Profc$on Co,.lc): An, C(y or Counry which hqun s a [f,rtur to ondrur! alrd. hpror' J'srnsh or qvt rnv
<br />sro.tr'ft,pmrroitsssrdcc,rlsorcluircsrh.rpplijdrforsuchFm(lolilcarign.,l$aicmnrrharh'orsh'islic'n'&l|rururnr
<br />rd rhc nruvsnrs or !l'. Co.rturu \ LEnsd L.* (Chap(.t 9, CommcNi,s w([ Sccrnrn 7flxi oi DilFion ] ot lhe Br$m$ anJ
<br />Pn,tcsii,ns Co.lc).r rhrl hc or she ir crcqr lhcrcli{n a.d rh. hasis for ln. alk8erl $cnDrrn' rv lolarion ol Selhn 7lr'rl'5 bv anv
<br />{plicanr ni , tErnir su$jcck rh. lPdicanl k, r.,v,lP..!ltyornor mrc rhs livc hunltrcd loll6 ($50o)'
<br />L$ own.rolihcpft{cny.orny.mPloyccs*nhwrgcsasihcn$b.o l. salion willdo dr w{r* dJ rltr srtut@ n fr
<br />in ,l.d or ontrcd tm elc (Sc..7oi4, B;iindr and Prole$iom Cod.: Th. Gn rrcrtrt Liccns tjw J*s not apdv b " ownq or
<br />rhc pDpcny wh. btrilds or inriaruEs rhcErr. !tr'l wio dms nrch *.r* himscu or h.rsll o' drlulh hs or hcr own cflrplovc's
<br />,tuvkl.L, rh(i sch iiptuvcmnlseR irrcndcd orolitrd lirsrk.Ii h.*.*r. rhc hurltling or inll'ortm'n issUwrhhonc,td
<br />;)lcon{krtrn,lhc owrcr Builtcr Pill lEt rh. bun cn olFlvi,s rhd rEor she,lil frn h{ru or inl&t lhc prulenv lbr lh' Puqx)eor
<br />-1.
<br />r\.wncrol lhc F)n ny,.mcrchsively co, k...rin-s wirh lic.n*d Lontacro6 n) (on(ru.r lh' P'j'cr (Sec 7ol4 Bu\inc$
<br />*r t-r,,i.*.- Cua" r'r," C"nrd.roa x Li.cnsc Law docs not .PPlv to u own r ol Prut'dy wlhr huilds or inDrovcs rhcr'on'
<br />and who conr@k tor rxch nmiccr s w h r conra.ro(9 liccoscd lusulnl (' rh.c.n racrois Liccose Las)'
<br />_lMr.xcmfl tndcr SLU
<br />WORl(FRS' (-'OII'PENSATION
<br />BECI EArlA!
<br />I h.r.hyrlnnu .rF..llyoiP.riuryonc{llhcn)lltsn*,lcclarlio.r:
<br />-lh{v..
<br />will m,inrah ! Ccll il-Earc ol co.scnr b Sclllo rc ior *orkcc omPcnlaln'n, !\ Povidcd n)r bv Sc'r ion l70o or thc
<br />Lalxtr Cdlc, tur lhc Frao!r@< ol thc ,ork t whi.h lhe pemn ir i$ucd.
<br />I hrvc {ndvill nrinrain workcr'c. r|xnslrio" insuraE-c, !r rcqui.J hyScdon.l?(nol rh' L!6or Codc Lrrhcr'dnm"nc' ol
<br />rh. work tur whichths pcmrr is,soul. My work.n' ..mFnsanon in\ur c.Qr.rul F,licvNmhc, dcl
<br />taDm\:
<br />-
<br />l.cnily rhr nrthc pcrlnimdnccol ihc *ork litr*hi.h lhFl.rnrir n ^\ucl,l shilln.rcmfl()v rny l'N"n itnnyntnnc'
<br />s h ltdrE $bi*i lo rlE -orko i .onrF nsulir bw\ or Cal,Lnri! rnJ rsmc rh.r il l rhnrld b"'m uhjc'r to
<br />'lEwo,kcr( conrp.nsarb. pmvnn,n\ orsc.lNn l?00 ol rhc LrtNr CGlc l shall nnlhwilh('6plv withihos ptuvisbts"
<br />\lAl(NlNC liJlu,c ro {cm *orkri o llf,ns.rtD c.vctxsc ,s nnh*tul. rtrd \r 11 {'hr:cr d cnr0l
<br />)n. hrm!r.J rhousxnJ dollr in rJdntr t' rhr co( ol .om
<br />S.Lrtr llrl6.l rlr tifitrCil]c. nrrc,r! x !^',
<br />I hcNbyrntr u crpcn,hyorPcrjuryrhr I rm l"tne.l un.lcr p"rision ol Ch'fl'r g lconrmncin! wfh Se'rirn 7000)'rDivtkJn I
<br />ol rhc Dusmcs ad PruL$iou CoJc. .nd my ltch\c is in tull torc ! .flc.i
<br />N/t
<br />I lrr.hy rinnr und.r Fnahyol t'crirtr-v rhI
<br />rssu.J lS.. .109?, Civ. C )
<br />i)n LRii,,p rlcn.y lnr rhc pcrliirmrnrc ofrhc work tur whr[ llri\ Itnn (
<br />l.ndcrs Nam:
<br />drrrtcA!.LoEct Ea.Ilol{
<br />I lErhy,ilmu cr pcnrhy.rp.rjury onc or rhc rdLwnr8 dccla, ions:
<br />rlcnrnn$n Pc.nik Asbcslos Noritci.on ltJcr{lRqrlariotrs (Tillc 40. Ptn6)
<br />Itcqutcd t rt.rol Ndillcrton
<br />l.cnilylhd thc t d..alrcsulariohsnt Jin-! ish$tx r.m'!al ire nor rylicahle k'rhi\ t'i(i'cr
<br />lrxrcct)uonflyw(hallCi!yrtu]Counrv
<br />aurhorr. rc[.s.nrr$.r of rhis C, dd Counryb cnrs uFnrtE
<br />Site-Work
<br />Communications Cable
<br />Sub-Panels
<br />Walls
<br />I
<br />D,,", 3- 9 - /,
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