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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrchysffir utolcr pcnany or pcrury lh l am cxclnpl lioar rhc C6.hro6' Liccns. hw t'or lhc i'ollowing d*on lscc70ll.s
<br />Busircss a.d ftofcsion Codc): Any Ciry or Coonty whi.h tqxtcs a lc.mil to .onsrod. alr.r, inProvc. d.molth.,l EPnt any
<br />srtucrurc. pnor ro ns nsnu.c. nl$ nluncs Ihc 0lpltanl tor surt Flmir ro filc r siBrcd {arrmol th hco, shc ir li.cns.{ l)ur$.nt
<br />ro rhc rolisions ol thc Conrraclols l-i..n*d Law {Chaprcr 9, Commcncnr-! *irh Sc.rhn ?cfl) ol Division I ofrh. Bkln.{ xtrrt
<br />PmtusionsC6dc)orrhrrhcorshcncxcnplthcElromandthchashtorrhcalh8cdcrcmplion.Anyviohln,nofs..rirnT03lt6]any
<br />aptlicsnr roru pcnnir subicts lhc omli.lnl ro a ciril pcnal'r or nor ftrc dnn five hundrcd dollar\ (trm)
<br />l. as opncrolihc prcrrcny. or ny cnDl.ycc\ Birh $aecs !s th.ir $lc comlcn$rtnr, willdo rhc w.tk.trd rhc slMr!ft k n,l
<br />inrcnH orofrcrcdrorelr(s(ro44.Businc$andB'ofesiorCelclhcC.ikr.torsLicc.scLawdocsnorapplyro!noqncrol'
<br />rhcrmlEny who huilds or i.rFmm rlsNn. and wh' d{rs su.h $(* hinsclfor icrclror rhrnugh his or hcr own cnDloyec\.
<br />p'ovnlcJrhar such idtrcvurnB arc n.r inrcBledoroficri for eb Ia Fn)*crci rhc ttrildiB ot irq'ovcnEnr is old wirhin.tr( rrr
<br />ofconDkrion, rhc Owner Boildcr will lurt rh. br ctr ol pmlin3 rfud ht or \hc Jid nor huiu or inumv. rhc pmIoly fitr rhc ru(Fsc of
<br />-1.asorncrofrhcprop.ny.rncx.lusirclyconktinswilhliccnscd.otrrdcknsro.on{ru.tth.tNrlTr(Scc7(r!1.Bu$Nsrn,l Pn,lcssi.n co,ic Thc ContBcln \ l-i..n\c l-!wdo.s noi upplyro {n owncr oi ProFrry who huildsor nnPr.vcsIhcrcon
<br />and *ho s, rocrs ror \u.h !6pcls wilh r C.nretorls ) liccnscd pusunr t rh. Conrm.ror s LiLrne tiw )
<br />I rD.rcn,tn trftlcr Sc(r(tri
<br />Drlcr ()mer:
<br />wotl(ERs, cu[tpr-Ns,\Tt()N
<br />DEII,AAA.IIIIN
<br />I hcrchy 0ifin, under pcnalry.rp.rjury.i. oirhc blbwir8 d*hrulbns:
<br />-l
<br />hrve an$ill roinrdn dCcdifi.rrcof Conrc roSclf'lnsurcfor*orLcFc.m$n\atn,n.as[ovidcdlotbyS&rion:t7(x)oflhc
<br />ljtxtr Codc. for lhc pqlonturcc olrhc wurk f(t uhih lh. rrmit ( tsucd.
<br />I hnvc {trd *illnuimri'i rorkcrl .onrpcns.lion iNummc- as rcquircd bysc.riotr ]?r)(jolthc Lrlxtr Codc. r.r rhc rnli)rmflnccof
<br />rhc *o ntr rhi.h rhn mrn'irV\ ir i\ i\sucd MyNorkcri ()mNrsr[i,r irs Jtrr..rni$dd lnicy nunrhcr rE:\.^l^{t c_ <tL 1.,a.
<br />co
<br />I ..nity rhar ir rhc Icr,i'fllrnce oirhc $ork ior whi.h rhis Pc.nir is isnut. I $all n.l cnDloy rtry ncn.n ir rny nunnc.
<br />$stohrsnrcsuhl.dlolhc*orkc.olPcnsdiofllrw\ofcalifffria.udag(rrhrrifIsh)uldbcconEsubjecrt'rhc
<br />trnrkcs' conll'ctrs.lion novisn,ns or SNrn,n l7U) of rhc tibr Cod.. I shrll n'n htr irh .oifly sirh rlrc Pn,visions
<br />WARNIN(;] r ilurc h {rnrc so*cr'c.nrp..\irior.ovc.rg. i! unh*ful, r d shrll subtc.l !n.rpl,)ycr n'. 'nm.llcmllic\ and
<br />.ivil lincs uD r,.nc htrndrcd rhousunn dolhr lSl0l),0m). i'r oddirnn r,Ihc cosl oi conDcnsrrnn,, dd'n.8cs !s Prcvidcd hr rhc
<br />S(rtrnr.10r6rr rlr lit-r('!id.. inrcrc{ ind iI.nf,y ! fc.\
<br />a-c. t$
<br />I hcEhy Bftrmunder pcnllryolFrjur! lhd I.m liccnrt u.ds omvhn,n ofChspro 9 (.o,nnrRing sirh Sedion 7ID0) otDivkion l
<br />ol lh. Busircss ond Pnrassbns C.d., ,nd my lkcnsc h in tull forc and cllccr
<br />\ 0o1 ;1 oga-
<br />n.q.t%W"|3r r -"
<br />II)XSTAUCII0NTEdDIIIj-{CEN(I
<br />I hcrcby alfirh ude, Fnill, orrsjury lhtrl thsc is r coNlruclion bnding rgcmy ror rhc P.dbrmomc oarhe *ork r(tr whi.h Ihn lErmn n
<br />issucd (Sc..109?, Civ. C.)
<br />AIILICANLP&CITIMIa!
<br />I hn:t y {1tnn undcr penslty ol p.rjxryonc drrh. rollowinS d.chalions:
<br />D.nDlirion PcrnrilsAsbcsros Nodncdion Fed. l R.gnhr bn{ (Titlc ,lo. P0n6)
<br />-Rlquncd
<br />krtcr of Ndifrcrrion
<br />lnir',r'*,r'" r"a*,1 *.,luuotrs ,cErd,ne d\bc
<br />2.,,,*,, *'".r*^ *r*,^*.,"*,
<br />slo\rcN'vrLrr ior l,!lr.rhlc ri rhi\ prqccl
<br />x,rcd. I lAre ro condy sirh 0ll Cny inl Counly
<br />ortlinrncc\ anl Sri.l-nwstohritr! tu bu l(lin3.!oirhh Ciry d a,unly to cnts urrn rhc
<br />$.vc nr.fri0r,l pa,lEn y lnr rfc.l
<br />ApDli.onl or Aaent Sknan,(
<br />I'( r& nn[.(Drnrr):o,.itlzL--k6
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety i Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release
<br />Rough qA"ilx gNcb
<br />Service [t/eter I
<br />FINAL loA/p 1*(
<br />Notes, Remarks, Etc
<br />DATE
<br />Under Slab / Floor
<br />t.llr
<br />t nd.r'\Nrm.
<br />-
<br />Q. 1o.
<br />T
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