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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.-COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountarns
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communicalions Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Torqueino
<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 />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rouoh
<br />tService Meter Nwr.,FINAL th./zD ,.
<br />Notes, Remarks, Etc.7
<br />(rt\NEL BI ,lrtiR Dl:1,( aRAT(,\
<br />t hcrcty atlirh und., pcnahy ol !.rFry rh,r I m crcnrp( rbm lh. ConrBc(,6 LiicnE Lnw nn rh. ,dlldrr,! !21).lS& 70.11 5 r
<br />Bunncsc dnd Pnncsion Co,ic): A6y Ciry or Counly whiuh drut.( I ltmil ro q'n{rucr, ilrcr' iflrl'rovc, dc'nx.$ I rqat anv ,
<br />sruclur., prM b ns tsuincc. also rcquncs lhc a,,pln.nt tnr su.h F.mir lo rilc I r+rc.1 n.tcmnt ihrr L or shc ir li..ns.{ llnudtr ,
<br />ro rlrc nrcvtrio.! of r ConrE.loas Li{.nsd tl* (Chrrrcr 9. Conockin8 P(h Salidn 7Ix}0 ol Divniotr.l of$c Buisqss uJ
<br />PnncssDns codc) or rhil heorrh. " crcm/ ihe!.liom an,l rhe briir rDr (hc dlcscdcrcmplDn Anv vnnrlnrn or scrbn l0-11.5 tvafl,
<br />dltlicad fur ! I'cmi lul,jeB lh. amlicanl ro a tivil pcnxli y or not nnrc lhrn i,c hundrcJ dolhr (S5&)
<br />-1,
<br />r\ own rotlhc pmpeny,,n ny cnPkrytcs with w(8cs r\ rh.tr vrc .ompcnsaiion. wiI.lo rh. M{k m'l rh. {uluc is rt'
<br />mcMcd o! o,icrc,l tur saL ( 5*.7044. Busines {nd Pn'r.$ons C(tlc 'th. Conkd(tr s Li.ctrs Llw 'l.d\ nol {Pl} r' an owkr or
<br />rlE l!)pc.ry who buddx or ml,nlv$ rhcE)n. .nJ who dcs such vr* hmr.ll o, lrcr$ll .r lhmugh hr or hcr ou cdploy..(.
<br />On,v .d rhil su.h inpnrrcnf,Nr m ndr ill.dcd oro[.rG] rbrsalc.ll, howcvD.. rh. huilalina d imPNvcEnr is eld wnhinonc ]sr
<br />of con{hi$n. lhc Owncr B lkr wil hnt th.ltrrlcn 01pn)ving rld h.orsh.d! nor hu Jornif trc rlr lx)trny htr rtr purrxE ol
<br />yl..s.*tr(,)trhcnmrny. rhcrclu\irlyco raols wirh
<br />lnrl Pn,l.\\r'nCodc: Ihc C.nkrntr'r Lrcnsc LN o$nor
<br />lkrnsc'l .onkrdo6 ro co,r(n,.i ilt rioj.( lSc..71!,14. BNinrss
<br />r) rn.wncr o, pnr:nywh hurllr or lnlnvc! rh.rc.n,
<br />and wr$ coordrk for sBh lrojccls wilh a co rdo(3)
<br />I am ci.hfl utoicr S€ction-, B.I
<br />I hcmby dfird utrdcr I'cnalry olp.4ury oN olrhc tulbwire cclmri(,s:
<br />I lDvc rd willmrrain r Ccni6carc oi Ci,n*nr o scltlnsurc l wotkcis' ompcnsition. f,\ 0tuvid.d lorhvS.crn,n.l7(x)o, thc
<br />tlhor Codc. litr lh. pcnomnc. oI rhc wo* for which rhc Nm,t s tslcn
<br />lhrvc x wnlmNrm *o!k.rr ronf.nsalon nsurnntc. sr rcqum,lhySccri.n.lT(DotrltLib.r(rl..lrtrrhcJ"r16nnrn'col
<br />rh. work n, which this pcmir is hsu.d. My sorkcrs .oryinsa(n nsura cc .id.r rnd Flry nnmhcr m:
<br />".,,,4,-", _
<br />!4lccdrlirltll inrhcpdrffnranccollhc *ork tur whEh lhs ncrmrt i\ tru.d.l slullnor ctupklvanvl.ron in rnv mn'cr
<br />$ $ k' Irroft sutjel ro rh. Mrk n'or{EDsation hws oI carlfonria. .n'l asd rh,l il I lh)ulJ h(om stbFrl ft' rtE
<br />workcs' conpcneti,r ptuvtrons of S(rion .1700 of rhc trbor Clrle. I stull tudhwilh .ooply wirh dDs I'nvEi'ns
<br />IVARNIN(i, Iiaiturc io {.u( w(trk.ri ..n{tn\.rirn .ovcE3.
<br />.n'l 6nc\ rp ro on. hundr.'l rhou\rnd dollrr ($lUl.lIlO. rn
<br />S(rR'n:1076otrhc tihtr Ctdd. imcrc( r attnrcy\acc\
<br />"fl*,,
<br />uh
<br />ki!.r k' di,nDrl Ftrrlr.\ Md
<br />dmr!.r as p()!L'i.!l Li rhc
<br />DECLARATION
<br />I h.rchy lirmund$r.n,llyolpcrjuryltar I rn lien{d u JerF,rnn,nol (
<br />D.l€:- conlm.lo
<br />CONSTRUCTION LENDINC AGENC1
<br />I hcriry .liirn ond.r Fnllly ot Pcrjury fiar tb.e i1 r on(ru.lion Lndre ascrcv for rh. p.rrornErr ol rhc mrk tn! which rht pmir is
<br />(su.d (Scc. .lS)7, Civ C ).
<br />APPLICANT DECLARATION
<br />I lteby rnm u nds !.nalry .f ,.tjuty o* of thc follosi,s d.cl*.1tuns:
<br />Dcmlii!'nl.,mreArh.{o' Ndrlh'd!run tRlcnl RcsulllFn\ (Tnlc 4. Pd6r
<br />Re(utr,dt llcroiN.rilMrrn
<br />Iyrh{lrh.ltd.lrlrdguldli{[\ rc3r,lin3 r!b.do\ cnr,vrl rlc norrPllrdhlc n, rhi\ Pniccr
<br />Vucfli,y rl'd I h.l. rc.d rhn.r,pliariun coqcrr I rsre ro..mnly w IillCil,indCounry
<br />oilnrn.e\ and Srar. Lrws rl{roe n) huild,
<br />llh vc nrDrrnrd ptuIf,nyntr
<br />/LADDli.utor AscnlSixn{lu
<br />Transformers
<br />I((o'nnr .ng wtrhSc.rk,n 7fto)oll)rvi\n,n l
<br />ot rhc Atr$nc$ m Pnf.lsi'mr Cdlc. u ny li.cn* ir
<br />'n
<br />tull,i)rcc.ndclLc{.
<br />tf,tuicis N.nc:
<br />-
<br />Iutrtl '. A'lJ'.s
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