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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Bouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rouqh -/f '/E J/ttl .€D
<br />Service lvleter
<br />FINAL 7- t4 - /tt Jlell o(-y,t)
<br />Notes, Remarks, Etc
<br />OIVNA|r BU!LDTR DEI-CARATIoN
<br />I hcrrby rrfiln u d.r nc.dlry .r p.ijuiy rhd I N cxcmrr ri.m rh. Conrn.r,s' Liccnsc Law r',,r lhc nnbwir8 c8$n lS( 70.11 5
<br />Bulir.ss Pn)f..sioi Coic) Atry Ciry or Counry whi(h rcquir.s n lcnnit lo connrucr. alrcr. tn!iov.. ,icrmli\h ' r,rn J y
<br />srrucrurc. pritrh ils h\u,ncc, rho rcquircsrhc alrpli.anr li). such p.r.rir h filc r si8md {.rcNnr Ihrr lEor shc h liccn{d purumr
<br />to thc DrolhioDs of rhc Conrrrxr\ l,iccnscd liw (Chalrcr 9. Commnci.s sirh secrion 7fiI) or Divisnr. 1 ol rlc ausirc$ lrd
<br />P!,tessioni Cod.) or rh.r h.orsbc i\ crcmrr rhcrcfirm Md rhe h^h for rh.nlklcdcrcmptn,n Any vi(,hridrofSccti'n?O.ll.5 byrn,
<br />!!plirrnrr(nrp{rnnsuhj(l\rhc,tpli.anirda.ivilF.nakyolrxnmftih,nlivchutrdrcddollsrs(S5(x)).
<br />I. ,s owk-r .l fic pmFnr. or nry emDloles wnh Rtr8cs ,s rh,ir k'lc mmpensaiion. *ill nn rh. wrk !d rhc {fmrc i\ nor
<br />inlcticd or oilcrcd l'or sulc (56 ?044, Busi.c*,nd Prd'csi{'ns C('d. Thc Contn d s Liccne tie docs.ol apply r. an o*mrof
<br />rh. tmlany sk)hrildsor i,q'mrcs rhcNn. lnd rho d@ssuchwrkinnsctforhc^clforrhn,trBh ht or hcr own cn{'kryccs.
<br />ptuvidc rh soch in9rcv.mds d mr inrc cd orollcErl for \nL ll tnscrcr. rhchiuin! or i'r{mvcftnr;$h {nhinonc$t
<br />olc\'nrlrlcrion. thc O*nq Blikkr will hrvc rhc hurdcn of Foliig rhd h. or rl[ did mr build or imlmvc rhc fmtcnr ror rhc plrFr ol
<br />_l- as osmr oI rhc pn,rcny, adcr.lu\ivclr.onta.ring sih liccnscd.onka.ttrsrostr{nr.r lhc flojLrr (Scc ?0,14. Bdiih-\\
<br />rl Pir)f6si,n codc Thc conlrmktr s t.iccnsc tjw docs nol .mly l. an oqncr ot Fopcrl y sho brild{ o. imlrolcs rhcrcon,
<br />rnd sho m racrstorslch pmjcds wirh a Conrrncro(s) licenscd phumr rorhccont,.rn's Li.cnsc t w).
<br />I amcxcmnr undcr Se.r
<br />I h.vc flrl will rMinldn n Ccniararc oi Cons"llo Sclfi trsulc for $orkcn coryrcner ion. rs p.ridcd for by s.dion ]?m ot rhc
<br />trhi, Corlc. for rhc FrfornDn.c .f rh. Nork for whkh lh. p$nrir ir issucd
<br />lh.!c und willr.nrilir so crs'conpcnsorion insurumc. or rcquircdl'ySccrion.lTmofrhc Lah.rGdc. for rhc pnfoinum. ol
<br />thc sork lorwhi.hlhN Feirnit rs hsucd. M! worlcN' comrEnsur ion insurun(c rtrtricr d'd Fni.y nun'h.r m:
<br />cmkr
<br />-
<br />PolicyNunrbcrJrptcs
<br />-l
<br />ccnilyrtlr in rhcFrtorroncc orrh. eo ftnwhichrhtFlmir is i\sDdd.I chrlt nor .'nploy ony Frsotr inanymanncr
<br />y,nsfuh.ontsuhjc.rr,rh.*ortcraconncnlario.h*rorcdlirffii4a,ENrnarifIshouldhccomsobidhrh
<br />wdik$i .dnr.nsdnr !ftrvisions ol Sction l?otl ol rhc hthr C.dc. I slmll. lonhsilh omply w ith iho{ pd*ioN .
<br />NARNIN(i lirilrc b rctr'c *orkt^ .o 'rc.ivil lnr\ uI b o'k hDtrdrcd rh.tr\and doll$s
<br />n .a,vcrrgc i! udlnwtuL and rhall suhjcr a. emplorcr t, oiminal p.Hhic aid
<br />.o{ ol ..f,|.r\ni,,,. drn go\ r\ pn,ridcd lnr rhc
<br />:"::w,4il::
<br />l)h( 1,,\k,\ I ll r\
<br />I hcrchy rlfinnl(lcr pcn.lry o I pcrjury I am lic.nrd undcr pmvnion or chaprcr 9 ( commn. inS wirh s.trn r Tfiro) or Division .l
<br />oa rhc Busi'rcs rM ProfcsionsCodc. ad flryliccnr is itr tu|lforcc i cr'llcl
<br />C -,O zt Eqg
<br />8/t,/k
<br />I hcrchy oifirm undcr lcnrlty of perJury lhar
<br />n\ucd (Scc 1097. Ci!. C.).
<br />srtucrion kndinsas.frynn rhcp.rronun.c ofthc sort lor which lhis tcmir t
<br />Arg.rcANAD[qJAAIlO!
<br />I lLEtry afilnr undcr rcnnlty olFrjury onc ollhc foUowin8 dehrarions:
<br />DcBrniofl Pcrnirs Ashgror NoinErion Fcdcrol Rc8ulario.r llirL 40. Pd6)
<br />-RcqoiEd
<br />l.{d ot l'Llilidlhn
<br />l.cr'llh0t rh.l.d.nl meul0rrn\ Reanl'nE 0\bcqroq rcmvJlarc n.'.mlkal'h rn rhtr nmJe.r
<br />',..\r,,,/**.r*-rarlr'rnn,rldnsr.rhrrrh.sb.vcinror@rionir.ofu.lssrcrocomplyuithallcityaidcounry
<br />,tri
<br />IIr
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<br />tvoaf,!&5:lrDtfl,Nta.Il0N
<br />lECr.AndDQN
<br />I hcrcby!lri nun spcnrllyoll,crjuryoncofrh.lnlk,winedcchruiions:
<br />7V',4
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