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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS IDiSIG.COMMENTS
<br />Site-Work
<br />Under ground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />LiIe Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor lt
<br />Bonding / Groundinq / UFER (m*ll.?erM-/5-)
<br />Transformers
<br />Torqueing
<br />Sub-Panels '*tln 6lruq*-1 7D--/
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service lVeter I
<br />FINAL I .hll/&'6rYhfh-It)-,
<br />Notes, Remarks, Etc.t
<br />oWNER BUII,I}ER DEI,CARAl'ION
<br />I hcrdhy Dflr uidcrp.MltyotFriuryrharI..x.mprrnnrhcCorka.ros'Li.cn$L1w&trlhclolbwinsrer\rn(sr.7o:ll5
<br />Ausirc\\ ,trd Profcssion C.dc): Any Ciry ot Coutrry whi.h rLluirc( r IEflril rn con\rrucl. !hcr. imp.ovc. d.nrli(h ,n q'rn Jny
<br />nru.xrc. priorro ih issurncc. lko rcquncs rhc applicinl forsuci pclmir ro til. r \i!n d inr.ornr rh ltror shc n licctr\cd ltuFurtrl
<br />n, rhc pri,visions of rht Cunka.k s l-i.cn*d Liw lchaprcr 9. Conncmn,! sirh Scclion,lX[ o, Divisn,n:] dfrhc Bu\ntt\lrnd
<br />Pnnt$ion\ Cod.)or rh.r Irorshc hcxcDrpl lhcr.ion rlrbusn ior rh. rllcgcd cxc'nprn,n. Anrvi,l.ri.iofs.frro.7(,.1l5hyrny
<br />applicanr nn al).rnrirstrhjcch rhc nptlicrm t, dcililpcdrhy.fnor iFrcrhro livc hutrdrcddolh6l$5OO)
<br />-1.
<br />.s owrcr of rh. 0rcFny. or m, €mrLrccs wnh s!s$ as rhcir {lc .onl).neriotr, wiu do the wotu an ltu (ui!rc n fr,
<br />i.r.ndcd or ofici.d lo. elc {Se.7{x4, Busircss and PrcLssions Codc thc Conrraclofs Licensc llN docs fr drply lo !n owrcrof
<br />lhc pmpcny who hoikls or irqrcvcs rlt@n. sJd wlb dcs skh k,rk hinNcl,or hcrclfor lhmqh hh or h.t own€mpk,y.ci,
<br />[ovidcd rharsuch infnrvcrEnts m nor inr.nd.d troilcEd lor slc. It howcvci rhc trillling or i.qmwmnt is sll wnhi,r onc rr
<br />ot complerho. rhc Owncr Builder will hik rhc burden df povins rh'rt h. or shc did d build or inwov. lhc pmpsly lhr lhc Pqsc of
<br />*1. asow,crorrhc For'.dy. nnrcrclusivclycoullacrins wilh liccnscd contucb^ t'.onnrud llf, l( jcd lsa. 7()4,1. B!!trcs
<br />,nd Pn,fsrin Codc: Thc Conracrals Liccnsc Ln* docs trol rptly to anowncr olt'nryn, who builds nr inprovcs rhcr.on.
<br />ond who o r.ch for sucl pnjccis wirh a Conrlaclo(s) licenscd punlanr ro rhc Cdnra.ttr\ LiNtr* tjs)
<br />lhlc: orn$:
<br />rvrrnxrns rtrrnius,rlrirt't
<br />DECL AAll!2!
<br />Ihcr.hy llirn, undcr |[nrlryofp.rury om ofrh. ialk,ai',! dcclJrnrnrs
<br />-l
<br />havc &idwill mrn'rair aCcnifi.arc orconscnr x, s.lr lnsurc lor eorkds ..nD.trs ion.as pmvt.i t rbys.rri.nlTmorrhc
<br />rj&trCodc. forlhc pcrlormaneof lhc wolt for wnichlfi.pcnnil is nrudd
<br />I hrvcaid will rinhnr workcrs conrr..sri.n i$umrcc. rs rcquircd tly Scclion:1700 ofrhe Lal"tr CGl., forrhc p..fo.mncc ol
<br />rhr wor* r., whi.hrhi{pomir is i\flcn. Myworkds .ompcnsi'n,n inrrflrEc conicr!'iflricy nrn,hern:
<br />-l
<br />c.nify lhar in rhc p.rnnnunce ofrhc *ork lbr whth rhi\ pcrn,ir is issucd. I shrll nor.,nPloy rny p.son in !o, 'nr.ncryi !r io lrL\,m suhi.r lo rh. M)*cn onp.trsrt,un laws of Cdif.mia. d n3Ec Ihir it I should h..o . sxhJcd ro rh.
<br />wo c^'..ncnsdrionli,,visionsofScclion1700ofrhcr:hnCtde.Idull.Ionhwirhcon!,lyoirhrho*,ftvisi.n(
<br />RNINC: Failurc lo sclrc
<br />rincs up ro onc hundrcd I
<br />l. and dmll slhjccl or cnrploycr ro (ini'Ll Ftr his r d
<br />thc.oq ofcootrrsrrnnr. drnn8cs a\ lrovi.tcd ior rhc
<br />c q
<br />I littuhy rltfln un cr p.Mlryof
<br />DICI,IIAI,ION
<br />u.dn fovnintr ofChoptcr 9 (conrnErcin! wirh Smri]h 7flDl urDivisi.n l
<br />tdsE)>|.al't t8
<br />(1)NS'l RL( 'l l(l\ l-l,lNl,lN(i ;\(ila\(l\
<br />I hcrby arfirn undcr Fn.lryofpcrjurylhal thcrc n a.on(rctiotr tndins ascnc, aor rhc Frtilmn . oalhc worr for which lhis Fmrir ir
<br />issued (s(. lo97. civ c ).
<br />AIEIICANIDEI;IdM.IIA!
<br />I hmhry nmm undcr lEnally of pcrjury onc ofrhc follo*ins dccb,alions:
<br />Ocmlnion Peflnits.Asbcstos Norificoln,n lcdcEl Rqulolions (Tillc.l0. Pan6)
<br />RL\uiEd htr$ot Notificalion
<br />rTnlic lc h rhn |n)r.cr
<br />mDply wnh all Cil, and Courly
<br />:::dqd:-
<br />DATE
<br />I nncxcnrfl undrr Scrn,n .a & P.C. forrhisrason
<br />t$
<br />ol rhe 8u\ircs\ud Pr.tc\rio'r Codc. fri n,r l.rns. is ir fullntr.. rn.lcllicr
<br />kndci.Nam'-
<br />L.ndcis Addrcss:
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