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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under SIab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouqh
<br />Service lvleter
<br />FINAL ?/B JlcSztt , 9.)
<br />Notes, Remarks, Etc.
<br />,/zr
<br />OlVNER AUILDER DEI,CARATION
<br />I hcrchy nllirm under r.oahy ol p.rju.y rhar Imcr. pr rfl,n rhc Conti.tofi Liccns tiu rbr rht i,lk,Rins rda$n (s.r70rl5
<br />Bu\incss rll Proae\si.n C{dc) An! Ciry or CiDm! which rLrtuncs a |xirnil ro cotrslrucl- llrcr. improvc, tumlish RNn rl/
<br />sttu.ruc.rMl(,ns nsudcc. also rcqut$ Ihc Erplic{nI for su.h Fnnit Io lilca \isncd sdcrum rh hc ot shc h l iccnscd Nrsi.r
<br />ro ihe pmvnions otrtr Corki.rois l-i..n\cd ljw (Chaptcr L Conmcmirs wirh Sccrnnr ?fi]() ol Divirbn I ofrh. Businc$ ,nd
<br />Pn,fcsi.nscodc)orrhrr h.orshc is cxcnrr lhcrfrom.nd rhch.si\ lhr rhc lllescd cicnurion nyviohrhrofScclionTtrll5hynn!_
<br />ryDlicanr lor a p.nnn suhjcckrhc lnplicanr ro 0cirilpcnllryolnornrmrhM fivc hundrcddollms(S50o)
<br />-1.
<br />!\ owNr nf rhc pnrlEn y. (n flly cmll{Dles rirh tr {gcs i\ rhci v,lc con,pcneridr. sill do rlt w.lk drtE(utEt nor
<br />i'rcfllsl or.fi...d ld \slc (sc.7(I14. ausincss otrd Prof.sids codc lhc Conrrlcroir l-iccnsc Lrw docs nnr irnly ro !.owNr ol
<br />rh. rmpcny $h.hoilds o. i,qamr$ rhcE)n, d Nb d(a snch sb* hin$cll or hcts.li ot lhnueh hk u. hcr osn cmPloyc.s.
<br />pnividcil rh such nnprovcnEnrs tur mt inlcndcddofitrcd li,rsrb lt how.vt. rltrbuildiuori rmlcmnl h {rld *irhin onc ,td
<br />ol com0lcrion. rtr ONrcr Buitls *ill h!v. rhc hunicn .f rovin8 rhd hc or shc dil m! hoill or inr,rorc lhc pNpcn, ld dt pu,Tb{ of
<br />_l-0so*ncrofrhcpn'Irny.lmcrclusieclycodtr.riigqirhlicdn\cd.oridostoconsrruclrhcFrjrcr(Scc7(x4,3trqi.sr
<br />rd hlf.*sbn Codd. l hc (\nrr0.tol s Liccnsc l-tr$docs norq'plyr. uorncrolrioF- y*ho builds or nntrovcs rhcr..n.
<br />!trd who onlmcrs rbr such proJccr\ sirh a Coirracr( I li.cn*d lthumr r, rh. Contacroi\ l-iccnsc li*)
<br />;.%IS
<br />Dta( t. \R \ l()N
<br />I hcrcbyrmrmund.r Nmllyol pcrj y onc ol lh. lnlk,wins dR..l$ ion\
<br />-lhlvc!d*illmainrainaCenificlicolCon\cirros.lr.lnsurcrr,workcn'compcnsrion-!\Foridcdlorbts.dionl7u)olrhchn)r Codc- lor lhc pcrlornnncc oflhc worl tor which lhc pcrmir i\ hsu.d
<br />I hnic,trd will 'nainrair $orkfr conrFcnsart insumtrcc. trs rcquircd hy Secr ion l?(D oI rhc tihor (bdc. lot lhc Nrlonurcc oI
<br />thd uor* n shich rhhrfinir is nscd Mywork.6 LulEnsnrion i.slrrncc crdcr rkl [x,li., numbd m
<br />l.cnirythir inrhc |trtbflMnccol'lhc *qk tur *hicI rhn Fnnil h tstrcd,I nr]lnol ctl|)l.ydny Frson iD arynwrr
<br />w rsro b.com srnj.\i l,,lhc work.n conrncnsrrn,n h*\ ot Crliron,ir. md rBro rh{ ii lshouil h(onE s,bJttr r)rhc
<br />s.rlcrs.ompcnqriorpmvhions.lSccri{).:17{X)ofihcLnhnGxl..ldidll.f.nhsith.otrrlywilhll}'rF'ri\nnh.
<br />WARNIN(; Irritr () {curc workcrs coDpcn{ tD .orcf'gc is nnhsful. rdtl \hnll \ult.r ,rr c rll.ycr lo.ritninrlNnrlric\xDl
<br />civil fincc u!
<br />'o
<br />onc hundrcd lhou\rnd dollars ($l
<br />.:"<:i3i"i:
<br />I hcrchy rllirr undcr |rrilry of!.rlury rhd I am
<br />DEQAB{IION
<br />u.d.r rruvi\trlr ol Chrpr.r 9 (r,nnNmn,g *irhSrrioi 71100) ofDivi\i( l
<br />ol rhc uu\inc{.nd Prolt$ii{sC.dc, Jnd 'ny liccnsc is in tulli,rc i cii.r
<br />l,iccnsc Chs:-l,rctrsc Numhcr
<br />D.le contreclor:
<br />q]ISIATJCIIONI.ENITIN GENCI
<br />I hcrchy atfinn undcr l]ctuxyorp.rJxry rhd rhsc is i.oniru.riotr Lnding oBcmy 16r rhc po{o!.@c orrhc work tu which thn Fnni n
<br />hsucd (Scc 3097. Civ C.).
<br />AITLICANLDICIASAIA!
<br />I hcdry lmm undcr Fnllry ofti.rjury onc olrlr folhwnlg dccl.mrions:
<br />Ocrmliliotr Pcflnik-Astr(os Norificsrion Fcderll Rcplaiionr (Tnlc to, Pd6)
<br />-Rcquired
<br />Lcl rcr ol Norilicnrio.
<br />ordiM .c\rfd Sr rc I-.*s relir ildins connrudi,n,. ud hc.chyrrlhori/c rcprc\ctrrx.vcs ol rhis('iryMd Counryio. isuBrdr
<br />rlxrc trf, rtrntcJ p'olt v tnr
<br />,\pplirntor
<br />^xrnl
<br />SiAn lu " -'Y'J519
<br />I
<br />III
<br />APPROVALS
<br />Translormers
<br />Policy Nutrrbc.-Exptes:
<br />-
<br />k.Jd { Nrm
<br />-
<br />I.dtiliihar ttr fcdc$I rc8ulal ions rcg{dins a\hcnos rcnn,vd 0a nol ap iohk t, lhn pmjet.
<br />-!
<br />ccnily rhlt I lmlc rcud lhis applhrn,n ! i srllc lhs' rhc ,h)vc inli,rmri( is .orol I r81a lo .otrdy wnh aU Cir, and G,xnry
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