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ELECTHICAL.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILOER DELCARATION
<br />I ncrchy aflnn undcr Fn.lly of Frjury lhll I aflr excmpl lmrn lhc Co rlclors l-iccns tnw t r lhc following re*o (sN 70.ll.s
<br />Businc$ .rd lrofcsiotr Conc): A.y Ciry or Counr, which requnc\ ! pcnnn ro c.idtucr. rkd, impiovc. d.nnnish or rcpnn any
<br />nrucbrc. I'itr b ns issuarc.. aho nlunes rh. ,pplaor f(r ruch I*m ro lilc a siSEd {aEnE thd nc or shc h liccn\.d puruon!
<br />r. rhc provtionr otrhc ContEctoir Li...Ed Llw (Cndprcr 9. Conrocncin8 wirh s..(ion 7flx) ol Division 3 olthc Businc$.nd
<br />Por.si..s Codc) or rhit hcorqh. is cxcmpr rl[rcrmn,M rhchasi{ lor rhc rllcecd cxcDtrion. Any violalionofSccrionT0.ll5 h, lny
<br />aptlicont for0 pcnnit subjcckrhc itplicrnt lo 0civilpc.rltroinot nFrcrhin five hundre]ddollatr (S5t()).
<br />l. rs .wn.r or rhe pmFdy. oi ny edpluyr.\ wnh *agcs ai rhct {L .o,nl).nerioi, will do rrE wort dd E (Muc t rn
<br />ink o.l orolIcrcd for slc (Ss.7(}14. Busincsrnd Profc$tuns Codc:1hc Contracnn !l-icensc Llwdoc\nor,rplyro,nowmror
<br />rhcpn,pcny who bnilds or tnf(,rcs rh.Ni. did who &rs soch *ork hi'nscll.r he^clfor rhouEh his or hcr oan cmployccs.
<br />providcd rhlr such inlllmrcnEnt m rer inrcajcd ofcrcd lorsb ll howrcr. rhc hilding or iq,mwr iss,kl*irhinn c rJr
<br />of(nphlion. tlE o$'mr aui}lc will h!( Ih. budcn oflbvire rh,l tE or shc dil ml $uild or iq,m\! rhc rmFn, for rh. rr4sr.r
<br />-1.
<br />!sosnerolrlElopcrry. lnrcxclusivclycodricrins sirh liccnscd conrrucn,n t, con{'acr rh.rn,ic.r (sN 71r14,lrurtrc$
<br />anl Pisltssior C.dc Th.G)ntrcktr sLi.ctrsc Law docs nor lprlyro rnown r ol troltciirwho truilds nr imtrorc\ lhcreoo.
<br />and *ho conlrds lor such,,oj.!h wirh ! Co.lracro(9liccnrcd puruanr ro rh. ConrlrrDis Lkrn* lir)
<br />lrmcrcnDr und.rSc.rio
<br />tQaxE&strQuf[NsartQB
<br />DICIAaAIIOA
<br />I hcrcbradt undcrl)crrllyolpc4uryonc.lrhclnllowir8d(lnrarnnN
<br />-lhivc.nlqillmi
<br />ain a Ccdiararc ofconrnl lo Scll.lnsurc for worksi comncnsalioo. as lovidcd a.r bysc.'i( '17ft)orrl.trtrtr Codc. for rhc !.rformr. ol rhc work for which rh. dmn is isiucd.
<br />-lhrvclndwillnrainrairworkcr'conrIlnsarioninsuroncc-$rcqutcdhySccrion.lT(noflhct-*nrcod..turrhclrcrloirnimc.irhe $nrk nr$hi.hrhi\pc ir is i$uNl Myworkcrs .onfcnsarion i'ruran cricr aririni.y ix rtur rc:
<br />I ccdify rh r in rhc lcrLir:rn.c olrhc *ork nr *hrh rhi\ rdnir is i\{rcd. I sIill nor cmnloy rtry pcron in ]ny nBtrncr
<br />q, !s ro bcn,nE sul]jecllo rhc *orkc6 conD.n\llion L,e\ol Crlifon,ir. {nllgncrhtrr il I \hould hc.onf, \uhlc.r ro rhc
<br />rorkcn c.rlpctrs0rbn nmvnbns olScdion:lTO0oirhe Lrh, Codc.lshnl tunhwirh conr/y *irh rhosc tiovisions.
<br />WAnNNC rdlun t, sur. sork.N .oiD.n{rion $v.ra!c is unl.$tu|. rtrd shnll suhjE' .n cmplorr lo siminll Fmhts Md
<br />cNil iltr.s u! b .fu hxndrM rh.usrnd dolla^ {S100.(XX}), nr
<br />Suclotr 3076 ofrhc lnhrr Codd. i crcnindrnorncy s Lcs
<br />lhcr.by rlltnundcr pcnrlryofnrrjtrry rhrr lrm lic.n{d un,lcr \(trrrlfl t)idqi1ontr ctr(tr!\rhSc.li( r(rxr),,1l)\i\i(r, \
<br />oi rnc Busircssnnd Polt$ionsCodc. sd nrylicctrs is ir iulllbrcc ina cllirl
<br />i\\Ed (Scc 1097. Civ C.l
<br />d!ILICANIDECLABAUq!
<br />I hf,$y nrnn undcr pcnally orpcrjuryonc.frh. blnrwins d.clcolions
<br />Dcnn'lirnnr Pcrnrir*Asb.eos Norificrriotr Fcdcr.l R.Strhridrs (Tnb 40. P.n6)
<br />Rcquncd htrv.lNotifi.ntiur
<br />l.cnifyrhdlh'vcN rhn rfDlr.trotr.trd slarc lhd rhrrh)yc ifnrn ioniscod.cr l0erccr.mnrplywirhlllCiryudCotrniy
<br />odrnuNcs and Stlrc tiws Elatir8 to l,u hcrcby 0ulhtrir Eprcscnlarivcs oalhh Cny lnd Counry t, cni.r u,in rrr
<br />,hvc rmnrioNd ,mFny for iri
<br />Applirx r Aqrnl SiBmrur\
<br />l'e 'ilm nnmerpn r:+ ,1
<br />X'
<br />W1^'!koy^
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Bualding
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soffit Bouoh
<br />Ceilings (T-Bar Bough)
<br />Ivleter Release
<br />Rough fl\tlr( ',hlttt€ tt-t v,
<br />Service IVleter tt I 0
<br />FINAL ///q//*Oyot*/a-
<br />Notes, Remarks, Etc
<br />Sub-Panels
<br />l-ir!n{ Ch\s
<br />L.trd4 \ \ddrc!\
<br />!.cniiyrhd (hc riicrrltuguLri{,n\ rc!rdinE x\hc{o\ Enx,vrl i.o nor ilplicrhlc t, rhn fnijrcr
<br />I
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