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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS O,tvNEN AUII,DER DEI,CARATION
<br />I hcrcby ,mih u6Jcr pcmlry or pcrjury rhar I d crcnur frcn rhc Conr,acnra l-iccn* l,* ror rh. r.lbuing rcis.n (5(.7011 5
<br />Busincss lnd Ploic$ion Codc) Any Cily or Counly *hi.h tquifts a Frmir kr on{rucr. all.r. nnrovc. dcnnhh o' rcnan lny
<br />{ructurc. prior ro irs tsuon.c- aho rcqunes rhc lpnliconr f{n such lrrmi h nb ! si-qncd srarcmnr rh{r tc or she c li.cnrd Nruanr
<br />lo lhe lmvisnrns ol th€ ConlEclols Liccn*d t p (Ch0prcr 9. ComcminS wilh Scdion 7uD or Divtion I ofrtE Br\incss and
<br />Pma.*bis C.dc) or rhlt hcorshc ncx.nrpr rhcrclromuRlrlrc h€sh rbrrhcullc-qcd cicqrnrn. Any violurioiorS..lionT0ll5 by rny
<br />aptlicrnr lor a rcrmn subicchlh. trptlic0trrlo.civilp.n,lryoru,mr.rh nv. hn.drcddolltrs ($50o)
<br />L as owmr of rh. rn,Ieny. or nt c'tployccs wnh wa8cs !s lhcn sob cofipcnslrion. *ill do rh. *orl 8xl rlt nrudm s tur
<br />i,rlcM.t or .tfcrud roi eh (S(.?04-{, Businc$ ,nd Ptuf.ssn,n\ Colr: Thd G irduis l-i.cn* Law de* ior altly to an nNncr ol
<br />rhc propcny wh hrilds or improlc\ lhsorn. md who docs skh wort hims.lior hcnclfor rhmu8h his or hcr o*n cmnl(,yccs,
<br />lmv cd rh, slch impmvcftft m nor inrc Lrl or olttBl r'or eL lli h.qcv.r. rhc huilling or irtnwnEnr is rkl sirhin om )td
<br />.t..'npLri.n, rhc Ower lluildcr *illhnt rhc htdcn oi poving lhd lE or shc did mt buill o! irrpovc rhc pmpcny for rhe purIIM of
<br />Lr\owidorrhcnmpcny. mcr.h\ntlycoikrcrins sirh lic.n\cd cotuartr\ ni coiiru.r rh. pi(,jc.r lSe 7(}l,l, Btr\ir'c$
<br />rfrl l\ntcs\irtr Codc: Thc Contrcrois Li.cnsc Lr! docs nor ntfly k, M otrn.r ol proltdy uho huilds or nnprolcs rhcr.on.
<br />rnd qho co tucrs fr su.h tnq&( tr irh a (i,nrEctn(s) liccnsctl Frsur n'rh.Gnnrncror'sl-ir.d\cl-rw)
<br />I mrcxcml und$ Scrion
<br />.UOB6EBAIIEITENSAII!]!
<br />DICI.ANAIIo!
<br />I hcruby 0irrirn und.r pcnallyorperiuryonc ofthc followiff d..karions:
<br />ln!v.lndwillmainrain!CcninclrcolConscnlroSclilnsurcLrworlcnonpcnslrion.rsrovidrdtnbysccrion.lT0oorrhc
<br />ljlxtr Codc.lor Ihc Frfnmncc ol rhc uork io.{hich tlE pcnnir i\ hslcd.
<br />I hnv.and will nbinrri'r $orkcri roh|f,nurnnr insurrncc. n\ rcqunci b!Sc.rnin.17(x)ofrh. l]hor(idc. for rhc pcrlirnMkc ol
<br />rhc w.rk firrhichihi\ pcrtoir i\ i$ucd. Myworkcrr con,Fn\rrion i'xurrncccr sddB,licyixmhfirr
<br />.,",",, - Mt .t *vl. Qudss sicu lrq
<br />;[*;"'",,,*"*,in rhc pcrf{rmtrtucorrhd q.rk lor *hichrhi\ Fi,nir t
<br />subEct rorhcwo cs conn ,rs.rim lrasofCnlrftrnr.
<br />nsarion prcvhions olSarion lr00 olrhc tjtsr C.dc.l
<br />i\\ucd, I shrll nor cm!h,y
<br />oftlurcc rharrll should b6om suniccr ro rhc
<br />sh,ll. lon hs'irh mmply uirh thos povnionr
<br />WARNINC Frilurc h rcurc workc*'c. rNnsrri{)n N\.rrgc i\ unhwlll. rnd sl ll strbirr tur cnll)loycr k, dirninnlpcniiics ntrd
<br />..n'l fi'.\uILti.frhutril'.Jrhu\dfrl,t,,lh,\'!'lrrfl '.'nrilltritr'iirh.xi',f.r.,F.ru
<br />":;,.''dIi,':-
<br />" ":-',SXl', k{l' tt(E1s[:pr(u\r'r,\troR'I
<br />n,n. damg.s .r pmvidcd for lhc
<br />DICIdMIIAN
<br />I hcftby nrnundfi p.n.lry or p.rjury rhal I am lic.nrd undcr F,vhio. orchnpr.r 9(.onmncnrg wilh s€rhn ?0(x)) ofDivision l
<br />oa rhc Ausnrc$ and Profesbns Cde, afll my liccr* is ir lull lbc a.d c{fcJ.
<br />g tbllq\Q
<br />ZA
<br />I:OISIBIJCIIONIEIDIIC.ACDNI;I
<br />I hcrcDy ofllrn undf Nnalryofp.lurr lh0t ihcr. n r.otrslrucri.n hMirg,gcmy lor rhc pcrlor.ronce ollhc uork tn *hich rhi\ Frmir i\
<br />AsucJ lS( .1097. Cir C I
<br />AIPIISANLI)ICIABAIION
<br />I lmhyrrfinnunder pcnalry oI lcrjur) onc ol rhc nnh*in8 dcchnrions:
<br />Dcnmlirn,n Pc nic Asbc{os Nolili.urn lcdeRl Rcsuhrions (Tirlc 40. lado
<br />R.qutrcrl Lc(crorNorifi. rnir
<br />-,
<br />arrify thlt lhc fcderal rcBuhrions ESeding $bcstos rcmval arc nor applicablc ro rhis Imr.d.
<br />\l ccnirr rhal I havc rc.d lhk appliclrion ! slarc rh.r dc rbovc inrormrion is conecr I lsB lo ompl, sirh all ciry .nd (roumy
<br />odimnccs ind Shrc tiws rclrline 'rTrrrnrc\.nrrnd!.1 rhi\ CiLy,'nJ Counr!ki rtrrrr trtx,trrlr
<br />.bvc trrnri( .dln,l.nyf.rin
<br />,\pplittrnl o.,lxcnl Sirntrl
<br />lat1rtl,.kt
<br />t/anlrr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lafe Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It4eler Release
<br />Rough 1/tl I t q) 49t
<br />Service lr/eter
<br />FINAL 1/lrrls sNrv
<br />Notes, Remarks, Etc
<br />Under Slab i Floor
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