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ELECTRICAL-INSPECTOR RECORD
<br />()*G'Bu,lds Ddlmnoo
<br />I ns.by .flirm und6 p.tr Iy of pd,ry d{r I e a.mpl forn rh. Cmhdo^ Lieo& lr* fd t}l lollo*ins..u (E Tor l 5 Au!83
<br />ud Prordio. Cod.) 4,, C'ty o, Cou y eh'ch r.quirq. Fmn b @Ertuo, dlq. irFM. d.mliln d r.Plr uy rtu<r@, pnor ro Bitrla, rlF r.qurd rh..ppli t aor $.I pqDit @ lil. r *..n Grdrd th{ h. or d. r lic6..d p{,od ro dE poviros ofr!.
<br />( onll.cblt Lic..rd Lr* (Ch.pr6 9, CM.Ein8 enh Sdio.,0m of D'vdo. , oatn. Bum.$ ud pmfdiou Cod.) q rhr lE d
<br />sh. ir d.mfl tlEr.6oo .,'d 6. t.ln for E nl.3d a.mprion Ary yiollion ofscson 7oi I 5 by uy rp?lid lor . Ftu objdr rlF
<br />+pli...r ro.civil p.n lryo,d mr.thefiv. hMdi.d d6llr! (t50o)
<br />I, s ow oath. p6pqry, or my.aploy.B w h qs6 E lh.r rcl.onFuriol\ will do rlE wdl &d rlE rhde 13 nor i @d.d
<br />or olId.d for r.l. ( Sc 7o4a. Bur.or .d Proa.!.Er Cod. TIE Conrdd., Liar L.* de, nor +ply ro u ow ol th. pDpdq
<br />who bDild! or hp.ovc. tha.o'\ rd who d6 a.I *o.t hrE*lf d hd-tf or rlvouSh hr o, hs om .hploycr p.ovid.d lhd rrl
<br />improv.m.nr. u. d int.nd.d d ofrq.d as d. la, no*ffi,tn.build'.s orihp.ov.fr. 8 eld wirhir oE yd of@mpldioq rtr
<br />OlE-Build.r *iU h.v. !n brrd.. of prd'.8 rhri h.6r rt. nd buird or hDrov! ror lh. purpor or st )
<br />I, a omq or lfi. prcpdy, .m .rcllsiv.ly co.k.dins *irh I'...*d sr&rm ro @drM rh. Eojd ( sd 704.1. Bulnq! !d
<br />Prcr..lon Cdrl. Ttc Conurdor'! l-ienE Irs dc Br +ply ro u ow orp.opsg *ho b{ildr d mprov.r rha6n , &d who
<br />@nrrB for sl' prciek witi. Cotrhcro(r lic6*d 0{6umr to (h. conk.dof! LienE llr )
<br />_l s d.mpt und6 Sdion
<br />\TOR(ERS COMPENSATION DECI-AR TION
<br />I hd.6y rfllrhundd p.Mhy of p.r,ury 6.. of 0E lollo*r.s dclrrioE
<br />I hrv. !d *ill midin. Cstifiqt of C(Ed b Sda l@r. lor wtdr' @sp.dlro,\ t. p,ovid.d ad by Sdir 3rm oldr
<br />L.bo Cod.. ad tlE pdfm@ oath. @r lor *hict th. pamn ir re.d
<br />I h.!c ud w'll nldn, workas' @np.ution i!$rrm, ! raluir.d by s.did r7m or thc ubor Cod., ror !h. p.forunc. oa.h.
<br />*o for lhi.hlh'tpmi i!,e.d My *orlst @mF.oion i.tur@ ffid.d p.licy.umbn r.
<br />Poli.y Nurbs
<br />('l1lB Elio E d rci b. @mDld.d rfrh. p.rmn i! fo, On. hutylr.d dollu (tlool or k!,
<br />- -l cdify th, D tn Fforltlle of rlr sqt lq lhth rhir F6n n is.d, I
<br />be.m. &bjc. lo tlE 6rrdr ' @mFddin L*! of C.liao,nir Dd .grc rlr
<br />.Eployey p.r$n r. &y muns 5 ab:wri tTmorilEl,bor Codq I ih.ll, fonnwnh
<br />lf ARIIING Fr,lurc lo ,@r. wl6 @6p.MDn c6varg. u .*ful, sd rh.llsbrar t.mploys ro siom.l p.ndri6.,!d civil
<br />finq !p to oE tu t.d t!d{.d ilolbt (t loo,ooo).in rddnion ro rh. cd of @n ..qrioa drm86 . proviird td 0. Sdir ,0'16 of
<br />dE l.bd Cod., idslr .rd rnanEr'r fa
<br />l,( uNst-D( osDa,t( to8s trtj(1,,\RAtl()\
<br />I h.r.5y tmrm !ad.r p.nrlry of p..,ury rhrt I e l@nr.d ullls provirion ofchrpE 9 s wiln Scriotr 70oO) oarrivirio! 3 ot
<br />!h.Autin.sud Proa.sioE cod., &a hy lieB n in tull ao.e bd.fid'>#,t
<br />I is6y .llirn ui& F{Iy of F,llry dn 0E n. @ ltudd ladila ls.*y fu th. Ffoffi of $o wt fd *ti.h rni Frir i.
<br />iuld (Se roe?. Civ C)
<br />APPI !CINT'S Df CI,AITATION
<br />D.mliion Pmiu- A!b..ro! Nodfidton F.dEn R.3d.!@ (Tnb ao, P.n 6)
<br />R.quicd t,cl6 of Ndi6arim
<br />_l calify tld .h. ltta, Eg .riou r.srdr$ llb. or r.mov.l r. .ot +ploblc i6 t ir prorel
<br />I ccnit $.r I hr!. dd rhir +plictrion ud tur..bo!t rifo.nl'on t cmcd I .3re b mply s.h tll Cny !i Comty
<br />udrn.n.6 md S& Lrwr ,.l.rnS lo Llrdinn
<br />rbov. 6..ton.d p.opcny
<br />A0plrqd s.jal aa _
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />F)W Dy '0€p 1/il/ 6.=ffis'fu "/--b) )
<br />Notes, Remaiks, Etc.r( \/IV
<br />M\WPs1\Porhrt lnsF.ts F ms\E r6dner-rnsp€dlon
<br />P..nnr* dm (prinr) _
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