|
ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lVleter Release
<br />tl
<br />Rough (/zart ,r*'tt
<br />FINAL I
<br />Notes, Remarks, Etc T_
<br />OWNER BUILDER DELCARATION
<br />I hcrchy 0fl_rm under I].nalr, {,r pcrjury rhar I !m ercmfl frcm rhc Currrb^ Li..nsc Liw tu rh. iollowir8 rca$n lscc.loSl 5
<br />Bu\nhs an{t Protcssion CodeJ Any Cny .r C.udy *hich r.quidr d |]dnir k, o.\iflct, altcr. nnl,ovc. dr'tulth or EFt aiy
<br />stu.ruic. tEi* ro ir\ i\sunR.. also rcquncsrhcamli.inr fd su.h Fflnir to lilc a signcd st.tcmnt ltar tEor\hc ir li.cntd pD^uanr
<br />b ihc pn,vtnnN ofrhc Conkr.tr \ l-i&n\cd ljw (Ch,prcr 9, C. nmn.rn! wnh Scdion TlxxJ of Division.l of rhc ttlxines ud
<br />Profcrsn,ns Codc) o, rhd h..rsh. k crcrn thcrcliom drh.br\isli,rlhcdlcBcdcxcmplion AnyliolarionorSc.rionT0ll5bynn,
<br />rypli.ant loraI'.nnn suhjais rh. rpplic.trl to icivilr.n.hyolnol nmrclhan nvc hlndrcd dollr\ (t500)
<br />_1. $ o*rr of rhc pn,Fdr. or my .n1pk,yes sirh sar.\ rs rlrt y,lc .onpc0sr( tr :. eill do rhc work mn lhc slnErurc ii Bn
<br />imc ]cd or ofi.rcd rff $k ( SLr '7o1il. Busi,rcst Md B'ofc(sioN Cdc Tltr CoDhcrr's I iccnsc li$ docs tror rmlt r. irr .u rcr of
<br />rh.nfl)|x y who huild\ nr irFmvd\ rhirdr. xl sl[ d(.\ such w* lrlm\clt or hcr{ll or rhn'ugh hi: or hcr o*n cnfloy.c\.
<br />nrovidcd r har such jmpraKnrnh rc nor i crtlcd or olIcR{ f{n wl{ Il li)acwi ih. lflildiu or n\rovcmnr is wld $irhin , nr )sr
<br />ofdinpkrFn, tlr Owncr Buil.Jd *ill haE rhc l$dcn ofprcvm8 th.l hc or \hc dil trol ttriklor impr.lc rhr pmFny iir rtE Ptrlr.{of
<br />-1.
<br />$ oNEr ofrhc Itl)pcny. !dcxclusntly conrrucrinr wirh li.ctr*d cont..ttr\ ro..trid.r rtE pmrd (Sec. r(}1,1. Bu$c$
<br />uil ftofcsi,nCodd:-l'hcG,ntactn s Liccnsc Lrw d.cs n l rl,plytu ar owncr of prorcrry who blildsor impoh{lhricon,
<br />rtrd who contBcf r'or slch prcj.rts siri ! Conrrdcro(s) licetrscd rluFoanr rorh.
<br />-l
<br />umcxcmfr undc, Scdi->o-U o*n..
<br />I h.d,y illirtrrnn(l.r N lry ol |['j f oN olrhc 1,,11,,wi,,!
<br />-l
<br />lrvc el wi,l ruinrBh ! Ccnificde of C.Ncnr h S.lflNrrc tu {orkda .onDcnsnliotr. !r 0rovnbd lor h} sccrion .1701) oi rhc
<br />tibor Codc. for lhc pcrformncc oI lhc *olt lhr which rhc pc,n l n iNucd.
<br />IhdvcandwilliDinrninwor*cH.ompcnsat,oninsurimc.asrcquircdhyScction37(I)ofIheLahorG)dc.furlsPrloiimncol
<br />rh. work fttr which rht p.mil is nsu.d My vorlcd .onrpcneriofl i,Numncc cnEicr ad policy nlahcr Ec
<br />_l ccnilythlr in rhc Frlorroncc of rhe wnrl for *hichrni\ permn i irsucd,l dru.or cnrrloyonyrcnon in lnynunMr
<br />$ a\ b r*om slbiccr b rhc wtr*c $mpcnslion lr*s olc{lilornir. and a8rce rh ifl should bc.o'ft subjrd rotlE
<br />*.dc* L\,n .nsnrt,n Imvisiois ol sedion l7m .l lh. knlr Codc, l shull- foah*irh co'nply sirh rh){ nmvhons.
<br />WARNING |rinrc b {cnrc *orkcri r.n,Fnsxrion cokrsc i\ ttr rwlu sh,lt subt{ an cnrloycr x, siminaln Nlrics snJ
<br />ciril lin.\ up b.nc hun r.d rlbr\r dollnr\ ($l(X).(xX)). in l'(ldil conDc.srrion. d Mgcs x\ pruvidcd ln' ihc
<br />Sc.rion 1076 olrhr Lrhn(odc. i crc{r d rtr.nrt'
<br />,".7 -)4 -{L
<br />I hcrbyatirnrrndcrpdnrlryofFrjuryrhnr I Mrli..ns{ undcr F,vi\n or 9(coflnmrcinA *ilI S.crion TlxX)rdlDivi\n :]
<br />ol rhc llusirEsslnd tto lassio n s Codc- dl n,y liccn\c is in lnll iiftr and .lT&i
<br />_Lke.s. Numb.r:
<br />SONiIBIJI:IIONI.DIDINCACENI.I
<br />I hcrcbynlfirm unds penallyoipcrjuy rhrr rherc is ! coniocrn,n bndin!.8ci.y lnt rh. rcrfoirm.cc oflhe work Lr shi.h rhh Frnrir il
<br />issucd(S( 1097.Civ. C )
<br />APILIqANLIECI,IBAI]OX
<br />I Mlt affim u*Lr n mh y or p.rjnry on. or lhc lollo*ing {h.lmrions:
<br />Dcmlirion Pcrmik.AslEsros Notification Fcdcdl Re-qlhtions (Tirlc 40. Pdn6)
<br />-R.quircd
<br />t rrcr ol Nolirr.lion
<br />Icc'lilyrhrrrhelidcrrlrcEUhri,,n\rgmln,ErhLnosrn^lrrnorlll)tl'.d,lct)rhisplrl..r
<br />I r. ilirhrr lhrvd rud rhirnfDlirri(r d {rrc
<br />odinrtr.e1!nd Srarc l:t*sr.t in8 h huildi',gcon{tu
<br />vr iniflndnnr i\corrccl IiBGx'con'flyIirhrllCiryMdC.unty
<br />rurhorizrftprcrnhrilcrofrhisCiiyan'lCounirbc crr1l rh.
<br />ali)v. rNnrioncil lropcny lilr inrpc.r
<br />,\ ppliont or ,\a€tr1 sianll ure
<br />5Maea,<.v ,",.7'lo'1b
<br />ITflfiAdEfiI
<br />APPROVALS
<br />Communications Cable
<br />Service lvleter
<br />,ar?
<br />EA t=t\--t=z
<br />T
<br />I
<br />I
<br />i-
|