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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTSAPPROVALS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />,,tg,ib 4,r^*,og2)' Bondinq / Groundinq i UFEB
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouoh)z-G,Ivleter Release D,tb,rb
<br />Rouqh W&.,,Service lVleter ./8, t 50. 19',b ./s?24
<br />Notes, Remarks, Etc
<br />OWNER BUII,OIiR DELCARAI'ION
<br />I hcrcby rr'.tr'n u.dcr ri.nuhy ot pc.lury rhlr I am .rcmpr tom lhc Conlta.r.d Liccnsc Llw lor lhc n,bwiry rcu\on (S'c'70r1'5
<br />Busin.ss urd Pntrcssnrn Codc)r Any Ciry or cou.ry which rcqlircs . lfrn lo connruci. ,hcr. imlrovc d'nslish 'r rcI'ii onv
<br />slfl.rxrc. prhrro its hs!,ncc, &l,o rcqutcslhc applicsm roi suc[ lcrnn h 6h u sistrd slakmnr lhar tror shc h liccn*d punuanl
<br />ro rhc pr,{sn,ns or lh. Cofll.!€kn\ I-ic.ns.d tiw (Chal)lcr 9. Cofrncncir8 wirh sc.rion 7u)0 of Divhid.I oflh' Busincs ind
<br />Pror.\sions Codc)orlhar h.orshc is.xcryr lhercfmmand rhc b,sn for rlrsll.Ecd.rcnlliotr Anv!id,rio.olScdi'n?0ll'5bvrnv
<br />lPtlicanr {or a Fnir suhi.ds lhc aprlicanr to , civil Fn0lry of nor 'erc rhs rivc hlnlEd douds ( $500)
<br />I. .s owncr oI the Dmrtny, or my cnDLysc\ wirh w,gcq N rhcir $ic cotrq*n\arion, s ill d, ll* *o* and llE (trr@ k m'
<br />i' . dl or oflcrcd rnr sl. 136.?(}14. Eosinc$ dnd P$fc$iors Codc: Tht Conlnclor'r Licn\c Ldw docs .oi oltlv b M owmr ol
<br />rhcpopcd, *hot ius o. inDrcrs rnchn. nnd who des s!.n $* him\.lr or hcrcla or rhhuCh hh or hc, own
<br />'mplovccs.ptuvidcd thrt $(h nnltr amnh arc mr inrcndcd or ollcrcd tl,r sal. I I howoq rhc t{iktirE .r inlpovcr in'ldwihironcJU
<br />;f..q,lcriotr. thc (^rncr Blilld *ill hirc rhc budcn ofFovi'rB rhit hc or lic dii ft hild or invrevc rhc pRrr.ny for llE I1u{ns of
<br />-1.
<br />as.wncr or rlE pn,l,cny. am.x.lusivcly..ntmrinS wi(h licenscdconr,cMslo.onxrru.lrh. pmlccl (Scc ?o44 Busmss
<br />and Pmt6sb. O)dc: Thc C.nka.roas Li.ensc Llu de\ nor applyro an owncr or nrorcrtv who huilds or impoves rheron'
<br />and who conrn k f.r such ImJccls sirhn Conh.iinlt li.cnscd Prhutrtrr to rhc ConrEcl(' \ Lic.nsc hw)
<br />I rn cx.mplu .r S..ri(
<br />D.r.: - O{rcr.
<br />wonxrns' coNtPntirlrrol
<br />!ECI.A8AtrO!
<br />I hcreby ullirm rndcr pcnalry ofpcrjuryonc.r'h. i(nl.*ine dcclararionsr
<br />l havclnd*ill mi"r'in rCcdilic cofCon\corbsclrlnsnrclnrsqkc^.omPctrsrrion ss Pmvid.dforbvSccrionlT{n'rrh'
<br />tjb.i C.dc. ior tlr pslormncc orrhc wort lor vhich rhc plmir h isslcd
<br />Ihuvcrnd*irln,inr,inNotkcrscon,Fnrrrk insuDmc.$ rcqtr n.rl b! SGl ion :l7m ot rhc Ltho, Co& nn lhc pcrfr'ronc"r
<br />mtlctrsalion in\urrtc cMicr Md lolicy nrn$er (c:
<br />1/.-\-tq
<br />-lccniryihtrr
<br />inlhc pcrfornEno.r$c worl lbr*iichrhi\ p.rnrii is nsucd.l \hallnor ctrlPlovnnvFr$n in rnv.unncr
<br />soNrok+onEs!tj.{lx,th.wo.rscompcnsalbnldw\.lC,lilornii.lnd4r.cth.tifIsholld}f,r.msubitrrorh'
<br />*orkcs ompcns.lion p&vi\n,ns olSccrhn 1700 orrhc tjh)r Codc., dull. fonhwiih con{'lv sirh rn.$ flovisions
<br />WARNTN(i, Failu* k, *curc workcA onll)(.\.rion covcrrSc is unhwful. rnd \hrll suhF_r .n cnrplorcr t, dnniml Pctruhi\ rnd
<br />civil nncs ut k, o.c hundred rhou\.nd dollrs ($l0l).ooo), in ddiliotr ro llt co{ ol .onDcnsarion- drm,ges rs !rcvidcd n' rhc
<br />:::"jtiHb"$lctr
<br />IicEbyrmrdundciP.mhyoipcrjuryrharI nli.rntu.dundcr!n'!hionotChaPtcr9lco rmminf *irh Seclion 70fi)) of l)ivtnrn l
<br />oi rhc Ausincs Md PioLssionsCode. ad ny liccn* t in tull
<br />,-"-,--,q
<br />C(TNSTRUCTION Ll'NDIN(i A(;EN(:Y
<br />I hcEhy trrfirm undcr pcnah, oiFrjnrr lhr lhcrc h o consrdclbn lcndin8 asency r rhc pcrli,,nurcc or rhc work lor vhkh rhis Frtrrit is
<br />nsucd(s( :ror?, civ c.)
<br />AflLllalfllEcLA84rlQN
<br />I hclrby altm lnder D.nnl(y of perjury otu of rhu foltowin8 dccllr!{ions:
<br />D.mlrnr Pc rs AstEs.. Nolificaliotr Fcdcral R.lxlarhns (Tillc40. PM6)
<br />-R.iutcd
<br />t l.rorNdilic iotr
<br />-l
<br />ccniry rhnr $c Ldcnl rcsul n,ns r8ddirs lsb$lor tcnn,var nrc mt {plicabL r. rhn 0rojd
<br />I ccdily rh l l l c rcid lhn rtlli.rrnn ndd { rc rh rhc rliM inli,i,nrri,,n i\ c.rc.i I i!r$tuc.nrllysirhrll Ciry dCoutrry
<br />ordi,ancc\ md Sllre Ltrwsrclditr3l,i blildiiC .on{rcriotr
<br />bovc rctrrio.cd lropcny lnr
<br />FINAL
<br />tJnJd q AJdEs:
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