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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS ()WNi]R B(JII,DER DEI,CARATION
<br />I ncrchy trIirm undcr pcMlty of |Erjry lhrl I ar cxcnu lmr rhc Contricl.n Ltutrsc ljw l{)r lhc lnln,*ing rMlr iscc 7):11 5
<br />arrirc\\ rnd Prolcs\i{'n Cdlc)r A , Cir! or Counry $hich rcquircs a p.nnir b .otr{fu.r. dhr. nnlft,rc. dcnnlkh .r rcNn y
<br />sru.rurc. rFrro irs isur..c. iho rcquncs rhc iptlic,trrr.r \!.hFnnir h filca {gncd (,lcn*nt rh h.orshc h liccnscd plru li
<br />b rhc nn)vision\ of rhc Conrrackr'\ l,icen\cn ljs (Ch!rrc. 9. Comrrencins !irh scrrn,n 7000 or Divtio. .1 .l rhc Busirc* rnd
<br />Porc\si(N Codc ) or rhar h.orsh. isdrcnrr Ih.rcfn,mud rhc h!\is lorrhc rll.gcd.rcmtrk,n Anrvidrln rotScdionT0ll.5hynn,
<br />rppli.rnrfdtrp.nnirsxbjc.rsrhcqrtlrNtrrbr.ivilp.nahyornotflr.rhdfirchundrcddollr6(S5(x))
<br />trarf,E&i:lanurlsatra!
<br />DES.AAAUAN
<br />I h..cby uritu undcr Il.nnlrt oiFrjrryonc orrh.lbllowinr dcrLnrnrns,
<br />I hav. dld sillminr{io a C€nifrar. .f (-l)n*nr roSclt ln{r. fff sbrkts .omp.nsdbn.N pmvidcd ror bySalionl70Ooflhc
<br />libor Gic. ro! thc Isfomumc oI thc *ork f{ qhich lhc F.nnil is tsucd
<br />I hrvcr {t *ill tuaihruin s.r*c( .omBns,iotr i',suftic.. a\ rcquncd hySc.ri.n.l7(X)orrhc llh.rC.dc. for rhc lcrfnmmtrcc of
<br />rhc wuik ntrqhi.hrhis p.rnil is i$krl. M, *or*cN- .oflp.nsar i,ln insuid.c .,micr od Fli.y .uml,< r uc:
<br />-l
<br />.cdiri rhri ln rhc ncrri,nrLrDc! or lhc {.rk lnr rvhich rhN rcrinir ir \{rn. I shill tror cnl|n,iy rny ncr(n, n, rny frrtrnrr
<br />y) r\ t) lroDrc suhjccr h rhc sorkr3'on,tci\ir i(r lnws of Crlilarnir. a rgrcc rhnr ifI\h,uldh.{o r{rhlccrlorhc
<br />qorkc^ ronl|{n\rri{rnpn)i\ioi\olsccrn)n:l7u)orrhc Lhtr corlc.I d ll. nflhfirh .rn!ry *irh rho{ ftuvisioil
<br />WARNINC: liilurc ro s(ur. workcr onpcNrri.n covcr4c is unlaw
<br />.ivil rnN rf ro otrc h r(lr.rl th.trsr rlolLrr\ l$rr1).rxxr). itr '(nLri{lS(tion .1076 of thc lihor C.ic, inrctu{ Jnd,rbmv\ ics
<br />Drte ^rrr-.;,K
<br />DECLA8A.IION
<br />I hcrcb, !fl1fln trndcr r...xy of lcrjury rhal I i li(nsiundcr,,svisionorch8plcr9(ommmiry*irhSeclinn7m0)ofDiri,n:l
<br />of rhc Bu\in.ssand Pn,fcsi.ns c.d.,8xl nry hcrnsc n h liillrnr( dd.
<br />CoNSTRUCT!oN LENDIN(; A(iENC!
<br />I he,eby:finm undcr rE.alrrotrcrjlrylnar rh.rc n oconnrudbn lcrlin8 rscncy fu rhc p.rromnc. orrhc *6rk ror $hirh this |^rrrir i\
<br />ksucd (Sc. 1097. Civ. C.)
<br />AITLICANI.II:LANAION
<br />I h.Eby !fijnn undcr Fmh, of perjury om ollhc lblbwin8 d{lodions
<br />D.mhi Pcntu*-Ash.ios Noriilctrlion Fcd.rrl RcBularions (Tnlc 40, Pad6)
<br />-l
<br />cLni! thal rhc lcdc..l rcgulRlions rc8ardinB oshcst
<br />-l(nilyrlIr
<br />I nau rcldlnn arplicsri,r$nd(llic ']rl! $nh al C ryrM Cortrry
<br />o inrm.\ r srde I r$\ rchrin8 r,bnilding..f ivc\ ofrhis Cirt dtul Cortrry t) cnld u|totr lh.
<br />atxNc nrcnriuEd propcny li)r irNpccrion
<br />/tppli(.nl rr ]1genl Silnnhr
<br />Yl(ALt .L ^*7-rL(':1/7
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dam pers
<br />Communlcations Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />-)
<br />Rough Fy'tF,i* 4;7.r'"4"'l
<br />=?'Service lvleter
<br />FINAL l-zt1- *.f-}J t,,
<br />Notes, Remarks, Etc.
<br />l. as ow*. or rh. prcIleny, or my cmPlorrcl wirh wascF.s rhen sb conrr..\arion. willdo rh. *o* !d rh. emrm ie ml
<br />nncnd.d or otfc..d for srh I se.7044, Businc$ 0.d PJoresionr C.dr Th. C..rn tor's Lic.nk rje docs trol lpply lo en oqmr of
<br />rhe l,.rErly sho tnilG o irq)Ds dEmn. a.d who dm shw* nimsclf or hcRltor lhmugn hh or hco*n cnPldyees.
<br />orovidcd rhlt such impnrwmnls m ml idcnd.d oroficmd for slc.ll bwcE, rtE t iklin8 or irplwmnl h $ld qilhinom,w
<br />or.onDlcrion. rlt O*rc. Blildd will hdw rhc hrden ot rri.g rhar lrc or shc dn m| l ild o. inDtuw rh. p@F{y for ilr purp.s of
<br />I.IosrcrofrhcF,r,cny.s.rclniiklymnr6crins*irhlicensdcoirracronio.rfirrudih.I'.jtl(S.c704.1.BusiN
<br />ond hort{sion Codc: Thc Coolru.rols Liccns l,e des mr,mly to anowncr of tm!.rly who boilds or im[orcs rhcron.
<br />ud who conhcls for slch pmFcrs wirh a Conrmcrorls) liccnrcd p!6unt to rh. Conrrlcror's l-kenre L,w)
<br />-l
<br />am cichpl lnder Secrion-. B. & P.C. for thn rcason.
<br />D.lc: OMer
<br />tf,ndci\ AJdrc.r:
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