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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />l\4eter Belease
<br />Rouoh
<br />Service Meter ,/z/<///-.M.,;1
<br />Notes Remarks, Etc
<br />Jr,"=-v
<br />OWNER BUILDER DEI,CARATION
<br />I hceby ,fllrnr undd lcnrlry of plrjury rh0r I nm cx.mpi ftom rh. Con(mctou Liccn$ t R ior rhc followin8 rclson (Sa.?031.5
<br />Bu\ine$ and Prolcssiotr Code) Aiy Ciry or Couly Bhich rcquircs a lmit ro connod. alls. introvc. dcmlirh ur El'nn Eny
<br />*tu.rur.. prn, ro nr irsuan c, alr. rcquircs rhc ,rplica for such Fmn ro nb , sigmd {arcmfl rhd r. or sh! is liccnscd pusuonl
<br />lo rh. provisio.s ol tlE Conraclols Liccnscd L{B (Choplcr 9, Co rmcncing sith Scclion 70m of Divhion I otrhc Bu\in.$ and
<br />Pmlc$ions Codc) or rhrl lE or shc h ctumfl rhJcfron and lhc litrsh lbr rh. allcrcn eic'nprion Anynn,hri,norsM(i,n?0.ll.5byNtry
<br />aptlicrnr lor sFrni rubj(krhc appli.anr r...ivilpcnllrro{nor nFrc rhdn nvc hundr]d d.Uars ($5m).
<br />-1.
<br />as owmr of thc l,olEny. or my cnrtloyes wiih w0gcs ,\ rl[n sh $npcnslion. will do rhc rort ond ltr slnd& G d
<br />i'ncded or o,Icrcd for srlc (Sa.?o.ltl, Busims lDd Pmfe$ions Codc Thc C.nrradoir l,tcn\c l-r* does nor arnlr ro,n owncr of
<br />rh. ptuFfy wlxlt ius or inpmhs rh.6[ md slk) dds r!.h s* hin*lf or h.mlf or rhn,ueh his or hc. osn.nplor*!.
<br />pmliilcd rhar such iDpmrcmnk !rc 'Dt inrcndcd or otlcrcd for $lc ll h.scw. rhc ioilJing or imDrorem is sold wirhir , ,c tr.tr
<br />ol comphrion. llE (rocr Builds sil n w [r burdcn ol pmvins rhar hc or shc did rn hoild .r in{erc rhc rmFny for rhc pu,Ii){ oI
<br />L a\oeturofrh. pmpcnt. afr.r(lurnclrconrdin8 *irh lic.nscd conhct,E b.on{ru.r rh. pn,j..r (SN. 7(11'1. Busirc$
<br />Inl Edi:si (-r c:|fuCotrtrrcrolsLl.cnscl-[wdocsnorat'llyt)itrosncroipropcrlywhohuildsornnpmusrhcrcon.
<br />and who.a,ikrcktu\ucht&l..rssirhrConrnckr(s)lie.\cdpurrtrnrhrh.(ilnhnc(tr\t-ircn*tjs)
<br />lutc\.nU undrr Sccri{)n .B &PC lnrrh^rcx\nt
<br />Dor. O*ner:
<br />]}otrKEBIiS:Qltt[NS rtor
<br />DEEIAAATQ!
<br />I hocb) rfl,nn uidcr Ftrrlrroffulur) o'F ol rhc r.lhtrtrU d(lrrnri(
<br />I hrvc !.d$ill mainrain aCcnili.arcofG'nscnr roScla!.s!rc tur sorlicn onD.ns,rion. as phvidcd fo.bysNtinn 3TtDolthc
<br />Labor Codc. for lhc pcrlornErcc of lhc wort lor shich lhc lcn t nsucd.
<br />Ihrkrn,lwillnuinr!in*orkcN..nrr.rsrri(tr,id{nncc.a\rcquircdbyS&rn:l7ll)ofrh.t'horCodc.lorlhcncrionmtrcof
<br />rltr qork fd*hkh rhnrcnnir i\ i\\ucd Mysork$ .onrpcisrrn,n i'N!'rn.c.rnicr dxl B'li.y nur$cruc
<br />Poln.v Ndnh(, _
<br />-lccnrlyrh.r
<br />ir rhc pcformrncc olrhc work for which rhk Nrnrir N i$ucrl.l shrllnol cmploy anr l{6on in any nrnn.r
<br />n, N ro hcqnx ruhjccr ro rhc sorlcr renDcnsarn,n hNs olCllilomir. rnd lgrc. rhar il I \lx,uld bcc.nk subjNr I' trE
<br />workc^ conpc.sdion !rcvisions of Sccr nn, -l7m of rhe l-rlnr C{xlc. I sh ll. f(trrhwirh.o'ntly wirh rh)* pmvisiotrs..
<br />?316.L3
<br />-LAZ""---"=
<br />I hcEby atfinn undcr Fnalr,oIpcrjuryrhar rhcrc is a.on$d.rao. Loding q.ncy lor rhc !.rfoirurcc olrhc worl fn, {hih rhh rsn i k
<br />nsucd(S( .1097. Ci! C)
<br />L.ndclsN.m:-
<br />AITUCANI.DECLAEAIIAN
<br />I Mry lflim und.r ,.nalry ol lc.jury om of rh. followin8 dNlrd io.sl
<br />DcnFlition Pcmits Asbesros Norincarion Fcd.ral ReBuhrions tTnh tr(,. Pd6)
<br />-Rcauircd
<br />l,rrcr ol Norifi carhn
<br />I ..nift rhrr rl'c LdcrrLrcguhr(in\ rctxrdi',9 r(rno\ r.nuxLxir Dor rtth.rh. r, rhtr |n]t..r
<br />-n,\".',r/*"'"f-'I hrvc,.ldrhn ellicotiona srrrcrh0r rhc ltnvc nriorlnurion rs cotut. I asxE ro.o.ply wnh.[ Cily md coutrl,
<br />rFcrc.rariv.s o{rhii Cny,rd Counlylo enln ulrnllr
<br />*,", blnlB
<br />ralc tjss rcr,liN lo huildina construcriul un h.rcby.urhorizU
<br />itDli.rnl r Ar?i siEnnrure
<br />lrm,i'\\Dlprid,:tlql"d iEl;
<br />Site-Work
<br />Transformers
<br />FINAL
<br />WARNING Failurc lo scurc f,olkcr' omp.nelion c.v.6gc is unhwtul. Md shal, subJccl ao cmnlorlr ro airud rt lrk\ dd
<br />cilil fincr uI r.. c hundrcd lh.ulnd dollr\ (1lur,o()(l). in 0ddilion lo lhc cosr of comrnsation. .btuges as ti..lidcd ror rhc
<br />SNrion 10,6 ollh. L.lar Gdc. inreb( and{tromv's fe.
<br />Drr': L/ts//B V"""-"" (2a*-a-- 7 \ r rcrnsrn rrrnrut nrnI DECLARATI(,N
<br />I h.ebr,mrnlndcr p.n{lry of p.rjorr rhdr I an licen$t uodd povirnrn of chdprd 9 (.om.f,ming uith Selion 7(l(lo) ofDilniofl ]
<br />ol thc Busi'rcss and Pmtt$ions Codc, lnl my liccnsc h ir 6ill lore und eflNl
<br />Cro l.i.c \c Nu $Lr
<br />(elts I ib
<br />I
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