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ELECTRICAL.INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safet y /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / 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 & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />[,4eter Release
<br />Rough
<br />Service firleter -(
<br />FINAL blzn tf/,,(,/4{7 r t9)
<br />Notes Remarks, Etc E7
<br />OWNER BUILDEN DELCARATION
<br />I h.i.by arun undc. p.nolry or p.duiy rh,r l d ei.mrr from rhe C.ntact,n Lk..\c tiw rorrh. tolliising rc.$n (S..7011.s
<br />Busincs .nd Profcssnr Codc): Any Cily.r Counly which r.quircs a F.nrit lo consloct. !lrs. imuovc. dcmlish Dr rclan y
<br />(rucrurc. Drior ro irs issurme. alw ,equircs ric applicsnr for such ncmir lo nb a sistud uarcmor rhar h. or shc i! lic.nsd pnEu:hr
<br />lo thc pmvisions oflhc Cont0doas Licetrscd tiw (Chrprf 9, Comnrcn.in8 with Scclion ?000 of Division:l of rhc BnsnErs aid
<br />Pmlts\ions Coilc) or rhar hc or shc t dcmpr rh.r€trcm and thc t{sh for rhc alLscd.icnprion Ahy virlrrionofsolion?0ll.s by riry
<br />fu*;ffi ffi*;;-;;ffi ffi;il;**i****.,
<br />lhc tmlEny who boildr or nr{mhs ltLBtr ml eho dks *h m& hnrls.lfor hcs.lror rhroxgh his or hcr ow.rmtloyecs.
<br />pn,vidcd I har slch inpmrcmnrs @ mr inreDd.d or oficNd for soL ll howrRr. rh. ttrildir8 or in{'rovcEnl h $H uirhin onc ycu
<br />ofc.mplcrion. lh. Opncr Suills will tlvc lhc turdm of tmvinB th,t hc or rhc dil ml tlit or iq,oE rhe Fmneny ,or lhc puqns .f
<br />Lr\o{nqotrhcFlpcny.rdcr.lo\ivclrco.rracring*irhliccn\.d..irrt^t,cod{fldrhcpnlc.r(S..7().l4.Au$0cs
<br />Md Lhl|s\bn Codc ThcCo6tr.ror's Li.cnsc Lrw do.s nor+tlyt, drotr.cr ofr,rcpc ywho buills.r nnfrcvcs lhcrcon-
<br />and $ho clntBds ld such projLrts s irh o Co.hcn,n o licctrrd puN'rnr h rhc ftnrra.r(, s l-iccn\c lj,)
<br />;:.'$1dt#
<br />I hcrc$v arrtnrundc. pcnrlry olF-rjuyonc olrh. li)llo{ing
<br />lhrvcrndwillmrinr0inworkcrs.omtnsarionin$traftc.rsrcqutdbySc.riotr:17U)ollhetfborCodc.forlhcperlortunccoi
<br />rh. woik rorrhkhthis p.rnir is issudl Myworlc^ ..mpcn\dn,n in\ur N c,rin drolicy nuflbcr rc:
<br />oirhc work Lr whi.h rhB rciinir is is{rcd. I \hnll nor cnrploy (try pcrson D,ny 'numrcs'.otru.ns ion las\ofcalilhnria- !.d rgErtrr irl\hould trcoft {hj.d t,rh.
<br />workcrs' comprn{arion provi\hns ol Sccrn,n .1700 oa rh. Llbr Cqlc. I \hf,ll- lbniNirh conuly wirh rho* ,n,v(n,n\
<br />:**u
<br />I.,ltrr t' f,urc lorLc^
<br />'.1-- ',"r-,,",-**r
<br />M;W
<br />.ovcnSc is unhwtul. ond shill sub,iccr !n cnrphycr x' Lri'nindl pcnahics Md
<br />I hcrcbyoitnrundcr pcnnllyol r.riurylhd lom licctr{n undcr i,r ol ( hrfrcr 9 (.onnn.minE *iih Sccr
<br />.l $c Busilcs 0nd Profc$iorr Cidc.,nd myltcn* is i,r lullfttr c md clltcl
<br />Dole Contmctor
<br />TONSIBIJI:IIONIINI2INGIIIINCI
<br />I hdchy!llirmtr crpcMltyoi rcrjuryrh.lihcrc h.coNnElinr lcndin8 trgcncy rorrh. pcrr.rmncc urrhcsoIk rar shi.hthi! Fnrir is
<br />n\ucd (Sc. 1097, Ci!. C r
<br />A.?ILICANIDECI,IMIION
<br />I hmiy aninn u.dd pcn.lly of pcrjury ooc of thc lolhwnrS ddlrarbns
<br />D.rmlnion P.rmirr Asb.s.s Norii.arion F.d.rdl R.Bulnrions (Tillc 4{), Pan6)
<br />-Rcluicd
<br />t ll.rof Nolrrotion
<br />h*fi
<br />iftrhrr rh ndc'rlrclubri{'n\ m!Mling r\bc{.\ rcnx,vrl rrc norr!|li.$tu n, rhn pnUcrr
<br />rhar I hrv. rcrd rhtrppli.aridr alc rh0r rtu nhovc infonMriotr n cone..r I aBre ro omply wir h lll Cir, rnd Cou.ry
<br />nd srrrc lrs\ rcldii8 (r huildi'r3 tucrtrnr. d hc'rhyrurhori7crctr.\cflrrivc\o, rhi\
<br />$ovc nrcnli,nrcd Inncny n ir\rclion0u
<br /> pDlicnnl or Atol Si*trrtu
<br />\\a
<br />'qu["L"
<br />I
<br />-l
<br />tqvc !,!r will roinkin a Ccniarcrrc ol Con{nr ro Scll lnsu.c for *o c6 romptnsarion.nr pmvidcdfoibyscdiotrlT00ofrhc
<br />L,txn C.dc. for thc F.rformlce oirhc sork rbr trhth rh. Dcnn h nsucd
<br />I
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