|
ELECTRICAL-INSPECTOR RECORD
<br />DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Unde rground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service lt/leler
<br />FINAL 6_27_ttr r.ww
<br />Notes, Remarks, Etc \.2
<br />OWNER AUILDER DELCARAI'ION
<br />I hcrcby slfifln undd p.mlry of pcijury rhd I m crcnipr fmm rh. CbntJcb*' Li..ns. trw fi, rhc bllowin8 r.rbh (x-.7031 5
<br />Busi'rc$ 3nd Prolcssion Codc) Any Ciry or Counly whi.h rcquncs n Nrn lo con(ruc|. altcr. nnprovc. dcnnlish or rcprn any
<br />srfl.rurc. pri,tr t, iis i$uancc. al$ rcqun \ rh. qdi.flnr lhrsuch pc.nir h lik ! \i[n.l darcmnr rhar h.or rh. h li..nr.d pu^rrr
<br />ln lhc lmvhions oi thc Conhcrois Licen*d L.w (ChUcr 9, Conrnrmin8 wirh Scclion ?OlrO of Divhion I oflne Businc$ and
<br />Phfr$iqNo)dc)orrhltn orrhc ncicmpr rhcrcfromlnd rheh(sn for rhe ulLscdciem?rnrn AnyliolnrionorSftrirn?0ll.5btrny
<br />lppli.anr Lr r p.rmir sublc.rs rhc .ppli.rnr tu a.i!il lcnrhrotnor mnc rhdn tlv. hundr.d dours (3501))
<br />-1,
<br />as ouncr ol lhc prorcny. o,
<br />'ny
<br />emplortc\ wilh wa8cs $ lhcn sk compcnsal ion- *ill do rbc udk snd rh. srurm i\ ml
<br />ini.ndcd or oficEd aor {k (Se 7U.a, Bucimss d! Pr.i.s\ions Codc: Thc O]nr6dor'. Lkcis lj* docs m' artly to an owrcr oI
<br />lhc DmFdy eho builds or irymvcs rhemn. atrd vho dcs such w.rk hinBclro. hcrsllror thmuBh his or hcr owncmfloyccs.
<br />lmvidcd rhar snch irpmvcmnk m nor inrend.i or orleBl ror sh Il ho*.rci ir I'uilding or iqmrccar i sld wirhin "m )rr
<br />or conDlcrion- ll". Ovncr Auibs will havc llE burdcn ol provirB rh,r tE or slE dil rcr t!i! ot in{Nrc ',r
<br />pmpcdy for r,r I)U4n{ or
<br />l. rlowncrofrhc prcI.nr. ul.rcluriv.lrconkldir8 *irh li(en\cdconrructnk,.dnnnr.rrhc pn,,..r(Sd 7{}14,Bhirr$
<br />and Pirfcssin Codc: Thc Conkr.rois Liccnsc lrw do.s nor apply ro M own.r or Drornd who conracr\forsdchlojcct *irh rconrrucrl'(s) |
<br />DECLAMIIAN
<br />rrfii,n, ^rlftr.'lrinln.rjurtnncof rhcf.,l'.$n,rdr,lf,r'o.
<br />I lrrr drd will minrrin r Ccdilkdd ot Co.scnr b S.ll ln\rft i, $drkc^ .o'hp.n{ n , ar trovidcd ln by Sccrion 37(rO o! rhc
<br />bbn Code, lor rhc pcrfun6cc of rhd worl ror {hich rhc pm r h hsucd
<br />I h,vc and will d int,in sorr.rJ ..nD.ns ion insxrancc. tr\ (qlncd hy Sod bn l?(D ol rM lrbor Gdc. for thc pcrlbflMrcc oI
<br />rh. work for which rhic Fhnn ii ilsxcd. Mywork.s co rpcNrrion i.\ u rnkc .rftici aid policy numb.rdc
<br />-l
<br />enilyrhor r rhc!.rrormakcoflhc work lor whichrhis p.rnln h issucd.l shJl not cndoydtry F:son iranynlnncr
<br />$ d\t' trcoE sh]ccr t' rhc *orkcr Lr'nteisarn,n hws oiCalia{,mie. !tui !3rcc rhd ifl slNxld h...ft subjc( ro (rr
<br />eoikc comncnsort,n prorisn,ns ofSccri{,n l7O0oarhc Iilu Gnc- I slull. ronhsirh d,n'ply wirh rhor pmvhions..
<br />W RNINGT Failu.c h suc workcs conw.sarb. .owag. ir unl
<br />lhousmd dollir lSlm.Ux)). r iddirn)
<br />(-
<br />Ll( l.\rit,r) ( r)\ I R\( l()l{
<br />DICI.IBAIION
<br />Ihcftlryrlfi' rundcr p.trJlryofFruryrhd I n li.ci{ rn crpn,rni(,.ulChrpr.r9l.o nkn.rnswIhSc.lion?{)tXDoIDirision.l
<br />of rhc Blsincs Md Pnfes\ion\Code. iud,nylicen* is in tull Lr.c und cifccr
<br />C(}NSTRU(]T'I(IN I ENDIN(: A(:ENCY
<br />I ncrcby afrtrD undcr pcnally ol pcrjury thlr rh6s h, onerucrion hdins ascmy lor rhc pc,f.r@ncc oIrh. wort ror whkhrhis p.rmi h
<br />ksucd (S.c.3097, Civ C.)
<br />,{PPLICANT DFCLARATIoN
<br />I hoEt'y lfiinn undcr pcn.lry orp€rjuryonc ollhc lollowinB dNlaolions:
<br />lxmlnion Pcrmn*Ash.nos Notifi.ariod Fcd&trj Rcgulnrio.r (Tirlr 40. Pd6)
<br />Rcqurcd trrt.. o, Notf{rtion
<br />-l
<br />enilyrlut rh€ rcdcrul r.Bularions Esadnr8 asbcsros,cB)!
<br />I ccnifyrhd lhrve rr rhnrpplicrrir)n rfrlnrrcrhrr
<br />ordinrncci,nd srrrs lrws BhriiB k, building c.n{ocr
<br />ahor mnlioncd lmpcny for inspNlionlurFss
<br />lir nt or nHdl SiAnrlur.
<br />,\tx? ;:'.1',,:,'i1if"ff H" ",. r-(z(ty
<br />APPROVALS
<br />Under Slab / Floor
<br />7
|