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ELECTRICAL-INSPECTOR RECORD
<br />COMMENTSAPPROVALS
<br />Site-Work
<br />Under round
<br />Pole Bases
<br />Li ht Standards
<br />S FountainsasPool
<br />Life /Low Volta e
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Under Slab / Floor
<br />Bondin / Groundin / UFER
<br />Transformers
<br />To ueln
<br />Sub-Panels
<br />Rool To UI ment
<br />Facto Wired Unit
<br />Walls Conduit
<br />Walls Rou h
<br />Ceili S Hard & Soflit Rou h
<br />Ceilin S -Bar Rou h
<br />lvleter Release
<br />qRouh
<br />Service It/eter
<br />t)FINAL
<br />Notes Remarks, Etc.
<br />OWNIlR BUTt,DER DELCAIIATTON
<br />I hcrchy affim und.r pcMlry ol pcrjury rhat I aar cxcnrPr fn,n rhc conracknr L-kctr* L.N lor rh. rolhwirs rcrvnr lscc'70r1 5
<br />Busincs Md Ptuicssion Cixrc)r Atry Ciry or Colnr, *hi.h tcquircs ! Fnnir ro consrtucr. ,lr.i inltrovc. 'L mlkh 'r rcn'n rnv
<br />nrucbs. pri, ro ils nsuai.c. arso rcquncslhc atlli. l rot such pcnnir r.lilc I siancd srrrcmnt rh.r hcot shc k liccn*d Pu^umr
<br />k,lhcprovhbn\.rrttConlraclor\Licctrscdti*(CMplcrg.CoNmcncinsRirhsc.rnnrTO0OorDivision3ofrhRx\in'r\and
<br />Prolcsshns C{vlc) or ihar h.ot\hc n.rcmPl lhcrcliomand rhc h,sis lor rhc rl ldg.d cxc nlpl iqr Anlvn'blionolsc'rk l0ll5 bv riv
<br />sppli."nr ror a pcnnil suhj.chrhe ryPlicotrlk,ocivilp.mxyolnolmolcrh fivc hnndtcd dolle\ lS5(Xr).
<br />-1.
<br />!s owo.r ol rbc poltny. o, ny.mllores wilh waBcs rh.n $lc comt'cnsrion. wil! do the wdk $d rlE (tururc k mr
<br />inrcflldl iir ofi.r.d lor qlc rse.704,1. Busimrs dnd Pmlassion\ Code: fi. Co nd.ir t,iccnsc tiw dus n r atl,y ro an osncr ol
<br />rhcnmllry *ho hu ilds or impmrcs itEmn, .nd wls des such nd( himsclf ot he^clf or rhrcuBh hn ot hcr own cmplor!'r'
<br />pmvidcdnrd su.h inwolc'E.rr m ml idcn,,cd or olTcrcd lor \alc ll hoscwi rh. t{rikliu or improlc'n issldsirhinoic ttd
<br />;t.otrlIrr:ri,n. lhc Owncr AuiBcr willhaE rh. h!i.n of Imvin8 rlur h. or shc dilfr, f ih or iqrrok rhc pnrJrtv for rh. purrx'* of
<br />L a\osrcrofrhe prcpcny. imcxclusivclrcont rinr wirh licc.\ed coihr.ro.s ro condrucrrh. Pr+cl (Scc ?(}1'1. Bu\i"c*
<br />.M Pnfs\i[ Grlc:1hc conlr0crois Lic.ns. Law docs nol lPply h,tr oPocrorpii,Fnt who huilds 'r nnprorcs ll'cr'on'
<br />ud who conhclslor ch tmj{ts wilh a Conrracr.(\) licctrsd Pu^un brhc CoMecrni\ Lk{nsc tjrr'
<br />_l Un.rcnrpi utrdcr Sccrt
<br />-.
<br />a & P.C. fotrhis rca$n
<br />lhlr ()Bn(r
<br />* oxxr:trs trr;rt tt,lrs,rirrtr
<br />lllrlr"lB ro!
<br />II'r'rhJnllrNund.' iLlt fl J)rrlu Ior.olrtu l,,ll(N r!t[cl]'rri,nN
<br />I xhtr Co(l( 1,, th. |r1li)'nnn.. tl rh. \.rk lnr \hi.l] rlr l)c nrir \ nn'.J
<br />hisIt. nil is i\\ucn. My rorkcr' ron{f,ns .n nNmh--c canicr ind P.li.ynumhcrdc
<br />CN\15t2567{\.t.r<
<br />-l
<br />ccnirrhar nr rhcrcrlorronce orrhc sorl ii,r 'hi.hrhi\ p.i,n n ilsucd.l sh,ll not cnrrlov'nvrcnon itr rnvn'anncr
<br />", ,s ro bc.onE suhjccr r" rhc wotkc6 comPetrs,ri.n hBs or Crliiooia. r.d n8rcc rhsr itl \htuld hccom \objd b rtE
<br />workrs compcnsrioi truvlsn,ns ol scd n,n 17lx) or th. bl,r Cdle l \hall. fonh* irh c.nrrlv s ilh lhoe pmlniotrs'
<br />WARNING: F.rlurc to scurc workcrs mmn€n$ri{n1c.ldn8c r unhstul..nd shrll nrhJccr sn cnlPlovct ro sintinal tlnalit\ and
<br />cilil fiics up ro onc hundrcrr thousand dollsr\ (51(x).ur)). in.ddilion h lhc cosl orcoDPcnsarion drm8c{ as rovidcd ror rlr
<br />S..ri()n 10?6,nr[c L(bor Codt. rrct{r rltnif,y ( lcc\
<br />DFCLARATION
<br />lhcrcbyafllrnundcrFnihyottcrjuryrh.llonrlien$dund$l,l,virionofChrnrcr9(commEingwirhScclt'n7000)'rDivisnrn:1
<br />.r rhc arsincs and Phr.sions Codc. ,id ny liccn* is in tull ntre ,nl cllNr
<br />lofi4@
<br />1'.1,\5 tlq+'w!-
<br />qq!$f,lJsflQNrENpac-acrNlx
<br />I ncrcby olfirm xndfi ,rnalry of Frrffy rhd rhcrc is ! on\rrud bn hndinS aserv ror rlr pcrlommc ol lhc qn* ld whhh rhn Fnni n
<br />issucd (S(.3097. C! C.).
<br />APEIANLDSCIABAUAN
<br />I hcEbt alllm unJd pcn0lry orrrrjury onc ol lhc Iollowin! dcclnrari,nE:
<br />Dcnblirion l'cirnirs sbc{os Norilicriio. Fadcril Rcsulaiion\ ( rirlc'10- Pan6r
<br />R.(u'r,l lxrrrr of N lrlicrrion
<br />-l.cnilyrh
<br />lhc lidcral rcruldioN rc8flling th.sr.s r tr,v0lrrc noralPlic$lc l.rhhr(I.tr
<br />6.cniryrnd I h!* t"d rhis lprlicd
<br />oftlnlrnccs ond Slalc l-awr tlllin8 ro hu
<br />lh)vc mnrn,n d p(,r.ny for nsF:riotr
<br />i()nnndidcrhrr rtu ihnc nnnr rri.in i sco tr I +rN locorply Nirh {llCilyriJ Counry
<br />rcprc{ hrncs ofrhi\ ciry and coutrly k, cnrd uF)n rhc
<br />Alrll$nl or &€nl Si*nrlure
<br />lrl
<br />1'?^to'
<br />DATE ID/SIG.
<br />'?'2.1""
<br />A,
<br />Sions (monument)
<br />Buildinq
<br />Air Conditioners
<br />+//ali
<br />c\q\r4 W.q,l
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