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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILT'IR DELCAR-ATION
<br />I h$.b, airr,h undcr pc.ahy or Frjury rhar I m cxcmpl nom rhc Conrraclos' Ltens li* for rh€ follo*ins easn (sm 70.1 I 5
<br />Buiincs lnd Prof.sn'n Codc): Any City or Counly whi.h (qriEs a ldnil t' .onstru.r. dt.r. impnnc. &nDlth or Np3t My
<br />srdclurc. pr6r to ns issuamc. alo rcquir$lhc rrtli.anr ffi ru.h F.nrir ro fiLr sigkd sarcm t rh, hcor sh. ii li.en$d lu uair
<br />lo lhc pmvisi.ns or0r. Conkr.rois Li.cnsM Law (Chlprcr 9. Conmcncinr *irh S€crioo 7000 ol DivtnJn .l orihu Busines and
<br />Pofcsi.ns CodcJ or lhar h. .. shc k cxcmpr rh.errcn and rhc harir ad rh. alhgcd .x.nprirn. Any violalion of Sdio. 70:l I J b, My
<br />Mffi ffi Jffi#;'','*ffi ffiffi--;iilff:,*", ",rhc poltny sno builds or in{mrcs rllcm[ ! *ho des shh u,* hinMlf or hcsclf o. thmu8h hh or hcr own cmrloyecs.
<br />povidcd rhor such i.pmEm.rr ft nor i.rundcd or ofrcRrd ror $h lt ho*cvcr, r huilding or iqmvcmnt is sold *irtin om yca
<br />ofcoir0Lrio.. th. Owncr Buiun rLll hrv. rtr bnrdc. ol pmving rilr hc or she dA mt hrild or in'Ilmk rhc ImFiy for rhc purIIN ol
<br />-!.rsowncrollhc!mp.ny,oDrcxclusivclycont..rhrgsirhli.cicdc.fii.krsro..n(ructrh.pft!..r(Se.1014.llunN$and PDltsbn Codcr Thc Conrrrcroas l.iccnsc L!* docs nol ltply ro i" own.r oiproll.ny wh. builds or improus lturcon.
<br />aM sho .onr(( ror su.h ln,j..h *irh , Conrfrckn(s) licc.\ed punr r k, rhc C.nrn tr'l Lien* Lrw)
<br />I hcrchy aflnn undcr lcrrllyolrcrjuryorc otrhc i.lrowirB de
<br />-l
<br />havc uld will nEinlain a C.n if8lL of Conscnt lo Sclll,Nur. ror uor*cr' ollln.mll,otr. as omvidcd lbr by Sd ion :1700 ol rhc
<br />Labor Codc. lor lnc pslormmc of rhc wort for (hi.h th. ldnir is isrucd.
<br />Ihrlcud*illnrtrirhinworkcrrconDosrrioninsunncc.rsicqutcJ$ySccrionlT(x)ofrhcL.horCodc,(,rh.nrr.n,umcot
<br />rh. iqk,nr which rhG p.lnil is hslct M,trclkcr compcn{rion i.summccmhr dpolicynumh.r&:
<br />aiil.*ntr'runcofrlt sork for which rl,i\ pcnnir i\is\u.d,l shrll nor .mtloy any l.n.n in rny nm,fr
<br />nnd rBE lhd if I should tE{om subjd lo rlr
<br />slllll hnh*ithcomply wilh ltrs psvisions.
<br />r,rc worlcH omp.nsltrtr lows otCrlifomin
<br />sorkem conrpcnsatiotr pmvnions ofSccrion lT0Ooltic tihr ci,lc.I
<br />urhtifl
<br />.otrrNn\rri, .or!rxA. i\ tr rq,nl xn,l ntrl \u1+.ntbyd Li drnmrl l}-mlri$ dtrd
<br />doll \ ($l(D.(XXIr. ii ad iotr. ddrMscs as prov cd l.r rhc
<br />I h.r.hy llnf, trnJcr prDrliyolP(irl thrl I xn lic.trscd i,r,.l{ hrJ,r.' ! l$nnn.n.i'r! Birh
<br />or rhc Buim$a Pdassins Codc, und my licctrsc ir ir fu
<br />CAN,SIBIJEUANIDNDINC.AGINCI
<br />I b.rby afllrn undd Fnrhyorpcriuryrhd rhm ic r..n{tucrt,n lcndins ae.ey ror rhc p.rroinrftc olrhc w6rk l'or shich dis p.rni is
<br />hsucd (Sc. :1097. Civ C ).
<br />AIPIICANLIECI.ABAIIIJN
<br />I lrl*,y afimundcr r.nalry of ffrjury one of lhc f.lk,ein8 dElaarions:
<br />Demlirion Pcrnik-Asbcsr.s Nolinc io. trdcol Rcsulations(lirlc,l0. Pan6)
<br />_Rcq0itud Lrr!er of Norilralbn
<br />l.cnirv lhrr rl'. lidci,l r.puldi'ntr
<br />df.",,,'n,',,",",",,0,n,.,"",'.",,,,
<br />i,du,fu..! dnd sr . tjtrrrcLrnF ru huil
<br />rcsardinB osbcslos ,cmldl arc nor alflicoble lo lhis I,oF:l
<br />n lnd sratdhor the lhove inlnmtion is comcr.I asN bsmp l)-$irhrll ciryiid cou ry
<br />y rtrd Couoly ni cnrcr trF,r llLconsltu.rion. ad h.rcby aulhrizc rcjrcsnllrivcs ollhk Cil
<br />ahov.
<br />'nctr1i,nrcd I'n'!cny tur insp(ri(,,
<br />,\pdicrnl or,\!rnl Si{nit'r(
<br />Pemile. ntrmc llrint ):
<br />*"blnltb
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />rqpas, Pool, Fountains
<br />Signs (monument)
<br />Llfe Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Bouoh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service lvleter )\
<br />FINAL 6t1b {utdbl
<br />Notes Remarks , EtC I IV
<br />COMMENTS
<br />Under Slab / Floor
<br />;:
<br />Lrcnlc ('lx\! l.iccnsc Nonil{r:
<br />Duk. ('i'nrr n,
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