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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG,COMMENTS
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eler Release
<br />Rough
<br />Service lt/leter rl.tk,tO /J( z ')
<br />Notes, Remarks, Etc
<br />OWNIiR BUILDER DELCARATION
<br />I h.tuby,lTr( undd Fnalry ol Frjnry lhsl I m creinpt lmnr lhc Conlraclo* Ltcnsc tru lor lhc lollowing rc.str (Sc?0315 \
<br />susincss ,rl Pmfcstun Cdlc): Any Cit, or Coutrty which rcquircs ! pcnnir b on{ocl, ,xd, improvc, dcnmhh or rcPan any .
<br />sru.rurc. prid io irs issuamc. llso rcquircs the anplicanr for srch Fmir ro filc a si8trcd slllemnl that he or shc n licen*d pursanr
<br />k, rh. Erviqionr 6r rhr Contr.rorr Li.cnscd tjw (Cn.ptcr 9. aommrcins wilh S€clioo 7000 or Division I oflhc Busincss nnd
<br />Pr.rc$ionsC.d.)orrhartf.rstuiscrcmptlhcrclmmatrdltehasixihrrhc{ll.scdur.'nPIiotr.AnyvioLtionofScrioo70115bymy
<br />!![lic!nt Ibr opcrnrirsuhjcch rhc applica lI, !cililpcn.llyoretr mElhm fivc hundrcddolla^ (S500).
<br />-1.
<br />N owncr of rh. pnrp.ny, or nry cmployccs wilh was.s rs I hcir elc conP..\erion, will do rht wort od lh. (tur@ i\ nor
<br />i, cnd.{ or oficrcd lor elc ( 5(.7044, Busincss ,nd ftofcssions cd. Thu Co.rncroas Lic.n\c trw docs nol lndy ro an owtur of
<br />ric pmFi, wh) bxilds dr irn mEs rhcBrn. ud who dms such krk hinsclr or hc.elf or rliri,rgh hh or hcr own cmPloyccs.
<br />pnvidcd rhar such iDpmwd.ts e tur inrcndcd oro'lcRn for $lc.ll tnwcwr,lhc boildinC or impmrcnrnt ishUwirhinnnc F{
<br />or (,r{,lctirn. rh. ovrcr Blillcr *ill havc thc t udcn ol povins lhll hc or sh. dil mt boild or iqmrc lhc pmp€ny lor rhc p!,Ine ol
<br />-l.asowncrofrhcpn,Ilcny,,mcrclusivclyc.nt..rirBwirhliccnscdconrradorrocon{
<br />cr rtr r)ju.r (s( ?ol,r, Busir'.\r
<br />rid P|oracsirnCodc: Thc conrrndois l,iccnsc l.!$ d{Es nor lPplyt, owru ol l]roNn y sho build\ or nnpr.rts rh.rcon.
<br />and who conracc tor srch an,jc.h wirhaCont(ttrl() li.cnrcd ,urruint kr rh. Conlackn s l-tcn{ If,a)
<br />-l
<br />amcxcmpr undcr Ssrion ,B &PC fnrrhhrcuwn
<br />uoa6Eru:coutrNsA:IloN
<br />DDCLAAAIO!
<br />I hcr.hr.mnn utrdcr pcMltyofFrrury orc otlhc f(nhring dNl{n nnt\:
<br />I hivc u uillnminrainrCenifical.olCon*nrt,Sclflrrurclirsdrkcr-.omNnsarion.a\ povid.da.ihySdiinlr00ollhc
<br />Ijlx, Culc, ritr rhc pcrLrnrmc ol rhc wort lor which lhc !'.rmi n n$cd
<br />Ih.ucrndwillnr irt(in q'orkcn con,It!\ari,n, i',\ura'f,.. r\ rcquncd htSc.riotr 3701)ofrhc t.a$orC.dr. rdr rhd pdloiinrr. of
<br />rl[ q.rk l shich rhis Fnnil is i$ucd lly * orl.A (,nlpci\arn,n nr\urrmc .ricr m] !m licy nun$cr r.
<br />Poli.y Nunbci-Expircs
<br />lccnilyrhrr inrhc pcrtunnrffc oi r hc work f.tr whi.h rii\ ncrmir i\ is\kd.l dklltror cDI,!oyrnytxEo. inrn, trrnncr
<br />$ r\roB(orE shjccr t, rh. *orlcr\ .o'nFi\iiion hss.l Crlili'arin { a lgr.rhrr if I \houkl hc.onrnrhtcclrolhc
<br />*.rkcn' .onrpcn$ii{,npro!ni(,n\ fSLtrion:ITUJofrh. t-dhor Codc. l shrll li)nh*irlr m rPly sirh rh.t lr.viiors
<br />IVARNIN(;] Irdlurc ro {curc *orkcr co'npcns rion courr8c i\ u llwful. rtrd \hrll suhjNl m cmPloycr ro.ri'niml Nmhics rnd
<br />.1vil fincs utl to om hundrcd rhousind dolh6 (Slm-ml))- in lddln,n k, rhc.on ofco denBEcs ,\ ,tuvdcd lnr rhc
<br />srdn 1l)76.frh.Irtnr aod. inr.
<br />ctol zol ra
<br />!]I!nl]]!rc}
<br />I hcEhy ifln utrdcr pcnrhy oipcrjury tr*l undcr pmviioi or(-hrprcr 9 (connmNirs *irh Sn.-tir ?OIr).f Dni\ii l
<br />of rhc Bu\i,,r\\ ud Prutcssi,)ns Codc. d myI
<br />,",", Cut&Ll?
<br />I hcrchy i,lnnunrlq acnllryor F-rjdry rh,r tu.ri,r! htrdillllilercylor lhc pcrfonron.c orrhc $ork itrshichrhir rcnnii k
<br />is\u.d (Sc. 1097. Civ C.).
<br />IIIIICANLDECT.AAAIPN
<br />I lmty,mm und$ p.n0lty oI Ilcrjury onc oflhc |ollosi.B d(l.rarn,orl
<br />Demhion P.rnns Aitr{oq Noiinca'io. F.dcrrl RcSuldions (Tnt 4{r- Pur6)
<br />_Rcquied lriicr of Noliicdbtr
<br />rh,rc irlnnrutri,ni\.o'r.cr Irll!rlo.onrply\rilhrllCiry!ndCounrt
<br />trd hcrchv.urh.'i7. rcprc\. r(ilc\ olrhis City dnd cotrnryni.nro nfon rlt
<br />^Dnlnanr
<br />or A,rnr sifrure
<br />""-**.-\1,Tnjna e\iq<aaDtltd
<br />I
<br />Pole Bases
<br />FINAL
<br />t nd.l"
<br />^ddr\
<br />-
<br />'cgIdi',9r\E(no\ rrnntrxlxr. f,[,t,!]r!hl. l,, rhi\ In,j..r
<br />t"n"*)a{
<br />I
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