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ELECTRICAL.INSPECTOB RECOBD
<br />APPHOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />TransIormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners I
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rouqh
<br />Service [t/]eter 1 -L,/,/ltl t.l ll I
<br />FINAL 7{//1t ',u I
<br />Notes, Remarks, Etc I
<br />OWNER BUILDER DELCARATTON
<br />I hcrch, afirn undc, Fnahy of ocrjury lh l m cxcmpt lmm lhc Co.t,rri,6 t-i.cns ljw for Itu following rcaen rS(.70:11.5
<br />Busincs and Profcssioo Code): Any Cny o. Cou.ly whrh r.nutcs a pcnnil ro onrrru.r- alld, imp.ovc, d.nmlhh or rPrt any
<br />stucrxrc, I,i, to irr issumc. 0ho rcquias thc lpDlicuol lbr such lrrmn h fib a siBncd $arcrnol that lE or shc i\ liccnscd Puruanr
<br />k, rhc p vhioDs of rhc Controdols Liccn\cd Lrw (Chaplcr 9- Coddehcing *ilh Sccrion 7UJ0 o, Divtion 3 olrhc Burinc\s ard
<br />Profcr\ions Codc)or ih3r bcorsh. iscxcmpt rhcrcrtun and Lh.b.ris lnllhc ol lescd c xcmrr nnr Any vioLrionofsationTOll5 h, lny
<br />lmlicanl nn i !.mn slbj.ra rhc applic,nr ro a civil ,cnalty of nor mrc Ih fivd hundd dollais ($l{ro).
<br />L r{ oRtrcr ol llr fmlcny. or trr, cmplo}tcs wnh,rgcs a\ rh.ir $lc.onFtr\0rion. will do rhc wori end rh. {mrut i, tr r
<br />intc or ollcrcd a{tr eh I SL{.7(l'4. AusRs\ and ft.fcsions (lodc l'hc Contncxr's l,ic.nsc bw docs nor rPply ro rn o*Rr of
<br />rh. pnFny wlF t{ilds nr inrlF$( rlENn. ,trd trho dms such nn* himQlf ot h.r\clf or lht ugh hh or hcr own d lrlo}tcs.
<br />trovi'lcd lhar such imporlnrnk m dn inrMdcd or oficftd for srb lr. howcvcr. rM hikli',! nr nnpmvc tnr is $l.l wirhin unc )cr
<br />.f.onDlcri.tr. rhj Oqnc! Buildq*llhalc lhc hudcn ol provins rhli h..r\hcrlid,x, buildor im[orc thc pnDcny f rh.pu4rs(l
<br />-1.
<br />n\oencrolrhcnmp.nt,,mcxclusrvclr.onr(rinS wnh li.cn{d conlr trst,coi{fl.r rh( rn,l.ct (Scc. ?(!3. Bu\inr\\
<br />rM Pdlsirn codc: l hc Cotrlrad{tr s l.iccn\c I-aw do.\ nolrrply n) rn ownd ollr{cny $ho builds.r i'npmvcs rhcrcon.
<br />rnd *ho c.nrtucr\for\uchp(,jc.rswfhrCronh.nrns)li.ctr{dt'ursurnrlorh.G)nrrrcrtrll-ic schw)
<br />lrD,rx.nr un,ljS.cri(r .ll &l'( lLtrrlri $n,r
<br />I),r€ ()rnrr
<br />rrcatr[&r.CalrtlNsArr0N
<br />DECI.AAAIIAN
<br />I hcrch, llltD ondcr ImlryorNauryonc ofrhc r'ollowins dcclff(lioos:
<br />-lhavc&drillminrainaCenirrnrcofco.snrrosclal.surclor*orksi.\,mp.nstrn'n.,srr.vidcdforbySeclion.lT0oofrhcLftor Codc. for thc rcrfonMncc ofrhe korl ror {hich rhc nmir il isucn.
<br />_lhavcrodwillminnaiiwork.Bc.np.n\rlrcnnNunrcc.!sr.qutd$yS(rionITIX)ofrh.tjbotCodc.Iorrhcprnon x.nr
<br />rh. *ork lu lhichrhi\
<br />')(rm[
<br />is isucd Niy*orkcra corDcnlarion in\0
<br />4 k u)
<br />o'10 L
<br />-l
<br />ccnilyrhut inrhc pcrforroncc ofrh. wo.k forwhich rhrFrnril n nsucn. I\hallnor c Dlo!atryFrson in rnydanncr
<br />{, $ tu tr.o'ft subj.cr ro Ihc wo*c6' convEnsar ion llws ol Crliloriir. ,trd o8m rnar il I lhould t co,t iubjed u rtu
<br />wolkcs.onv.nsdnnrprcvGionso,Sccrion:1700otrhctrtrrC,il.,Ish{ll.,t)nhwilhconv'1,*irhrho*F)visions
<br />WARNIN(i, Iil[r b \ccu'a {orkc^ (ntrcD\ rtni .olcrrtc 1\ tth$t. rn,l \hrll stric.l ar) c d.ycr n' ci'ninal P.irki\ rnd
<br />r. onc hundred rhousatul dollars 1Sl(D.uD). in 4niioD n, rhc co{.r.omPctrstrio., damscs r\ Pdvid.d fin rhc
<br />u[rhc Ltrh,?c.rtc, lcrcn in,l drla\v{ *,
<br />DICL.IBII9I
<br />I hcrcby alftrmutrdcr pcnolly of rcrjury rhar Lfr lien{d undd Eovision olCh{lcr 9(commncins wnh scdion lom) ol Divhtr:l
<br />of rhc lrusincsand PmL$ions Codc. ud myliccnrc is in tull lor 3rd.flatr.
<br />. .62* rz-g5ZLo1
<br />,,,, s[.4 f] g ..,,,*,." l,4,tt ldl h"^tc,t 7(wnn
<br />s)Nuausu0NrlNDllc-&cEN(r
<br />I h.rby rrfinn undft Fndryoip.rjury rhar lherc n r con{tocrhn hftiine aAcfly ior Ihc !.rformrcc orrhc $uk nr which rhh Pcrmi n
<br />hsucd (Scc 1097. Civ C )
<br />AIIUCANTDEIIABAIION
<br />I llrt, lmo Dnd.i lEnahy of pcrjury o.c ofthe lollowins dsldarn'ns:
<br />Demlirion Pcrmirs A\h€do! Norirrarion Fcdcral RcSulorions (Tillc,l0. Pan6)
<br />-Req!ncd
<br />kucr of Ndifa.lion
<br />I ceniry rhar rh€ t deml rcSularions rcsardins asbcsror rcmval arc nol ,,'rla,bh to thh Imj.rl.
<br />-l
<br />ccdiry th0t I h8c @dlhk appliclrt,n ud s . rhar lhc.boE inrorndion h corer. l{8xe roonllly*ilh 8lt Cityaod Counl,
<br />SL duthorizc rcprcsnhrncs .t rhn Ciry,M c(Isi?L/L .1ra
<br />-LL
<br />Communications Cable
<br />K\'l-l ,,(,
<br />(\
<br />x /r'L-
<br />Gndcir Addrs
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