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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <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 />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFERA. <br />Torqueino <br />Sub-Panels <br />Air Conditioners I <br />Roof Top Equipment I <br />I <br />Factory Wired Unit <br />Walls (Conduit)I <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Rough /a4t7-il-/t ,//lr,*fr <br />FINAL <br />Notes Remarks, Etc <br />OWNER'UILDER I,)EI,(ARATION <br />I hd.hy amm undd ldally of p.rjury lhal I m .xcmfl foh lh. ( onlrldor' l,icena Lsw fo. lhc lollo*in8 r@. (Sa 7011 5 <br />Busind and Profsion Codc): Any Ciry or Cou.iy rhkh ratunB a Fnil lo conetu( aho. imProve ddrclish or cp.n ey <br />sruclue rrr ro irs &ue... rt r.quiE lh. opplicet lor such p€mn lo 6k a si8n.'j slalool th.l h. or sh. ir li.6*d FBU!, <br />1o rh. FovsioN of rh. Conrrci& s Lic.ns.d Law (Cnap'd s. ( omncmins *irh sdion 70oO of Division I oa$. BNi.as md <br />Prel€sionsCod.)orrharh.orshcis.x.mpilhd.iiomedlh.tEsG16rth.tll.s.dcxmplion.AnyliolarionofSdlion?011tbv&v <br />appli.anrlor0pmilsubjelsthcap?licertoacivilp.nahyolnolnor.lha!fivchunitrcddollas($t00) <br />I. s omcr of rh. FoFny. or m, .mplot6 with was6 s lh€n eL .omP6s3lio,. will6 lh€ *ort ad th. rnIIE b nol <br />inrdiddl or olt@d for 3.1.156 ?044. Busind ed Po f*ioN ( od.: ltu ftnrodoi! Lic@c ll* doB nol a,plv to d oMa of <br />rh. r,mFly who hilds or inpmrB rlE6( ,xt *ho &B slch w* himscll or helf or lhhu8h hb ot hs oE dplovcB. <br />providdl $d 3uch imp.owls 6. mt id6d.d or ofir.d Lt sl..lf. hosar. rlE hildin! or inpro!ffiiis Fld *ithin on. va <br />6f6dpldi'b. tlE 0\,.6 aui&r will harc dt hnda oaForing th, h. ot sh. did ml hrild or inProv. lhc FoDqty 6r ih. purF* oa <br />-Zl* <br />"*. r*. <br />"".-r. <br />m.\clrsr.l, conrmdins snh licscd codhdou ro coNrrucr rh. proj.n (s( 704'4. Bsin* <br />'and Foisbn cod. fi. Cunlr.(r or ! L'(cns. Latr dod mr apply lo e own( o r popfiy shD buil& or improvc rh66n. <br />and *ho contrads for such Foj.ds snh a Conlraclo(, licau.d pdrat ro rhc Cor Dcrr'3 l.ic@ h*) <br />,,,"^,EEP "rQ ""*,, <br />t)t.( t. rn \ llr)\ <br />I h(€by alfim undd p.nony of p<jury on. oflhc rolhvins ddldario6 <br />I hovc ad will @inlain a cdifiral. of CoMt lo Sclf'lNu. ad mrk6 comp.n3.ridn. s pnovid.d for bv Selion 1700 o f th. <br />t bor Code for lh€ pslolr11ec Dfrh. *ork aor "nich lhc ponil is Nu.d <br />-l <br />have and Nill mi.rai. vork.R comp.Balion i6unnc., s requi,.d by S(non 1700 of rh. ljbor Codc. ft)r lh. Ffommcc of <br />rhe wor! aor which thie pmit is i$Lrd Myworldi comFMio. tuurm. csnr dd poli.y nunlb r ac: <br />/ rl:l cdrty rhar m lhc p.rforliEfr. of lhc qort lor sh(h lhis psnn is i$ud, I shallnot dploy ey Frson in snv h&nd <br />' $ 4 ro bd on. rubd ro rh. u 0116 onpds tn Ia+. of C.lifomis. ed .sc rhd ia l should baon. subj<t to ttE <br />*0lt6'conpas.lionpmvisionsolSalionlT0oofrhctjtorCod.,lshall,lonhwnhcomplywilhltE*provi.ioB.. <br />WARNINC: FailuE lo c@ *!rt6' co,npqsalion covd.cc 6 nnla*ful. dd shall sub)cr M dplorq lo oininar FEnk ed <br />civil fir6 up lo onc nmdral lhouMd dollm {J|Oo,OOo). i. tddtion to lhc cos ol co,rr.Mrion. doMsd a Fovidal r'r ih' <br />(ide. i 6t ad in!n,.!t fs <br />2o <br />DrcLaEar.lll! <br />I h@by .ftrm rnd6 p6ahy of Fjury lhal I m licaE d unda Ftrvision of Ch'prq 9 (commacins wi$ Sdrion ?000) or DNi.i6n 3 <br />of lh. Bsins ed Pr.adioN Cod.. $d ny licce n o loll for ai cflal. <br />COIIIAUCIIANJ,ENtrTIC.AGEIII <br />I hs.by omrm und6 p.nahy of Frjury lhd th6. i' ! coNlruclFn k din! t{ncy for lhc Ffolr@.. oflh. mrk tur uhi.h rhi! Fmit i3 <br />is.d {sd.109?, civ. c.) <br />arIl.l(ANI.D[clrIa La! <br />I lEltry affmn uidd p.nal', o f Fjury one of rhc rolk]s'i.! d<lartriods <br />D.mohion PdrniG-Asb6los Norii.rtion F.ddal Rqulniions ('t'tlc,10. Pd6) <br />-Rcquncd <br />lnlsoaNorifi .dion <br />-l <br />cdify rhar rh. f.dd.l rc8ulnlioc Esedins Bb6los rdoval sc nol applrcabl. lo lhis pmjcd <br />lz#*r,r',1 hnvc rqd rhis applicaren mdsrar.rhd fic abovc infomatnrn s.odd I aare io cnnply wirh allCilt and Countv <br />!r. Ijss rchrins lo buildi ioi! ed hscby aulhon- cprMlativB o alhis Crty dd County lo dl6 uFn dE <br />abovc m6ttun.{ pmpeny lor <br /> pplicflrl or Agmr Sisnslurc: <br />/-1A-)?frrlt4 ^,", r/zqlz-r? <br />I <br />APPROVALS <br />Transformers <br />I <br />Meter Release <br />Service Meter <br />I.nJ..r Nrm. <br />-- <br />I <br />I <br />n