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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/srs.r'. 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 / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service Meter / /F|NAL 'l/ (/r// f /qllL .{f /t v
<br />Notes, Remar/d Etc.-' -
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<br />OWNIiR OUILOER DGLCARAIION
<br />I hcreby alirn unds p€n.lty ol pdjury lh,l I en .xenpl aioi rh. (onlr.cloB l,icens. Lau lot lhc followios rcen (s.c.70]l.s
<br />t usinBs d Prorstun Codc): An, ( hy or Counr, {nich r.qdir6 a pqmir ro co6rrud. alt6, iiprov., danolish or rcpat an}
<br />3'tu(r., rior ro ils i$ud... als r.qutB th. applicant lor such pqn b frlc ! .ilncd srar.mo( lhat t or sl'. i5 lico6.d pGUMI
<br />lo lhc rroisioN of rhc Conlraclors Licensd Ijw ((n.prs 9. comdcins $ith Sclioo 7000 of Divirion I oflt B6ins md
<br />Psf.$nrns cod.) or Uat h. or she is dempl thqefto,n sd thc b6is for the atlere! .rmprion. Any violalion otsdion 70lr l .5 t y dy
<br />applicant for apmil subj..ls lh. applica loa.ivilpe.ahyofnotrorc$mn!.hundreddolles(S500).
<br />-1.
<br />6 oNn6 ohhe ltropeny. oiny enrployB $nh rald 6 thct slc comFsalion. wll do dc s'ort md rh. sidc1re is not
<br />intod.d or oftd.d for slc (Sc 7044, Bsins ed lioftsions Cod€ Thc co ftcloi s LicN Ltw do6 nol apply lo d osnc oa
<br />llE lo!{ty who trilds or iqxov6 lhd@I! ad Nho d66 such $d{ h ro.lf or hNll or lltroush hG or hq ow, cmploy6.
<br />prolidcd rhar su.h in,,ovoflnls e. Dor inladed or olTel aor eL. Ii lDs'Bs, lhc hlildins o, idpol.md is $ld whhin on€
<br />'eroicohplaio.. the OMo B{iBd will havc rh. htrda ofFoli.s rht h.or slE dn nol build or inprolc rhe li.Fty for E purpoFol
<br />l. s o{nd oarlE prop6ly. am cxclBiv€lyconlBclios *rth hc€tred oonradou ro co6rnrcl lhc prol4l (56. ?044, &Ems
<br />dd l'rlfcsion Codc: Theconlractols Li.c.se Law do6.or applyro M osns otprorEny vho builds or improv6lhsmn.
<br />md Rho coni6G ior srch prljstsvilh a ConlEclo(s) licoscd r6udl ro rh. (onlro.lor's Licos.l$)
<br />I mc\.,npr undd s(tion .ll & PC ftn rltis rcaon
<br />D.rc: Ornd:wotxtrs'colrpmsalol
<br />IEQAAAIION
<br />I hdcby smm undd pqultyotpsjuryorconn follownr de.ldatioB
<br />6 prcvide.t ror b) Sdri.nlT00ofihc
<br />rhc bbor Codc. tor thc p<tumdcc ol
<br />-l
<br />cenilyrhd in lhe pdfonnmce of th. work for qtich this p€nnit is issud. I sh6ll nol @ploy my !.Mn in.ny odnd
<br />s s to b.comc subjsr h Inc m*6' coopdglion l.ws orcalaodia. ad a8r.c rnar ia l should be.o'n subjdr b tn
<br />\o,t6' omFa$rion pmvisioB olsdrion l?00 otrh. Lrbor Coda I sh,ll, tontviln co'nply *ith lho* previsioN..
<br />WARNINCT Failure lo *cre $ork6' comp€Nalion covmse 6 unlasltrl. md shall subjsl & cnployd lo .,ihi6al paulriB and
<br />.ivil lincs up lo on€ hundrcd rhous&d doll6 ($100,000), in addn b rh. con ofcomp.nelion. ddasd a provid.d fo!
<br />I h6cby omnn urdd pdalty o f pdjury $a! I d licc.$l undr Folision of Chapl6 9 lcommmcins vnn S.a1i.n 7000) oi Division l
<br />ol rhe B6in6 and Prcfsiom Codc, and oy li.*. s in tull rorc. dd eiler. '
<br />,r..,t.rrr.rtV-S04 z 691s-Fb:1t:tJ Contrsdor:X\
<br />COISAUCUO!.IENDING-AGENIT
<br />I hcr.by .ltinn undo penahy of psjnry lhrl ths. is a construcl ion lodins agency for the pdfof,nmce oI lh€ work tur which lha penil i6
<br />isucd {56.309?. Civ. C.)
<br />AITIICANLDTCLAAAIIO!
<br />I lE+ afm unds p.nahy of lojury onc of fie follo$in8 daldalionsl
<br />o@olnio. P.miis-Asbrsros Noii6c.tion F.d6al Rcsulations (-i itlc 40, Pan6)
<br />Required I!t6 of Noriicalion
<br />-l
<br />cdify tbot rhc fedml rcBulatiom ,.s&din! 6b6ros ,ono\ ai u. nor rppli.abl. lo this pojecl
<br />fufi, o,n, , n^.,-o,n* "lph.arion dd sr.,.,har e,b.re,ronnarrcn
<br />.td,nan.6turd \rrr. b\srbrinsro bu.ldmE .oNtucr ion. and hr.h, aurhoM
<br />ahn e 'n.nln,ul pfuIrlny nrnNpc(i()n
<br />,:;;;V
<br />0*.e&t22r'---Applicrnl or ,lg€n( Sign!lurc
<br />o
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