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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEI,CATATION
<br />I hcrchy ,fllm unicr pcnllry ()l r.qury rhar I e c\cm lB'm rhc Conkkb6 Lkrn{ ljs rix rh. n,lnlqinS rcaqh lsec ?0.11 5
<br />Burncss atut Pmlistun Codc): Any Ciry or Cornr, Qhich rcqurcs a lrmir t' .onnrucr, .ltcr. nnpovc. dem,llsh or (P.r ,n!
<br />dtuclurc. lnor nr s isnrlh.'c. aho rqur.r thc ,mlilMr n* su.h pcmir n, ik x (ilncrl slarcnEnl rh.r lr or sh. s l(cnqd puruanr
<br />lo lhc nn,vsnm\ ol rtr Co.tracrd s Li.cn{J bw (Chrtr.r 9, Comftrein8 *irh S.(rtrrn 7flXJ ot Drvisbn .l ofrh. Ru(in.sunJ
<br />Pdcs\io sC.dc) orlhal hc or shc is cr.mfl thcr.Ao and rh. hffn i,r rhc rlLlcd c(crnlri,'n Anyvn,hrn,nufsetionT0.ll.5hvany
<br />rttlrclnlntrapcmrirsuhjc.Bthc,Pnhcanin,rcivilocrulryornornu.lhuniiv.hunJrcdJolld!l$50o)
<br />l. ,s o*kr.ilhe nn,IEdy. or ny.mployc.s w(h w.!cs rs rhcr v,l. .ofrl.nsltion. will do rh. *rk flt rh. slntlN t nor
<br />dcnlcd or oilcrc'l for salc (Se.7044. Businc$ {n.l Prnisson\ Cdl.r Thc C.nt!.tn'\ l.ir.n{ Law d,rs not applv tr m owtur.l
<br />rh. I,lp.dy who ho ds or inr0nlws rh.rdrn. arxl wh) J(*( rkh u)* himscll or hc^.lt or rhnrth hh or hcr o*n .nllovccs.
<br />pNv,Jcdrhrrsuch inpn'rcm.r m norDr.nl.tl oroninJ l'()r kL.ll, fi'scvc., rh. htril]ry or inlDvcnrnr !s $ll wiihin ok )t*
<br />ol c.mpbli'n, ltr Osrcr Blnl]tr wil harc thc ttrtdcn ol pn]vin3 rhd h. or sh. tld ftn huill or inr{roh Ih. ln[tnv h. rtl Puqr,{ of
<br />l. r\owncror rh. an)T-dy. dr.xllNrvcly.onrra.tns w hl'(cn\.d(n r.dor b uon(rud rh. ln,jtrr (scc. 704r. Bu{ncs
<br />!'rl Pnf.$rm Ci)dr: I hc C.nkauntr s l-rcn\. I-rw Jdi nor {tly ro !n owncr o, lr)l'., ty vhi) I'u r lds or mpntvcs rhcEon.
<br />and who c.nrncknn su.h p1*.h wnh. (-onlri.h(9 li.cn{,1 Nr\o.trr h,rrrC nktcnri l-rcn{ Lnw)
<br />l,mcrcmnrunJ., sc!tron .A &PC l{rln\rcdt'n
<br />lhlc:-
<br />lyo86E85:COrlfENlArrAX
<br />UE!:IIISAIION
<br />I turrhy all,r'hxn,lcr pcnulry.l Frjury on. olrhc nnh*trrP JNnurlion\
<br />I h,v. a,*l w,ll mamrrin I Ccnni..rc .l Con{nr t' Scll l,Nut lar w tkcr' !{mrn\rton. !s Jhvidc'l fitr 6yS.crRJn.lTtro rl th.
<br />trhtr Gilc,16r rh. ptr,or.mcc otrhc wo t)rsl hrheFm s,strcd
<br />-l
<br />hnvc .n<l wrll mht{in workcr' .oryEn!.rion insurafrc, !s rcqurcl by Sd on 1?0O of I hc I jlxtr Co]., lor lhc lcdnmaNc of
<br />rh. wor* torwhf,hrhi! pcmrr i\ trnhl. My workcs .omtcnsllion iuura^_. .Micr a{ F,lry nthh.i m:
<br />cnlnloy lny Ilcson in any nrnrcr
<br />\h)ul'l h.conr suhjcct lorlE
<br />B,ikdr ron,Ertrr$trtn,r,\tr'n\olSc(rtr JTlx).lrhd lrlrn Lirk I nnrll.l'nrhw h. 'nPl,w hrl[r{lrl,rNon\
<br />WARNIN(;: IrIltrrc t' {curc *orlrcn (omlin\rrM c"vcrrtc rs unhwrnl. an,l "l l {rh]cd rrr cndorcr k, dmlEl Fnrlric anl
<br />' r,l r'nc\ ut !, ,{r I'uftlr.,l ,h,,u.rnJ J,nlr\ 'Jlu0.urr,.n i(l.i k,, r) rh. (on ol .!nl p.ns.rn,n. Jamg.s as llt(rvil.i in rh.
<br />Scrlotr :1076 nl rlk Lihtr clilc
<br />x ,,"
<br />!!qn-E^]!9!
<br />I hcrchy arrrnr rnl$ p.naltyot Frjury rhar I am ldn\tl unlcr provsbntlChaprcr 9(.onrmn.ine wilh SariJn Tuxl) orDivnnn 1
<br />ol th. Busmcssud Pruic$n,.sG)d., lul my lEcosc s in lull tuN.rrl cffcct
<br />O.
<br />CANEIA!]SIqNIEIUIICI(iINSI
<br />I hcEby alltrm undcr n€Mlryof ,.4ury rhrl r[m * !Nn(ru(rbn Enrn8l8.my lor lhc pedolr11m. of rhc wolk ttr eh'ch rtur Fml s
<br />nsu.d (s4 1097, civ c.).
<br />Irr,lr' \ JJF*
<br />AETIICAIIIIEII.ASAIIAN
<br />I hNhy afm utulcr pcnahy or pc.jury onc ofthc li,U,,wrns J.cld,r()nsl
<br />D.n itNn Pcrnnl$Ashedo! Noriticahon Ftdcral Rc8uUrinr ('I L40,Pd6)
<br />\ rtd'n! Nh.rr.\,.trI)vrltr'c norxptli(al,lc r, rhrs I'r)j(r
<br />ktr,rirl{rt rlrrrh..nrtrc lnor I x!r..n,srnnlr_ w hrllC yrtrJ(in,nry
<br />,v.s dlrhL\ C y rndCornryhcnro trFn,rhc
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />LiIe Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER )plr(14 r'-Y/,nV4et tzry)
<br />Transformers U
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service It/eler
<br />FINAL rpl l9ltor Ch+nw JfD
<br />Notes, Remarks, Etc.I ut
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<br />Lrnjq . N!tu
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