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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS rD/stG.COMMENTS OWNER BU!LDER DEI,CARATION <br />I hs.br amrm xnd.r poally ot Fju., rhd I m .rcdpl Foo ftc Co.raloB l-icd. lls hr th. lollowioE rcen (S< 70.r 1.5 <br />Busi.6s 6nd Profeion Cod€): Aoy Cily or Counly which r.qui6 a Fnn to .odtud. ahd. inFov., d.solish or Epan rny <br />srrudue Fior to tu isusq .lso rcqic rhc qDlicdr ror su.h Frm ro frI. . ssn d sralosr lh.l hc or rhc is licscd pu6uur <br />ro rn Fovi3ios of$c Co.rrrclofs Liccned Llw (Cn dc 9. ComcncinS wilh S..liof, ?000 oaDivnion I ofihc Busincs.nd <br />Prcf6ions Codc) or rhai h. o! sh. i! .rmpr $dcioo bd thc bosir tor Ihc llkscd dmrlior. Ary viol.lior ol SalFn ?01 I 5 by .ny <br />ap,,licant for a p6nit subjcls th. applic.nl to r civ il p.mltl o a not mor. thtr fiv. hu.drd, dolld ($5ql) <br />l. a owna ol Lhc Fop.dy. or ny dployG {nh s.s6 6 Ihcn sb ompasrion. will d. rlE *ort ed thc srnf,ru. is fr,1 <br />irlddcd or oft6.d for el. (sE 7044. BNin6s Md Ptoi6sioB Cod.: Thc Connadois Lictu. ti* &'6 not arply ro d ound or <br />ih. proFry wh6 hrild! or nFoB rhd6n, a.d who &6 sct sort timsclf or h6clf or lhrcuSn hB or h6 own clnployc6. <br />provid.d rMl such inFo@ls e nol inrd(l.(l or orord lor sk. I[ h.]€c, fi. trildi.8 or nnproraHr is eld wnhm on. ]q <br />ofNmpk b( lh. O*rd au d6 wil h,E ilE hrdo oaFovins rha h. or $. dxi rer trild or ih[mvc thc I'oFly for ft. nn oc ol <br />L a om6 oarh. Fopsry. m €xclusrrcly contraclin8 snh lic*.d co.rndoE ro cons d th. Fojd (s( 7044. ttiinG <br />d Eolesiotr Cod.r Th€ Contactor's Licms. Lr( do6 not rpplylo a osr6 ot p6p.rly rho buildr or idt rov6 rhaon, <br />and *ho &nt6.l5 lor such proj{rs snh a ContrNro(, licmsd pru@t to ihc Conlrodois Li.os. La*) <br />I M.r@pr und6 Scrio. <br />EOAEEAI,COIITEN,IAIIO! <br />DECIAAAUO! <br />I h6cby,mm und6 p6ahy or p6ju.y on. oflh. follo{i.s daltralioB <br />I nav. dd $illnaintain, C.niflcal.olCoMr ro S€la-lNur. for *ort6 comp.6alion. s pmyid.d for bySrrion1700otrh. <br />bb.r Cod., ror th. Faomdc. of lh€ solt for Btich th. pdnit is isu.d. <br />I har. anrl wiu mai(ain qort6 .omp.Barion ituursncc. 6 ..qutcd by Sclnrn 3700 of lh. Lrbor Codc. lor rhc pqfomdc€ or <br />th. "o,k aor whhh (hi. pdnn is is.l My16116 comp.Eri,Jn iNurecc c iq <br />'d <br />policy numbq m: <br />.-,- C.rprqr> \..r <br />Do11*L _ \- \-\qEprd v <br />I c61ily lh.r in tlt pdfomtu.. oath. { orl fo,r'hichlhispnnit i5 issu.d.I shall not.mploy any p.son inanym nq <br />e d lo bcco,n subjel to fic "ork6s ompdsion bws ol C.liioh,a. dd ,sG thd ia l should b.(onc subj<t $ ih. <br />worl6 comp.Nrio. povisioBofSa-iion 1700 ofrh. t hor Codc l sltsll. fonh$nh c.nply virh rhoe prcvilioE <br />WARNIN(;: Failurc to suc sork6' compoEdion covnrr. is unlawaul. ond sholl subjat s dployq lo siminal p.nalti6 afld <br />cilil fin.s up ro on. hundr.d thou@d dolla (ll((r.000). in addiiior to lhc cosl olco'trp.N.rion. damas6 6 provid.d ror th. <br />Sdion 1076 ol$c tihor (tde im6d ed alrom.y i 16 <br />c n---b-1;1- \s { <br />I,rcEttELcotI8 CIQE <br />DECIJAAIIAN <br />I h@by amd und6 pqulty oapsjury lhal I M licctrs.d undd Foririof, oach$lq s (conmming wnn Selion 7000) of Division l <br />of rh€ Buins md PmfsioB Cod.. &d my lkN i! in full foic. ald .ddr <br />G 4t1trt- <br />G-1a-(\;.".(, c <br />caNraucraxrENDtxl;_aaffrY <br />I hd.by olItrm udd Fnally o f dju) thit ih@ i. a oisrrudio. ladins acdcy lor rh. pdfolr@cc of rhc work firr { hth rhi! Fnn n <br />isx.d (sd 1097. Civ C ). <br />aftltcaNlD[clrta IIo! <br />I ho*, arim und6 paahy ol pdjlr) onc of th. follovinS d..lrarions: <br />Dc,nohion PmnirlAsb6tos Norincarnrn F.Jral R.gularion! (Tnl. 40. Pan6) <br />R<rrircd l.(o of Norifi!_ariofl <br />I cdify rhd rh. fdldil rcgularioB r.tadins abGtos ronoval tr. nor applicablc ro lhis projdr <br />I.slilyrharlharcr.adrhis.pplicarionmdsr.rcrhdrh.ahrvcinlof,ndi(,ni!c.ncci Ialreloco'nplyNirhall(irr.nd(iiun(y <br />o inancs md Ststc t-a$s ElatinS ro buildi.s coNtudion- and h6.br- authonz r.rrBdrahv6 orlhis Cny dd Comtyh dls utx,n lhc <br />ah!. mmional ,iop.ny for iNFction <br />::i:::.""';#I*-" s. <br />'*F 4'-- <br />r.> 4or\au\ <br />A-u-t-t <br />Site-Work <br />Underground <br />Li ht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Facto Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ce ilings (T-Bar Rough) <br />Ivleter Release <br />&ugh I I <br />Service Meter fl?,il \rt*,{ <br />FINAL I //slDE <br />Notes, Remarks, Etc <br />DATE <br />Pole Bases <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER