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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION
<br />I h.tub, dm.n xndfi,cnrh, or pcrjury rhol I 0m cxcnU ircnr rhe ConracroN Liccnrc tiw for rhc follouin8 rc,$. (S.c 70.115
<br />Busi:rcss mil Prof.\sion clilc): Any City or Counly whah rcquircs ! lxn r k, consfld. ,lrd. nnlfov., dcmlish or rcI)arr lny
<br />sroclurc. prior to irs issu.rcc. ah. rcquidr rhelppliclnr Lr s!.hFmir ro lilca siSncd slolcmnl lhalncorshc n lansd ,'urua.r
<br />b rhe ptuvnbis olrh. Co.k,cr.ls Liccnscd bw (Ch0ptcr 9. C.nrmtrcins wilh Sccrion 70m ol Divisi.n I ol lhc Ausirrc$.nd
<br />Pn,rcsio.r Cdlc) oi rhd rEor sh. is crcnq,t lhercliomrnd th. b.sh for lhc al lcscd cicmpr ion. Any violarion ofScdhn 7lrll.5 hy any
<br />atpli.ld lorapcnni subjarsrhc lprlicanrro acivilpcnulryofnol dx. rhrn fivc hu.dnd doll0rs($sur)
<br />l. !s uwmr of rhc popcn y, or my cmplqecs qirh wa8$ as rhci soL $il]co\qr ion. will da rtr sork md lh. nErE is nor
<br />inlcfrlcd or o,ltrcd rbr slc (SN 7044. lrusincs and t\.fcsn,ns Corl. Thd conk,clo! s Licctr* Llw docs nor lpIly l. snowndr ol
<br />rhc rmldy who hoildsor tlFoBs rh.No. ord wh. des sEh mli hinxclar hcr*llor rhrou8h his or hcr osn c'nPhyccs.
<br />providcd rtnr snch inrlroktunk m nor inr.ndcd or .trsdl for slc. ll ho\rcvcl rtf, hilding or nrlr,io\tnrnr k $tl wirhin orc Fa
<br />ofcofl!)ldior, rh.Owner Buiklcr sillhrw ln.l cnorpnrving'hrrrEorsh.didnorhuildorin{,rcvclhcImpslyrorrh.puqhsor
<br />-1.
<br />is ownc! of Ihc pml{ny. !fl c&lu\ilcly .onkr.r ing *irh liccn*l cotrt0cktrs ro mnnrud ihc pmFr lS( 7Oi4. Bu\i,tc$
<br />sfll ft.fssi,n Codc: Thc Conkmnn\ Li.cnsc Low dms not npplyro !n ownc' ofpnlFn, sho builds or inlltrorts lh.rcon.
<br />and who snImcrr for such p6jc.r\ sirh r contncron\) lic.n\.d lu*u.trr lo rhc Gnlr0ctoa s Liccn$ t,u )
<br />-l.mcxcmpt
<br />nnds Scclion-. B &PC r(rrhhic,rutr
<br />D.rer Orner:
<br />won{ElL(:oMPrNsaTloN
<br />DECLAAA.IIIJ!
<br />I hcrcty ailnm unds pennlryofncrjuryo*.rrhc nnbwi"g d&lsdriotrll
<br />I hdrc 0kl will nmiorain ! Ccn ificare of Consnr ro Scllbs!rc tu sork.n omp.nr*rnnr. as Fovidcd fq I'y Ser ion :l7tn .l rh.
<br />krxr C,xlc. lnrrh.pcrr.rntrn.coirhcwo,k forNhhhrhc lcnnir is tsucd.
<br />tc nnd *illnrinrain Norkcr' comFnsar ion insu!'me- as rcqut d hys rnr lTtxiorrh. L.hot Codc.I{tr rhc p.rfomrn.c of
<br />hn$nl My workurr .onlrtr* i( i'r\D,r.r.r
<br />'cr
<br />niklJrilicyfunrhcrrc
<br />-l
<br />ccnify rhrr in (hc pcrfo.tun.. of rlr sork tu which rhis tr nir n nsrd.I \hnllmr c'nphyany l.rron inro! manncr
<br />n, r\bbLom subjccr urhc sorkc6'con{cn$rion lawsofcallnmir- n,l rsrcrhd ill\hould tuonf, ubrcd rorhc
<br />w.'lc^ conp.nstrt i,'n nn,visi()n\ of SL\lnr 37U) ol rhc L$or C.dc. l shnl. fonhsirh $ rd, wirh rho* fmrhi.ns
<br />W?|RNINC: F.iluE b sccur w(rkcr\ (,nDcnsrbi.orc'r!c is unlnqtul. a shlll suhjccr a'r.mplortr t) oimimT Fnaki1 trnd
<br />civil llnc\ un ro otrc hundrcd rhou\rnd dollrs (Sl(X).fiD), in rd [n l. rhc_con of.o r H!c\ rs lr,rntcd Tnr rhc
<br />:::."ilj[lih{ (idc. inrrru( rnd dkrty-\ t
<br />Irx
<br />DECI,Af,{IION
<br />I hcrcby aafirm unde, F.alr, or r..jury rhd I m liNns'd undc. pr.vision of Chaplcr c (codft.cing with Sdtio. ?000) olDivision l
<br />of rtc Businc$ lnd Pr.tc*io.s Code. dd nyliccns k in tuu rorcc.nd ellsl
<br />,-**"",.-,O*k,6 D
<br />r+EIr{
<br />ClLNSlSl]l-IlQlLUND]-IQilElrllt
<br />I hcrcby aflirm nndd Fnally of pc.jury thsl lhse Ls ! onslruclbn lcndins ag.ncy ior rh. pcformna of thc uork ao. whkh rhi\ F.nril is
<br />issucd (Scc.309?. Civ C.).
<br />AfIUSANLDECLAMIION
<br />I lrrty o]Imr undcr Fnally of t tluty om or lh. rollowinB d*Lrar ions
<br />D.nslnion Pcrnils-Asbcstos Nolificolion Fcdeml Rcsulilions (Tnb,$, Prd6)
<br />-Rcqutcd
<br />LIIcr ol Norifrcario.
<br />I iryrhar r hc r.d.rnl rc$ l,r ions rc8ffnin8 .shcstos rcmv.l rc n l atpltrbk rorhispmjlcr.
<br />rhar I hlvc rcld thh lpplicsrn,n lid {a{c rhur rhc abrc nrrornurion n.orccl. l0r,a ro.onpl, wirh 0llCil, lnd Counry
<br />Srarc L!w\ rclaring ro hoildin! co.stu.rion. r,rd hcr.ht Nrhorizc rcprescnrdivcs orrhis Cirya.d Counrylo cnrcr qxrn rhc
<br />FIX {z{+111
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lire Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />l\/eter Release
<br />Rough
<br />FINAL bfl.0/a.SD 6ft
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />Service l\ileter
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