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DATE ID/SIG.COMMENTS
<br />Sile-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />s, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<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 Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough
<br />Service Meter
<br />FINAL 7-tz't?-'Ac z'.)
<br />Notes , Remarks, Etc
<br />l. as osncr or rhc lmtcny. o, my emplor€s wirh warcs ns
<br />'hcn
<br />wh conrFnsd ini. will do tlr qtrk md rhc srMUrc n mt
<br />i.rctrdcd or olttrcd fff elc (Sd 7{}r4. Busincs md hotcsion! Codcr l hc Co rrcroist-i.cnsch*docsnorlpplyio!n.sncrof
<br />rhc pmpcny wh) blikh or in{r.r$rlEftu. and rho d,rcs uch q)tt himsclfor hcrrll r rimugh nn or hcr own cm lrj_ccs.
<br />,mvidcd rh su.lr i'npi.r'fttrh *. n ificndd or ofli:Nl nn v . ll h'wc\cr- rhc hrilding or i.rpsvcnr is {)ld wirhi'r ond $tu
<br />ofcomplcrion. rhc O$ncr Auikc. willhoE lhc hurdcn oirmvln8 rhd hc or shc did nor l'uilil or irllPmvc lhc pmlcny ior th. I)uq-s of
<br />l. asowncrorrhcpR,r*ny, xncrclulivclyconrEcrins wirh liccnsd conrracr.n t, co.nDd rhc projccr (Scc nl,r- Busncs
<br />atul Peic{sir Co c lhcContr&tor's Lrcn* Lrw do.s nor qrtlyn, itrosn.r.fpn'p.ii!who buildi or nnpo(s rhcrcon.
<br />rtrd who co t"d \ tur su.h pnlccrs wirh r G)ntrrff( n licctrred punulnr ro rtu Conr.a.rois l.Ensc l-lw)
<br />I rNdcn!, ttrJ.r Ssrrotr
<br />-.l,
<br />& PC rbrl[is rca{nr
<br />D.i.: Orner
<br />wotxrns ct,upmsmolt
<br />DEII/SdIION
<br />I h.db, arfirn und.r p.nrh, ot Frjury ok ot rhc lollo* inE dalamti.nsl
<br />lhavcandwiuminrainaCcailurcofConsnrroS.lalnsurcforwortai.otrDcn\ation.asFovidcdlorbySccri.n.tToOolrh.
<br />Lahor Cq,q lor lhc lslbrmmc ot lhc wo.k for which thc lcrnn n ksucd.
<br />I hirc rnd willnunnri'i work.rr con{tr\rri,in if,\urrmc, a\ r.quiBl hy S(r ii,n .l?(X) of rhe l:h.r (]rd.. ftx rh. IidnnMtu. of
<br />rhc work for shrh rhn Frmir is ilsucd My s..kcr' conlPcnrlrt'n i.\urlncecrtricr and polty numbcruc
<br />-lccrlily
<br />rhii in rhc pcrLnmnccofrltr work inr ehrhrhis prrn n is\ucd,I \hrll n.l cnrpl()y rDy prrson ir !trynrDrct
<br />v, r\ ro bcom \ubjcd ro rhc Norkss conrtenerion l.$s .f Carilornh. and !E N rhlr if I \bould hccom ubjcd h rtf,
<br />w.rkcE compcnsrtion rmvisi{,n\ ofSccrion l7(Dotrhc l-ah.! Codc,I sholl n,llhwirhconDly wirh rho* rmi\n'n\
<br />UARNING !!inm lo scurc $.rkc!s'comr.nsalion $vcrrBc lnd sh{ll subiccr rn €mploycr ro FimiMl pcnahic\ ud
<br />rilil nn(\ uD k, om hutrdrcd rho,sJnd do
<br />s.-,-" rrn*r,r. /+"ca" -"-" -r
<br />,.,". a(e(t8
<br />^
<br />'o
<br />lhc con oi.ompcns,rion. d mScs 0s lrovilcd lnr lhc
<br />I h.rhy illirnruNlcr n!Nlr) ol |EiJUry lhr I undcr F)vision ofChapls 9 (commming wirh SNrhn 7(X)) orDiri\ion l
<br />oI rh. Btrsircs\ rid Pmlct(ions Cidc. jM myliccri\c,s
<br />LD
<br />t-l
<br />I hcrchy rinnr unrtcr pcnrlly ol'p.rjury lhll rhcrc.is !
<br />irsucd (Scc 1097. Civ C.)
<br />t.dir8 08cncy li,, rhc f.rfirnuncc oflhcaork lin whic[rhi\ trnrir i\
<br />dIILICAIIDICLA.EAIION
<br />I ltahy inmundcr pcndllyofpcrjury onc ofrhc tullowin8 dNlnmrions
<br />D.N,lnn,n Pcrmir\ A*.no\ Norifi.rrion Fcdcrrl Rdeuhrn'ns ('lirlc,l0_ Prn6)
<br />hcrrht rurhtrrr rctrc\.nturivcs of rhis
<br />,"r,4-, - t*-, t'*,,f,
<br />t., ",,,,, " .,,,,,"\**(/ttl*f-S/,,,ng
<br />n lywnh.ll CiryandCounly
<br />ciyotrd counyo cn,cr ull.n rhc
<br />'c/4,2
<br />ELECTRICAL.INSPECTOH RECORD
<br />APPROVALS (,WNER BUIt,DER DEI,CARATION
<br />I hcrehy ofinm undcr tcn(liy of pcrrury $ar I nm.xcnpl rtun thc Conrracro6 Liccn* Uw 16r lhc lollowing uvJn (Sc.70ll5
<br />Ausincsr lnd ftofcsiotr Codcl Any Cirt or Cou.ry shich rcquiri a Fnnir ro d,n{r.i, slr.i i'ryovc. d.mlhh .r rcp€i, any
<br />\rtucturc. Dri,r lo ns $uoncc. ol$ rciuircs lh. lPplka for su.h Fnnir ro filc r sign.d saicmnr rlfr h. or shc n liccnrd pursanr
<br />lo dc ,rolisioN ol rtr c.nta.ttr s Li.cn*d tjw (Ch!pte! 9. Comtuncins wnh Sccrion 7000 of Uilnion I .t rhc Blrjnc$ aod
<br />Prcicsiotrs Codc) or llldt lE or sh. is crcmpt rhcrtom atul rh. h!\i\ tur rh. alkgcd.rcmprio.. Any viol,io. ofScdion T0ll 5 by ray
<br />rprlicrnr f{,r, P.rnir srbrrcl\ rhc lprlicanr ro a civil pcnrhyofnol
<br />'norc
<br />rhan rivc hutrd,cd dollus (3500).
<br />txnd$ . A,ldrc*
<br />I It{|.'xlr.gLIrii)n\ r.ErdiDEr\hc{.\ rrnn]vrLrr nor rflrl.rhlc r) ihi\ px,J..r
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