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ELECTRI IINSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ,
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor ra
<br />Bonding / Grounding / UFER 6- il-ttr
<br />Transformers
<br />Torqueinq
<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 Rouoh)
<br />,FAl\ileter Release 6-lz-ttr 7-\j
<br />Rough ,A
<br />Service lvleter (o:-tt"IY
<br />FINAL ClLzltg _
<br />Notes, Remarks, Etc
<br />OWNDIT AUILDER DELCARATION
<br />I hcrcby 0fllrm under pcnalty of Frjury rhal I mcxcm nom rhc ConrrrroF Liccn$ Law ror rh. follosin8 E$otr (S(.?o-tl.J
<br />Busincs lnd Pmfcssio. Codc): Any Ciry or Count, shich rcqliE\ a tcdir b cun(rucr. .xu, inprovc. dcnrelish .r rcnut Jtry
<br />srrucrurc. riorro irs tsulncc- !l$ requt \ rhc arplicrnr rdr su.h lErmir b fiL a siBk{ narcnrnr thal hc o, ch€ is lid,hcJ lu*umr r
<br />Io lhc ,)mvnions or lhc ConlEctois Li.ersd Law (Cndttcr e. Comntnci'ls wirh s.ction 7(xx) of Divhion 3 oflhc lrusincss ond
<br />Prolcssiotrs Code)or rhlr t(or shc kcrcdfl rhcefon.&l rhcba\is ror rhc.llct.ncxc'ryrirn. Any violllionol Ssri,n Ttill t hy trny
<br />applicrnrturaFrnrir subh.rs ihc appli.ddl ro a.ivilpcndltyornor mrcrhin livc hundrcddolloG ($500).
<br />-1.
<br />as owncrofrhc nrolEny. or my cmnln)es * h {!3.\ al rlrr sk ompfn{Lon, wrt do rh. *""," t* *.a* t. *,
<br />inredeJ or ottcrcd lor slc (Sft.7o!,4. AusiBs nnd Prclcsions Codc Thc Contnckr's l-i.cn\e l,,e do.s..r amly ro.n uqrcrof
<br />lhc pmpcny wh, huiids or iDrl,n'ks rlrEln. and ulb d(E srch u)rk him\clfo. h.nclfor rhmlCh iris ot hcr ow.cnPloy.c\.
<br />tovidcd rh0r su.h impmEmnls aE mr inrcnd.n ff oaar.t ,or sh lt hotrcw, rhc hoildinS or imlmvcm is {'rd wirhitr o.c )lu
<br />ol coqihrt,n. dc Ower Auiuci *ill h0!. 'tr huni.. or p Jving rhd tE or shc dil mt hoiu or iqrot lhc pDp.dy ror rrr N4B* ol
<br />_l-!\ownerotrhcpopcnr.dmdrclu\ircly(ntacringwirhlic.n\cd..itrr.!ntocoonruclrhcrojc.l(S..7Or4,Btr.ir(s
<br />.fi1 Phfdli Codcr ThcContacror'( Liccis. Low do4 mr.,rplyro rnorncr.lri{,p. ywho build.or im,rrorcs rhclmo-
<br />s.d *ho conrructntr \u.h tniccB wnh , c(,rn.tn( s) liccnkd puhu4n rorhlConlrocroi\ l.i..n\c l-rw).
<br />I rmcrc inr u drr S..ridr
<br />(
<br />Irr.(I.i-utMu
<br />I hcrehy rllirm undcr ptnrlr!otI}.rloryonc ofrh. r(,1k,$nig d.clrrtrrtr \
<br />Ihivcondwill'mnnainrCcnirtolcoaC.n*nlroSelllnsulcnrworkcB conr!.nsdion. !s Pmvidcd f(rhrs..rion1700olrhc
<br />tjtitr crxlc. ror rhc FJroiiMmc of rh. uoik for uhich rh. pcrmil is issued
<br />_l havc alldsillnuinrrin *orkcn .onrFnsdrbn insurrn..,,a tuqutcdbySccrion.lT(x)ollhclihorConc.rorrhcFtr.rmrktot
<br />rhc ,ork tor which rhis ponir ir il\u.d My wortdr' conlrns.rb. iNUn rc cmicr and policy nrhbd ml
<br />lccnirrrhar rh. Fr,nrmrn.cofrh. qo* fo whi.hihh pcflni is nsucd- I fiull norcmploy anrrc*on in.try.rrifr{
<br />$ m to tE$nr subrrl ro lhc w()rls\' con{i.nslrion lnw\ofcditurnia, and r8cc rhd rrl thou}d hccorrc uhJccr h rlt
<br />sorkcn conpcnslrion pmvisn,n\ofSecrion l7m ofrhc lrhr C(xlc.I rhlll.lonhqirh conPly wirh rh){ Pmltnnr..
<br />WARNINC: ltilurc lo surc *orker( .onqf,n\rrn,h (,v.rasc ir unlnNtul. nnd shall subi.{l m cmplortr b .rn$nnl FMhas md
<br />(ivll filc\ W ri ,rc [trn,lr.,l rhotrsrnd,lollrrs i11(X).01r)r. i', {lJiri ] nr I r{a1Nrlkr,. ,rnrgc\ r\ t ri(lr'l li! rhr
<br />Scction 3076 ol thc tiho. Codc. inrer.n od a ormy \ r.{s
<br />DoLr Appliatrt:
<br />D[CI.ABAII!'!
<br />Ihcrcbyutfi nundcrrEnllry.fFrjuryrh0r I a li..nr\l xndcr pmvkion otChtrllq 9{conrtuncine wirh s€!ion ?000) otDilision.l
<br />or rh. Busincs md Pml'csions C!dc, ond my licen{ is in tull roG ail .fic.I.
<br />CONIIBITCIXINIENIIIG.AGENCI
<br />I h.rcby am,n u.d.r Fndyorpcluryrhd rhs. h 0..n{dcrion lcndi,E asency ror rhc lJ.rrom.cc orrhc *ork for wiici rht Frn r i\
<br />nsucd (Scc.1007. Ci! C )
<br />AIIUIANLDECI,I8AIITN
<br />I hodry aEin unds Fnllty of F.ju!, oN or rh. rollowing derd,! n .s:
<br />D.mlition Permir$Ashcstos Norificariotr Fcncral Rc8ulort,ns (Tirlc 40, Pan6)
<br />-Requtcd
<br />Lerrcr ol fiorirurir
<br />Iodifyrhnrrhcf.dcr lrc8ulirio.s rcE3rdins ishcn.s renFvrl arc norrpplicftlc k, rhillnrF.r
<br />l.e(ilv rh.r I lne rcrdrhi\ iftli.xrn a nir. rhxr vc iDrarnhriotr is.oncd l rAreroconrplywirhall ciryr d (tu ty
<br />onlrfrn.c\ rtr(lsr c L:rtr\ rc]!lir! r) builtli',9 aJd hcrcby axrhorizc rcpescnrn'ivcs ollhis Cny and C.unryt, ctrrct u,rin'h.
<br />rbrvc n{Drnnrd FioFn! ntr nlt)ccr
<br />,\rplir nl or \a$lsixn k'rt
<br />""*U*,,.",rn.,,, P4If 4a- i4xwr(E€?*..,#!'
<br />Vlu.t)
<br />E.r4tt)
<br />.</4(fr,
<br />Canir
<br />I (cn\c ( lr\s: Lnrf\r Ntrnrl{r
<br />lhr(
<br />L(Flci. Nrmc
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