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ELECTRICAL-INSPECTOB HECOHD
<br />ID/SIG COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq i Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />It/leter Release
<br />Rouqh 5-r-ty b.%a
<br />Service lVleter
<br />FINAL ibzlrq lvat )
<br />Notes, Remarks, Etc.a(Tt
<br />OWNER BIJILDER DELCAR TION
<br />I h$cb, afrtro und.r Fnally ol !,crjury lhrl I am cxctrrpl rhm ttr ConlBcxrs Lreo\c tjs ioi
<br />'hc
<br />iollowinS lcosn (Sc.70315
<br />Busincss ud Profrss.n Codc): Any Ciry or Coul, shich rcquircs r Frnll ro con$d.r. rllcr, imtrovc, dcmlhn or elair lny
<br />slrucrurc, pritr to irs ii\ume. !k. rqunrs rhc q,plkn r(, such ltmir ro tilc ! sigrcd st0t.nEnr thal lr or shc is liccnscd punu@r
<br />k, lhc tmvisions or lhc Co.tsclols Liccnscd LIw (Chaptcr r). Comntncirs sirh sccrion 7000 or Division I of lhe Businc$ and
<br />Profcssn,.s Codc) or IhbrtE or shc isqcmpr thcrcfrom lnd rhc hlst lor rh( alhlcd crcmplion. Any viohlionoaScclion?{,.115 hy dny
<br />trrplicunr hr a Fennir subjds rhc lpplicant ro ! cilil p.nali y or nd m.m rhan fivc huturcd dolles 1S56).
<br />-l,
<br />rs oqrcrol rhc pmpcny. or mycnrphyec\ Nilh *agcs x\ rhcir y,l. c.nrtcnsnrrn. willdo lh. work md lhc sltrr@ is Rn
<br />inrcfrlcd oroltcrcd fir qL (Sd 7()ll4. Busirc$ d Bbrcsiotri C.dc Thc Conlro.toi{ Lienrc h* dc\ nor tpply t) nowftr of
<br />thctmFny who ioilds.r imDrcs lhcren. md who (ocs srch wd himscllor h.r{lror rhrough his or hcr o*tr cflPl{,yccs.
<br />[ovidcd rh slch iBpmrctunk d nor i,n.nddl or offcrd fn elc Il txr$$s, Ih( ttriklinA o, irr0mvcnrnl is $ld wirhin , 'k ,rr
<br />ol cohplcrion- rhc O{ rcr Brild.r will turw rhc hodcn .f F,vi.e ihd h. .r shc dd nr tflikl or imnmrc lhc nn,Fny for r({ puqxM of
<br />l. n\oqNror'hc pn,|xny. rnrcrctusnclycontr0ctins wirh liccn\cd conlrucror\ lo coi(tucr ihc pr(r..r (scc. r(!1,1. Busir'c\\
<br />aM t\trfcs\btr Codc: fhc Conrracttr \ l-i..n{ l-!w docs n.r rpply ti mown r orpiolcdy $ho huilds o! imp,orcr rh.r.otr,
<br />rnd who.onrrckntr\kh!ft,Jc.l\wirhnCofta.k,(N)li..n\cdDursurtrllorlrco)nlracr{tr\l,iccn{lnw).
<br />I rnickrfr unttursl{nfl .B &PC larlhi\r.rvr,
<br />Dat.:- _ _ o*mr:
<br />worx g*s clrtrlprtts,lrlx
<br />DE!IJ.8AfIOts
<br />I hcrchy dflnfr uid.r prMxy of pnjury om oflhc iollowing dalmrions:
<br />-lhlvcandBillnEinr0iraCcrrirKa'cofCo.sc(rr.s.lal.ixrcfdrworrcnN.pctrstrtiotr.astmvidcdforbys*tionlTmofthcL$or C.dc. for rnc nslormrcc o, rhe wrk for which rhc ncmi n nru.d.
<br />I hav. and willnrinrdir so.kcrr conrcnsalion insurrncc. r\ rcquiR'd hySmri{'n]700 ofrhc Llbor C1)dc, fttr lhc pc.lorutrc ol
<br />r' coarn tr\rtid nlurrncc.rricr lrnry nunrhcr Nc:Wr'-
<br />x Rt t-4 lt*
<br />;r rriiuic ro $curc so.kcF conDcnsrrior corcralc i\ unu*llrl. x \htrll subjc.l dtr .trPl(,ttr l,r c.iDn,rl Frhic\ rdd
<br />ut ro orc htrndrcd rhous.nd dollaG (Srllo.rxtr). in dnbn h rhc npcnsrrion. d.rN8cs !s poliddt for rhc
<br />HT':T"H-+,1 v
<br />DIIIABAIION
<br />I hcrcby ilttnr undcr pcnllry of pcrjury rhd I am licn(l unds pn,vistun ofChaptct 9 (connNnci!8 Nilh S\.'rion ?ofl)) olDivision l
<br />.r rhc Busi,rcs rnd Pmlcsios Codc. n nry liccnrc is ir ,ull n,e anl c'!91
<br />^'1 t( -blo oSa lg-i(
<br />COISIBIJIIIONIINDIIIjIIiENCI
<br />I hcFby nfirm undcr Icn(hy.tpcrru.yrhi h.rc is, oNrucrion hndinS aSoncy for rhc lerfqnu.cc ofrhc worr ror vhi.h rhn rcflnil h
<br />nsucd(s( 1097. ci!. c ).
<br />AIIIICANIDECLABAIIqN
<br />I ffi,t fim undcr p.nalryof pcrju.y orc of rhc ri,llowin8 d(hrart,ns
<br />Dc'n,lirtrn Pcrnirs Asb.s.s Norificrrion Fcncral Rc8un ions (Tnlc40. P!n6)
<br />RdquncJ I rrrcroi N,iifi(xri(nl
<br />I ccniiyrhd lhnvc rerd rhnrpplicdrnnrd {rrcrhir rfu !)vc itrtunn nr ls.otrc.r l aguh.oiidy$irhrllCilyind On'nry
<br />o irEmc\ a8l Srrrc liws tol,iigro ,ldinB consrDclion. and hcrc6y lurhnrir cprcsenrdivd .r thi\ Cny md Cou.tylocnlq Won lhc
<br />rMlc nxnln cd nroncny ior
<br />,\DDlirMl or l[.nl Siqmlu -S.t
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<br />APPROVALS DATE
<br />Communications Cable
<br />lccnilylh.r nrhc lcrlhflnrrccolrhc $ork fitrwhi.I rhi!tairnir i1(sord,l \lullnor cmt]hrrnyncrn)n in trny Nnu
<br />i, r\ t, h.roDr \rhJ.crr) rhc wortoJ.. rlicr\nri hw\ofcrhlnarid. itr(lr8r..rhrr ill d uld n(o'tu \uh.Jor Io rhc
<br />sorkc^.ompcnsrri{,npn'li\nrisolSc.rnrlT0OofrhcLrhrCDd..lshrll.nnh*irhcorllt*irhrho*f()visi(rN
<br />tf,nJc''\ AJdr\\
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<br />l.c'lnirh{ tl[ ftncrulrcsnlsli('ns rc!ardins ash.{os rcnn)vrl rr. orn ,lrt tc hrhn!rcis'
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