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ELECTRICAL.INSPECTOH HECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ce ilings (T-Bar Rough)
<br />Meter Release
<br />Rou gh
<br />Service lvleter ,/1 ?\
<br />FINAL lnhttlV\"Nry'
<br />k({-'k I
<br />Notes, Remarks EIC.
<br />6-L _t{
<br />OWNER BU!LDER DELCAR TION
<br />I hcrch, dllim hncr penalry ol pcrjury th0r I an crcmpr from th. Conrracro6 Liccnrc ti* fo. th. a.lloqir8 rcasn {S.c7011.5
<br />au\incs\ atul P(r'c$ion C.d.): Any Ciry or Couory whi.h rcquirus u pcrnir t, con{ru.r. nlr.r. infrove. d.rmlish or mr)an My
<br />srtu turc. prior ro ils i\sunftc. rlso Equncs (hc.ptlic,nr ro, such,rmfi ro 6lc 0 sieftd slalcmnl rhal lf, or she is liccnscd lunu.nl
<br />b rhe pR,visbns or d€ Coir,acrqi l"ienscd ljw (Chalrcr 9, G,mmencinB wirh sccrioi 7(Xx) or Division ] .rrhc Busincs rnd
<br />Pn,fcssons Codc)orrhat lEorsh. h cx.trrfl lhcrcrrunMd rhc basil ior rh. alLlcd .x.mprion. AnyvidalionotScclion 7011.5 byany
<br />lppli.ant lor.Frmir subiL.lsrhc rtplicant ro a.rvilp.naky.rnor fr,c thln rirc hundrcd doll06 ( C500).
<br />,M*owicr of rhc pDlicny. nr.ry cntll{,J,e\ wirh sngc\ rs thcn $b compcisarion, silldo rh. *mk r*l lh. {mrr. ( mr
<br />or off.rud for eh I Se 7O,1,{, atrsim\s Md Profc$ions Crxtc 'l h. Cont..tof s Liccnc L.* docs nor lpply ro on oumt .i
<br />rhc ImFny *ho liilds or ir{reks rhemtr dd who do6 such $nrk hi'nsclf o' hcmclf or rhruu8h hk or hd o*tr cmoloyccs.
<br />nmvidcdlhor su.h impruvc'rcnh@mr inlcndcd orolttrct fo.$h ll. houcrci rhchiHinsor iqmveftm is$kl{i(hinoft }tr
<br />or corq'lcli,n. lnc o*trcr Buildcr will htrK
<br />'tE
<br />hurdcn of rmvin! lhd ft or shc dil mr buitl or inpmvc 6c FmFny ior rh. puqnc of
<br />-1.
<br />trsowmr ofrhc pmpcny. !ncrclusivclyconrrodi.A Firh liccnkd conrNronro consrrucr Ihc rrolcr (Scc. ?04,r, Burncrs
<br />ud PFf6\ionCod.:TheConrruc'olsl,iccnscl,awdosrtrorlpnlyro0no*ncrorpropc ywh{, boilds .r ihprov.s rhcico.,
<br />lnd sho a,nrn rs r.r such p$icls qilh . Con'm.ro( $) liccn{d pursuanrbrheCanroctoisLicensc tiw).
<br />I hcr.hynrlir rutr{|., r xlryof tf,rrtrrv.icolrl[ lnllNi"g (1..h'nrn)
<br />I n vc ,ni will minrrir d Ccnirtr.ic of Consnr h S.lalntue fd sorkcH ..m!cns0r ion. $ Fmvdcd lor hy S€l ion l 7($ of rhe
<br />Itrhor C.dc. for lhe lcrfor.sftc of rhc w.rk t.r whin lhc ,.rn1n i\ nrxcd.
<br />lhlr rnJ sillnninlri', workcr! comrcns3rion i'Nurancc- a\ rcquncd byScdbn.lT0Oolrhc t]b.rCod.. lnrrhc pril.rnln!.c.1
<br />rl* sork l,r *hichthi\ pcnnn i\ is$dd Myqo c .onln.nllrion in\urno cDrid dllricy trtrnlbcr rml
<br />tuL'i,, * -",__ ",". "**\n o\ t' hcc,nrx luh]ccr h, rhc s,ilcr mrnncnslion
<br />-ErPircs
<br />uorkcr .onDcnsarn'n pft)visi.ns oiScdion lTsrol
<br />hi.h rht F.rmir i nsucd.l shallNr cmployrnyp.rcn hany nrrnn.r
<br />lass olCrlifonrir. lnd uruc thal if I shoul(l bc.onE \ub,&r k,rtu
<br />rlE tahor (.odc.l shJl. hnhwilh conrply unh lhos lrovhior\
<br />WARNIN(; Frilurc ro {.urc $o c.\ corp.n\dri( c.k.rtc i\ nnxslnl \hrll{,hi(i r', c oy.r t, dnnirl
<br />.ivil lin.\ uI b onc hu rcd rhou\r dolhn (SIlXl.lXl)). in t, rhc coi of..mfrtr\di0n. d
<br />::::'ltli4K
<br />I hcrcby amnnutucr Icnlhy ol r.rjury lhol I am licnsn undcr povtion ol Choprs 9lo'nmmnrs wirh Scdion 7(ro) ofDivi\n,n.l
<br />.l lhc Busincs and Pftrfcsiorr Codc. trd my lic..sc is in lull fore uld rfi.cr.
<br />Licensc Nhhcr
<br />Corl...1or:
<br />CQN$IAI]CIIQNIINDINC.AIiENCI
<br />I hcrcl,y aafi,mundcr pcndr) olFrjuryrhar lhcrc h ! consrDcrt)n kndins ascncy tx rhc rdrortuicc or$. work ror whi.h this l*nnn is
<br />i$ucd (Scc 3097, Civ. C.)
<br />ArfLrc NfDE!l,l8d.Ia!
<br />I hnby,llm u.dcr pcnrlry orpcrjuryonc olfic lolloNing dccldariotrs:
<br />rlcnFlition Pcnnils Astrsros Norifirsri.n F.dcrnl Rcsulnri.n\(-lirlc 40, PdO
<br />-Rcquncd
<br />lllrcr oa Nolifi cnrion
<br />-l.crriiyrhar
<br />rhc fcdcn'lrcgulurions rcgnlin8 $hcsro\ rcnFral!rc nor +plic$lr r, rhi\ prt,ilr
<br />Mlkl**'lu;:'-tli"?*ffi l,,tt;i:rcthll thc x'vci bnn.tion i\comd Ilgret,..mj,ly
<br />ioo.,rl hcrcby.urh.riz. r.Itr r.nh'ncs ol rhn Ciry
<br />tr)k tr,rtrr(nrd I'o|.nr- ntr id\tc.ri(nr f trrr\r\
<br />aPPti0nl o. aa.nl sisnartrrc Nla
<br />lod Cormy ro .nr.r u[x)n rh.
<br />+l$Jte
<br />I
<br />W
<br />DATE
<br />Under Slab / Floor
<br />I aJr''.
<br />^JJr
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