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ELECTRICAL.INSPECTOR RECORD
<br />DATE toisrG.COMMENTS OWNER BTIILDER DELCARATION
<br />I hcreby afirn lndcr Fnrlry {,f ncrj!ry rhar I d ricmlr fn,m
<br />'hc
<br />Conha.k,F Li..nsc tjR rrtr lhc lollo*itrg r{son (Sc.?031 5
<br />Busincss and Prorcssion Codc)r Any Cny or County shh[ rcquncs { Falil lo onstrucr, llrcr. imDmvc. dedolhh o! icprf dny
<br />ruclurc.p!6rrons issusncc. olb lcqltcs lh. lp,,licant ior such I'cmir ro filc a risred darcftm rhlr lt or \hc n liccn$d l,u.$a
<br />h rh. t'bvisnrnr orrlF Contnc(tr\ Lic.ns.d ti* (Chapr.r 9. comrcn.nr8 wilh Scdion ?tx)o of Division I o, rh. Burih..l a.d
<br />Pq)rc$ nns Codc) .r rhri hc or \h. rcrcn{r rhcnfnmsnd rhc hosn for thc llks€d cxcdpri.n Any violalionorsccrinnT0lr I by,ny
<br />/t$liclntlbrJpcm.ublcchrhcdlnhcanrros.nill)cnrlr)ntnom,,rrhrrrr.hundmdJnll0r\,110u,
<br />//,[", ,f *. ra" r.**. or ny cmnl.rrci s h ]a8cs,r Ih.i. slc con,r.nsarion. will do rhc $olk o,r'l rh. srurB is norjrdJelo..n rt,jro, 'le (se 7(,r4 Bu(mc{r rtul Prnrcsshtrs codcr Th. Cnnrodol\ Liccnsc Lav dcs mr aprly b rn.wmt of
<br />lhcrmpcny wno builds or impmvcs rhcNo. ard sto d{Es srch sod iim\elt.r lreltot rhough his ot lEr owtr cmpLyccs.
<br />pn,vidcd rh.t such inDrovcmnk e nor inrcdcd (r oflaE'.1 for s,c. It hoqcvcr. lhc huildir! or imnmrtunr i\ sld wirhin nic rr
<br />of co'rpLiri.n. rh. Owncr Buiud will hrvc rhc hunLn of pmring rhdr h .r shc dn ml buiu or iqmE lhc ImFny fo, rhc llrF,* oI
<br />l.i\o{n$.1rhctr,t^-.dy,rn,crclu\iv.lycoitr.rin8airhlicc\cd.o..n.hsnrc.nsndrhcDEicr(Se..r(}]J.Du\incs
<br />rM I'bh$a,tr Corlc lhcCotrlrrctofs Liccnsc t.iwrnrcs Nr rDrlylo rnorvncr.l pr.pcnywh. $uilds or nnpn,vcslh$con.
<br />rnd who $nt&t r{r \uc[ pRIL.r. $irhnCo r.rct,n\) ]i.rn\rd lusultri n,rhcG
<br />I hcicby ifilr.r undcr lcnalry ol !.rjury onc olrhc r.lloqin8 dcclaldions:
<br />-l
<br />hlvc trtrd willflrairhir 0Ccnilicnr..lCon\cnr roselt lnsurc ror snkc'r .u$cn*r (r1. rs ptuvidcd
<br />tjhor Codc.Ior lhc,rrfoinrrcc olthc wo* lor qhich ihc pcrmir is nsucd
<br />I h,vc.nd qillm0inlsin workcr' compcnsalion insu!.rce. rs rcluircd hyScc'i{,n1700orrh. btxrr c.d.,lor thc pcrloiin,nce ol
<br />llr wort forwhkhthis Frnil is hsu.d My workcr' onp.nsalion insuii'n.r catricr Erd Fli.ynun'b&dc:
<br />r:-Expirc.
<br />nrlhc lcrionunccollhc w.rk ritrlhich lhi\ pcnnl is n\ucd.l shrlldor.'hpk)y dny pc6o iDrDynranncr
<br />\uhj.c[orlr sorkcA cohpctrsirtn hwsorcrlinmi{ nndrfrclh ilr shoulJ hccom su},icr x]rhc
<br />sorkcrs comnrn\irionpDrisiotr\ofSc.rion.lTlx)olrhcLhn(id..lrhll.tunhrirh.otr y*ilhrhoelnvi\ions
<br />WARNING Frihtrc ro scurc qorkcs comP.nsdi.tr covensc ir unla*ful. rnd shall sohjccr dn.mtl.)k l. rininal,lctrrltts md
<br />srrtui. dnrmxcs ns ,i(,vidc{l lor rhc
<br />I hcNhyrftnnundcr pcn,hyolFrjuryrhal I m li.c.sdundcr prcvisionol Ch0plcr 9(coontocihg wirh
<br />of rhc Busincs Bnd hofcs\ions c(d.- d my lkch\c h in hrll r(tcc tLid .fit.r.
<br />l,i.rn\.( lrs:-l.i.c \o ND rlu
<br />ConlEcror:
<br />CONSIIIJCIIIINIENUIT(;.&CENI.:I
<br />I h.ichy aflnm u6df rn,lry of prlury lhal rh.rc n a conslrucli,.l€nd,ns lautrcy fnrhe pcrrormanlt .r ihc worl ntr whi.hrhn Pcir h
<br />nsued (S( 3097. Civ C.).
<br />A'ILICAII.IECIAAdPN
<br />I horrrydrllmr.dcr peMlry orp.rjury on orrh. tolk,wing dNlrdn'ns:
<br />Dctrxnirion Pcnnih Asb.sro. Noriicrrion ltdcrtrlRcguhrion\ ('lirt 41). Pan6)
<br />Rcluned krlcr ol Nolincalt)n
<br />lslrslor rcmval m ml E tltdbb lo lhG tmirl
<br />c lh rh. abov. infornation is coEccl. I lsrc ro onDl, wirh ill Cily rId C.unty
<br />ADpli.n orA8enlSiEmlum :"CI,4{s
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Slandards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / 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 & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Rough
<br />Service lt/leter it ../'l
<br />FINAL LQIT2 (whq
<br />Notes, Remarks, Etc ,I
<br />APPROVALS
<br />Ivleter Release
<br />lri{-. Ndn'c
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