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E ECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light 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
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rouoh I
<br />Service lvleler //4//4 Wu,\)()*.MFINAL7l,l'tq v
<br />Notes, Remarks, Etc.r'l
<br />OWNER BUILDER DET,CARATION
<br />I hcrcbt afirn undcrycn.lty of pcrFry rhll I an c&nlPr rmo .hd C.nkacb^ Ltcnsc t w fo! thc follo*in8 ,eas,n ls( 70.1 L5
<br />gusincs and Proaessn,n Cod€): Any Ciry or Cou.ry *hkh rcquircs r ,f,rnil lo onsltu.l- olrs- inpovc. dcn ish .r *_p!ir d.t
<br />srtu.lr'c, lrior ro ns i$udnc., slrc rcquins rhc aprlicanr for such i'cmil to lilc a signcd stareft.t rh.r h. or shc is liccnscd lunurnl
<br />ro rh. tmvnions of rlt Conrrucr.ri l-iensci Llw ichafl.,9. c.mcncnrS wiih Scclion ?()()0 of Division I .l rhc Busincs 8nd
<br />Pot€\sion. Cdc) o. rhar lE or {h. n .x.nll)r rh€rcfron and rhc brsh for llE allc8cd excmflion. Any liolsrion orScdion 70.11.5 h, m,
<br />nttlicanrrorrp.mirsuhj..hrhc.mlicrnrlo0civilpcnlhyofrcrmrcrhanfivchn.d4dd.llm(35001
<br />_1. !s o*ier.frhc tropcny. (, oycfrplorf,cs *irh waBcs.s rhci solc conr,'.nsarion. willdo rhc w,k &d rlt imu n nor
<br />i'trcftLd or .ft.rcd r.r el. (Se.7044. Busi,rc$ md Proic$irtrs C.de Thc Comracrors Lkcnsc Ijw d@s no' 0ndy lo !. o$ncr or
<br />rhcompcny {ho huild! or inDmwr th.d,.. srd wlk) des skh *or* hinsclf.r hcrcllor rhmogh hi\ ot h.r own cn9loyes.
<br />providrd rhtrt such inll,rokmdrs e mi inrcndct or oresl for slc li b$cvd, rt huililin! or ir{mwmnt ii sld wilhin ore y(r
<br />ofcoflplction. rh. Owrcr Buitler will hlw rhd bldcn .f pn,ving lhd hc or shc dh ml huild or in!)mt lhc lmrEly n, tu loqrr or
<br />t. $ o*B or rh. lmt ny, or qclusivcly conrrad ins wirh licenscd contacbn ro .onsrucr lh. pn+d (S( 7(HJ. Busincs
<br />lnd Pmf.\shn Cone:Ihc Conrmtr\ Lic..sc I:* tl*s not apply ro uno*mr oapropcny who builds or inProvcs lhcrmn.
<br />nnd who mnhds lbr slch pr+cls uirh a ConrBcro(s) liceoscd pursEnr ro rh. Conta.tols Licctrrc L{e)
<br />I !'ncx.mpl undcr Scct
<br />CiVtCt'{0L
<br />t)l ( t. rr \ {)\
<br />I hcic$yrrnhnu d.i pctuiryofpcrlryorc otrhc nnk,pin8 dccllmri.n\
<br />-l
<br />hrv. el will roinrain a Ccnificrrc of Cod{nr () Scll lNUs f(tr sortda .omNnsai i,)n- ,\ pn,lnl(l ttr by 56..r ion 37(Xr of rhc
<br />tjhn Cdc- ior lhc Friolruncc of I h. wo* for *hich rh. tcm,i! it i\{cd
<br />_l hovc trtrdsill nfinrrin sorl.N .onlicn\didr iri{trrncc. d\ rcqutcd$y56.'ri,,n.l7(x)olrhcl}lFrC.dc.lirrhcpctlolnumcoi
<br />rhc worl tur whi.h rhi\rcnnir is ksul. Mrsorkcrs c.nlntnsrlion iNuraNc crtrierMdlr,li.y nxnrltr *c
<br />Policy Numbcr
<br />-Linircs
<br />-l
<br />rtniay rh in th. pcifontuftc oirhc work f(tr whEh this rcr.ir is issucd. I rhrll n.r cmploy ony lcrbtr in lny oanEr
<br />$ .s lo bccom subjd lo rhc worken co t{r.rar io. lrss orcallorni., lnd osN lnd if I stDUld t{rctr subjccl ro thc
<br />Borkcs conrpcnstionpmvtionr orseli.n lT0oolrhc tjhor Codc.l s\rll. tonn*irn conply si'h rb$ pmvisio.s..
<br />WARNTNC: Flilurc x, {cor sorkcrs ..nprns.rion.!rr.Bc r\ unllllul. rftl stull suhid tn cmFlolcr lo aiminal Pemhtus,nd
<br />ciril 6nc\ up ro onc hunnrcd rhors,nd dollic (Sl ).otD). in 0ddilion nr rnc co{ or conD.ns.rion, drnu8e\ us I'Dlidcd lnr rh.
<br />S€crion 3076 of rhc Lrr.r C.dc. i erca 1i)"CroLC^
<br />I hd.by amrn und.r Fnally ol !,crju.y that I am liensd lndDr pmvhbn ofChlprn 9(co.nrcnciB uirh Scdhn 70m) orDivsrn:l
<br />of rhc B!\incs lnd Pbrc*ions Codc. ed my liccnsc n in tull lore od cilccr
<br />CONIIIIT TON..LENDINC.{CI!.CI
<br />I hcEl,y affirm undcr Enaliy of Dcrjry rhar rtm is , consldclion lcndin8 lscncy tin rhc FdonrEncc of lhc wo.k for which rhis pfidn i\
<br />hsu.d (S(.109r. Civ C.).
<br />ATTLIT.ANI.DEEUTAIION
<br />I h.n:6y .RinD udcr llcnally of p.rjury om of rh. lolbwnrs ddlrdrions:
<br />Dcmlirion P.rmi'$Asbc(os Nolirrcdiotr FcdcBl Rqularions (Tillc.lo, Pd6)
<br />Rcquircd txtrft of Notitrcltion
<br />I ccnilyrl rhc tcdcrulrc-qrlrri{'ns togrdin! Nbc{or(trxtrildc nolOplicablc n, rhn pmJ..r
<br />-lccnilyrharlhNcrcldrhhrppli.,ri.trfldslrcrhdlhc$ov.irfornElioni\con.crl4lcrocomFlywithsllCnr.ndCou
<br />y
<br />orninanccsandShrcLuwsrelnrinsr.buildinecotr$fldnrn.{rdncrcbyluthnizcrcl)rc{rarn$otrhisCiryondCounlyro.nrcruIx,irlt
<br />,h,vc rrcnrhncd pn,pcny ior inspcclionpr
<br />.\pplirml or.\!$l Sirn lur.I lvicn Crttz 6 -7 -t7
<br />ID/SIG.
<br />trndcr 'i Nrm
<br />-
<br />hndci\ Addrc$
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