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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)h- l'l-ly *,WN)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rough
<br />Service Meter
<br />FINAL 1-L- tg -lrt"-(rt>€r)
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />I hcrchy ,flnd trndfi l.ndlrt or prjury th l om cxctrpl fmin rl[ Conl'0clon t,iccnr l2q lor lhc nnlo*ing (+v,n (sN.7011.5
<br />Busincss ond ProLssiotr Codc): Any Ciry or Counly whi.h rcquirc\ a [rmir b .on(fl.r. rkcr. inwovc. dcmlnh ot Rimir .ny
<br />(ru.xrc. prhr io ils hsuarce. aho Eq nds ihd trpplicar for skh |{hnir to filc a si8md (atcnrcnr rhDr h. or rh. h li&nr.d ruisu r
<br />ro rhc pmrhions ol ltr Conl.lclols Li.cnscd Law (Chrprcr 9. Comnrctin! wirh Sccrion 7txx) of Division :] ollhc Bu\inc$ und
<br />Pnn!$irnsc{.)orIhrrh.n,shci(cxcnllrrh.4fn,nsndrhchNirrorIhc.llcgcdcxcmplion Any viollrion ofsdion T0ll 5 by rny
<br />lPtli.,d nn,Frmn sohjMh rh. iptli.n.r ro..i,,lpcnaltyoftror flbrcthin fivc hudlcd dolltrN ($5{x,
<br />-1.
<br />ns owncr ol lh. pmpcnr. or nry cmphltcs sirt wtrscs !r lhcn y,b .omp.trqrnm. *ill do thc worli a lhcsrulmismr
<br />inrcftlcd or ollcrcd ftr salc (Sd.7Gt4, ausim$.nd Aofcssions Code The Conrrrkr's Licc.e tiw (n)cs nol00dy ro an owncr of
<br />rhc0mlEly -lE ttrildso, inlmEs rhetn. mn sho dN such qo* himscll or h.rclfor rhmugh hh.i h.r own cmployc€s.
<br />pmvidcd rhar sx.h nqmlcnEnts m rn inlctu.i or oficEd lor slL 1,. hNeti rhc t ildinS or nnpmlcNnl is s,tl wilhin "nc ,w
<br />ol om0hrton. lne OMcr Bliher will ha!. rhc bonrcn ot povinS rh h.orsh. 'lid mtbuildor inprovc lhc pNpcny tor lhc plrtDe oa
<br />-1.
<br />6owncr ofrhc roncny. rn crclurir.ly contncring wirh liccnsL{ conrn nn r{, conincr rhc F,jccr (s(. 7041. 8u!rcs
<br />dd fi$f.ssh. codc: Thc Co.kr.rois Liccnsc La* doe\ nor apply ro atr.wnd ofrro!.ny wh(, huilds or in]prcld\ rh.ton,
<br />lnd who codruc( &r skh ,6jccB with . Cro mck"(s) liccnscd puisuonl rolhcConracbrrLiccns. bs).
<br />l mdc |n Dndrr Sccrirnr .A &PC hrrhnrcr\in
<br />ort. ()Bn€r
<br />]rcf,trlB,tr(]ltt! sA.rIaN
<br />OESANAIION
<br />I h.r.bynltrnr uNlcr p.nalty.i lE.ju.y om oflhc fi'llo*irs d6.'larornn,!:
<br />lhivc.rldpillmi.r.h0CcniararcofConsenrroSclllnsurctorworkch.onc,s iotr.us,,ovidcdhrbySeclion]T(D.rrhc
<br />Lihn C'odc. ,or rh. pontr.un& ot rh. work lor which lhc l)crmil n nsucd.
<br />I h,vcnnd wrllnrinrain sorkcrs compcns ion in{mnc.- !s requtudtysccrhnl7mollhc LahorG)dc. rorlhcrcrfornrkd of
<br />rh. Mrl ror $hich rhh r.n is hsudl M, $orkc6 co D.nslliof nron(cc.iri.rdd P.licytruNbcrm
<br />i. rhc pcrlblaunce olthc work lbr which ihi\ p.m,ir is '\sucd. I shrU nol cnrl,l.y trny per(,n nr rtry m,trmt
<br />\ubF-r hrhc sork$(.oryxrtr$rn hsr ofCrlrf.nria. itri agrcc rhxrifl sln'uklbc.onf uhlccrrolhc
<br />nslrionpmlisions ofS.cinnr lT0Oofrhc L$or Codc. I shrll. lon[*ilh cornlly wirh rh.{ Povhions
<br />WARNING l'rilurc b s.urc *o cri.otrtEneri,c vcm8c k unlnwful. md shrll suh]ccr an empbrr h ci'ninil tf,,trXic( t,td
<br />rprl finr\ utr h' onc UnJrcd th,,u..'n,l
<br />s-,,"" nr^,,r,h.rl", n,h i, -,"
<br />".,",e l,t ltu
<br />irioi k) rh. co{ oi .on,p.trrriion. draugcs rs Piinnlcd br rhc
<br />I lurhy Jl]ttr, undrr t,cn lryol F_4urtlhnr l iN I
<br />IIDCI.AEAIIAN
<br />undcrpmvisiono{Chaprd9lc(nnnEn.i,rg*irhSccli'nIu)O)of l)ivisi{n, l
<br />or thc Bu\n'c$ 3nd lrolrsi.n\(irlc. rtolnrv hcc \( n nr tulltur.c trkl.llt(l
<br />0116 2€
<br />lq L6
<br />I hcrcby 0mi!n uMcr Fmltyorpcrjury lhlr rhcrc i\ a
<br />isucd (s& l{)97.crv. c ).'rcrin' Ltuti ! ag.0.y li)r thr pcrthnrmc ofrhc aork tur qh'.h rhi\ Fnnil i\
<br />AfIUCANLIEI;I.AAAII{I!
<br />I hd.6y trfatrm und$ Fnally of !.rjury om o( lhe lollowins d€clarari.nr:
<br />D.mlilio Pdins Ash.ios Nolificnlion Fcd.r.l RcBulalio.s (Tirlc 40. PIrl6)
<br />-Requitd
<br />ktrn oa Noriicarirn
<br />I ir) r thr rL{$rl eSuldtions Esrdins ashc(os rcnDvll rrc norrpplicrbL ro rhn frcjd
<br />lhr\c rcid rhi\ rpplicrri,in u srrrcrhrrrhcrh)vrinfin r ur i(.drc.t lngNr,rcondyqirhrll(n
<br />t ?l{'lot o
<br />Pole Bases
<br />c ic'
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<br />I
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