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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />ht Standards
<br />S S Pool Fountains
<br />Si NS monument
<br />Life Sa i Low Volta
<br />Fire Alarm / Dam ers
<br />Communications Cable
<br />Buildin
<br />Under Slab / Floor
<br />Bondin / Groundi / UFER
<br />Transformers
<br />To uetn
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To ui menl
<br />Facto Wired Unit
<br />Walls Conduit
<br />Walls Rou h
<br />Ceili S Hard & Soflit Rou h
<br />Ceilin T-Bar Ros h
<br />Meter Release
<br />Rou h
<br />Service IVleler
<br />FINAL -t
<br />Notes Remarks Etc.
<br />OllN. I,R BtiIl-Dlll{ l)EI-C,\R,\l I()NI helcby a,Irm undc, I,emlry ol Frjury rhlr I o cxcnDr rn,n rhe Contmcros. t_ic. s tn* for th. rdtowins rcrson (S..70.I5
<br />ausin.s alx] Profcsi.n C.dc) Any Ciry or Counry whi.h mquncs a pcnntr ro co srd.r, ahq. impn,vc, d.mli\h or En!i, my
<br />(ructur.. Fi.rro its issuaR.. nlsn,cquncs rhc rpdi.nni r.r suchNrnnrk, rilc a \ismd \larcnrnr rh,r hcor stE s ric.ns.d r,trfiuorrb rhc poltiotrs ofrhc Cdftlcrois LnTnsd Ilw (Chaflc.9. Coi'n.ncirs wilh S.crion ?uD of Divixion:t or rhc Btr\incss atul
<br />Pmt$n .r Codc) or rhar lr or rh. t crcmnr thcrct.d and rhc t-t1si\ l rh.atkscdcxctrr,,tion Anl violsrionofscctiotrT0I5hrlny
<br />arrlicant for.Fmir subjals rhc aprlicnnr ft, !civilpcnalry.rnor nDlcrhon lirc hundrcd dolffi (S5uD.
<br />-l-
<br />as owmr or
<br />'hc
<br />pruFny. or Ey .mplorss wilh wdgcs as lhcn sb co'ry.nsdrioo_ $ll do lhc w.ll aid rtu srruiR s nor
<br />inrci'ded or oftcrcd ror elc (5€.?044. Busin.sr snd Prorcssbns Codc 'rhc CoDtr.cror's Li.cn* bw docs nor mnty to an owftr or
<br />rhc pDlrny *ho triiCs or inrl,m6 !lEd)n, sJ who dcs su.h trrt ninselfor h.rRtfor rhough his or h.r own cnptoycc\.
<br />!,rovidcd rhdr iuc,r impmrctrnh @ mr inrcnd.t or .ficEn for stc. lt ho*e& rlt tlitdinS or iqekmd n $b *irhu orc rdofor!,krion. r,x Owrcr Blil{tr wil hav. rhldcnott$vin8lhartEorshdAblt'iHo;iryNclncpn,lcnyatrrhcpuq.sof
<br />l. arosncrofrhc tmpcdr- imcxclusiv.lyconrEclins with ti.cnrcd conrrocroN ro..n{tuc[tE nmid (sd.7044. Busirc$ad Ptrr&\si,n Codcr Thc Conracrois Liccnsc Ldw docs nor ltpty k, an owncr ofpruFny *ho alius or impbvG rhcron.dn sho conracrs tor such poj.cB wnh ! Conlturon O ticensd puNnnt ro rhe Conlraclot s r_icensc L!w).
<br />;:":27i/
<br />l)a(l lR.t l loN
<br />I hcrcby aflnm und.r pemhyofpcrju.yde oath€ following dctmtio.s:
<br />-l
<br />have lrd will minrrin a Ccnifiql. or Co.s. ro SclatnsuE f.r workcrC oolEnsraon. B pmid.d tor bt Serion 3?m of th.
<br />ttrbr Code. for ltE p.rforurcc of rhc wo* tor which lh. Dc.mit is hsucd
<br />x,.",,,,,,Nill mairhir workcrs c.nrNtrr,krn in\uramc, rs r.quircdbvScctiotrj?ooofrhctrhor(odc.forrhc
<br />My *o*.r! conEnsdrnrn insurakc coricr..d roticy nrn$cr nrc:
<br />l.cnifyrhnt inrh.l. formak orrh.*ork forehth rhn Fnnil h isucd.I sh.ltnor cnfloyitryp.ro. innny oanrcr$ N lo tf,rnn€ subjcct ro rhc wortcr oq,cn{{ion h*sotCtrtir.mia, rtuj lBrcc rhar i slbutd becom subJc. o rhcsorkns.nmpcnsdbnF)vnbnsofSccliontT00oflhctitx,C.dc.tsha[.fonh*irh.omplrsirhlhornmlision(.
<br />WARNING: Frihrc ro ccurc workcB' compctrsd io $vcra8c is untjwtut. nnd $.
<br />ciril nncs trp b onc hundrcd rhousatrd dollan (SIu).(nO). i. addlnn b $d co\l of
<br />slhjd M c'npk'ycr x' qiniml Fnahics sn.l
<br />compcnsdn,n. da'nucs as nrcvidcd for rhc2#la:^:
<br />DFCI ARAT0N
<br />I hcrcby rfil,m undcr Ft'EIryol'p.dury thar I rn liensn u.dd Fotsion oiCnotrg 9 ($om"cins wnh Scclion 70(x)) oiDivhion 3or rhc Busincss,nd Pn,fcsions Codc. 0.d my liccns n in tutt to.e md c,Iccr.
<br />,r* 4
<br />C zo ,,"", *,,442 q9">
<br />(YINSTRT]CTI(}N I T,NDING GEN(:Y
<br />I hcrcby ariir'n onder F.ahy of prhry rhtrt lhc.. i! € onslruction hndhg asctuy f.r th. p6for@*e of the vdr( tor ehich this ljcmit h
<br />hsued (Sec.3097. Civ C )
<br />APPI ICANT DECLA RAI'I(TN
<br />I hcNtry dtrm undcr ,'cnox, or !crju,, onc of rhc rolowing dc.l,r,l ionr
<br />D.nnirhn Pcrmih-Aslrsros Nolincation Fcde,al Rcsul,!ions (Tnt 4,0_ Pan6)
<br />Rcqrncd blroof NorafE rion
<br />_l ccnify rhd rlrc lcdcdl rcSuldri(,n\ rcglrdine Nb.{os rcm,vat urc nor apptic te ro lhis rr+d
<br />_l.cnilt rhlr I luvc r.ad rhi\ rppliciri()n ixxl {
<br />ordirrrru\nod St.rc bw\ rularinalo huildins.on
<br />,}i,F rNnrbncd pn,pcnyi.r i[V,c.rn rttrrtoscs
<br />dclhrrlhc.lr,!c inrqnuri{,n i\.orrc.r I rlre t{
<br />nruclion..,rl hcrch,tru'horizc rcpr.sctrt n?\ or
<br />AppliGnl or ae SlEmluR
<br />E*z 7-6 -. .-1 <t
<br />i cotr{ry !nh aI cilrand County
<br />:".';)u;"
<br />B & PC nn rhn rcdlnr
<br />9' c"^^a* F--- -
<br />Irndcfs Addrcssr _
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