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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding i UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough
<br />Service Ir/eter
<br />FINAL /c'9- /O ^.UzldA /av)
<br />Notes, Remarks, Etc
<br />OWNER AUILDER I'ELCARATION
<br />I hcrcby nfltn nrdfi pcoalty ol pcrjnry rhr! I d.renfl rmnr rhr G,nr,do^ Lrrtr{ tjf, lor rh. lnllo*rnp reron (scc.70ll.5
<br />aurtr'c\ Mil Pro,c{mn rod.r AnyCtr, or c.unD chf,h rqu'r. L Fmr h mn{rulr. alrcr, rmnro\c. drm[\h or Npar 0n]
<br />strucrurc,rmrtons issuatre. alw rcquircsrhc 0odicanr lor suchpcflnirto filcastnci srlrc'ftnr rhar heorrh. ir li..6scd llmanr
<br />ro lh. pmvisions ofrtx cotrlracrols Lic.trscd Law (Ch,Icr 9. conlmcNing 'iih Sccrion 7000 ol Divhion 3 ol rh. Blsines ,nd
<br />Protesions Codc) or th.i hc or shc n cxcnll)t thercfrom and lhe bnsh lor lh. allcscd cxcmplk,n Anyliolarion.tScdi.i 7011.5 hylny
<br />!ptli.d, for a pc,mn subjecls rhc arulica ro acivilrnalryofnor morcrion fivc hlnd,cd d.llur ($5()o) '
<br />-1,
<br />as o*ncr of lh. propcny. or nry c'nployes qith r08cs as thcn sE .ompcnselion. $ill do ltE emk u'd dt Morc i\frn
<br />inrc.ddl or ofi.,rd for $ic (SL!.7044. BNituss rnd Ptuf.*k,tu Cod.: Tt Conrmto. s Liccn* uw docs ,or amly io an ow.ci of
<br />rhc pmFny *ho tnikrs or inpmks tlrtun. and wlrl dG s.h trd( himsclfo! heMlf .r rhmu8h hn or turown cmflloycc\.
<br />Fovidcn rhal surh in{'mvcmtu N ml intcndcn or .frcEn for eh ll ho*cvci th€ ttrildinE or iqmEE n eB {irhin onc ycar
<br />oi co,raklion. rhc O. mr BuiHs will hovc ltr burdcn of lmvin8 thar hc or shc dil ml bliki or tnpht tnc pmrqiy iot rrt puF{ or
<br />l.rrowtr.r.lrl[pn,p.ny.Nrcr.lusiv.lr.oftnnngsirhli.ctr{dc.iri.ro6rocrnnru.rlhcpr.j.$r(Scc7ll14.Bulnc\r
<br />und i\ofcsirn Codc: 'l hc Conrrrlors l-iccn\c l-ae docr nolulrrly ro an osncr otrmpcdt *ho huild\ or inDrovc\ lhri.on,
<br />nnd who co acrs for \trch pn,jcch wiih a G,ntacbn n liccn\cd pu^unnrhrhdContr.rofs Liccnsc ljw)
<br />-l
<br />d crempt u.d6 S*rion- B & P C. to. rhis rcason
<br />Drl.r O*m.
<br />]!1latrEls:1:0llt[NtarlaND[cl aa.uQN
<br />I hcrcby a0nh uMcr p.nalryofFrrur) oft.t rhc followirB delnrdt \:
<br />-l
<br />hnle !.d will mioruin a Cenificurc ot Co.enr ro Scltlnsurc lor sorkdi coop.nkrion, s{ rrovidcd tu by S.rlion 3lLU of dc
<br />tit r Codc, for lhc FriornEmc ofihc wort for whi.h lhc rcflnil t issucd.
<br />-l
<br />hrk rDd *ill 'rainrrin worlcri conlcnsdion insurrm.. N rcqui(dhyS.dn,n.lT0OofrhcLrhn,C..lc,forrhcpcnnnrftc.f
<br />rh. work for whichrhir prnnir is is\xrd My sork.d.6nrp. \rrnrn ir\uran ccMicr,rl pol'.y,runrb.rrc:
<br />/a l rcn i l) rhar rn rhc t'filorroncc of rhr * ork lor which lhis pcirtrx ( hsucd. I shall nor cnploy an, pc^o. in any mtrmr
<br />' q, s\ x, bG.n r \dhFr L i rhc * rlsi .onpcnqrmn la*i ot Crliadni,. 'nd agn. rhd if I snouh h..om slbjd ro rh.
<br />sorkcn.\,np.nsario.poli\i.nrorSdrion1700orthcl-lt{iCodc.!sh0ll.fonhwirh€nrrlywirhlhospmvhions..
<br />WARNINC t.ilurc Io w!rc ro.kcs'compcnsa .ovctuAc n unh*1irl. md shJll suhirr Jn cn,lloycr b .ri inrl o.tuI'ic\ i ,i
<br />civil lines ut lo o* hundrcd I
<br />Scc'ion]076 oalhc Lanr Codc.
<br />00.1xx)r. ir iddirtnr h rh. corr ol con,pctr\riion. drtrusc\ r\ ptuviJcd f{tr thc
<br />,,",G-G- 16
<br />I hcrchy.lrirr undcr pcnalr, ofpcrru.y I rm liccia\l undcr prcvnion.lChrprcr 9lconnrrncing *irh S.cri(r 7{n0) ofDivi\nr 3
<br />of lhc Ausinccs ntul Profc$iurs Codc. and my iiccns ir ir tull ,irEc $d cliacr
<br />I hcrhy nfiirm ondc! Iroalt, oa pcrjlr, rhlr
<br />issucd (SN. :ltr97. civ. C )
<br />ru.rion bndirg agcicy f,n rhc pcrfornrn.c ofrhc work lor*hich rht Fanii is
<br />APPI ICANT DECLAR,ATION
<br />I hs$y !trm und.r F.rlt, ol Frjury onc of lhc folloving d..lrd iotrs
<br />D.mlirion P.rnirsAsb.rlos N.rificlrhn F.dcBl R.e!ldlhnr (Tnb rr0, PM6)
<br />R.quircd b!r$ of Nolilicarion
<br />ldr ,.
<br />'cal rhi\ lltli.ari(,rruxlinicrh r rl[rh,r. inntridir)n is.onccr lrFrctucomply$irhnllCiryindConnry
<br />I rtr\ ftlrri,rg k) builthtr!.o {tu.rnni.JJd h.'rhJ rurhnn,. rrm$nhr'v.r ofrhr C'ry md Counry rocnrc' uIInrtr
<br />t--,.r.,..-a'a#G- r.- rS
<br />(orE ru €A.--€' J
<br />€-p--.'--n
<br />Ldcrnl rcsulrrion\ rcEurdins lshc\r.s rcm.vrl ffc nol q,plic,hlc n,lhi\ !ri,jd
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