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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS OWNI]R BUILDER DEI-CARATION
<br />I h.rcby amn. undq pdalty or pcrjury rhar I d e&ofl fre6 th. contadoE Lic6s L.w tur lh€ followinS t@. (Se 701 L5
<br />Ausin6s and Prol6sio. Cod.)r Any Cit, or (ounly *hicn rcqut6 a psnit lo contru.l, ahe, imprcv.. dsnolish or Ep€t ey
<br />studs., prio. ro irs bsnmcc. also rcqut6 lh. .pplicanl for such ,<mi lo 6lc a signdl sralomt lhar h. or slE b licos.d PIIMI
<br />lo rhc provisiod ofrh. Co.r@ror's Liccn*d LiN (chaprd 9. Comn.ncins Nilh Scdion 7000 ofDiririo. I oflh. Bci.N md
<br />Pml6sions Code) orrh.t h.orshc is cronpr lfig.iiom ud rh€ lEsis aor rh. allc!.!.r@Fio. Anyviol.lionofscion T()ll 5 by any
<br />applicanl for a Fon subjcds rh. applicd ro acililpc.a[yofnor more rhan fi\.hund,.ddollas($500)
<br />l. 6 oqn.r oathc pmFny. or Dy eoployes with wdrd s lhet $!c smt dsal ion. \ ll do lh. \orfi and rhc nrucl@ n et
<br />inrerddj or o{!s€d lor slc (Sd.7044, a8in6 and PrcfBio6 Codc Tn. Conlrelois l,i.dse lrN do6 nol aptly ro m own6 of
<br />rhc pmFry w[o Ltuilde or impmv6ln.on. ad vho do6 such *!* hins.lt or h@lf or rhmugh hjr or id ovtr c'nployc.
<br />nrov/.d rhar such rmrro\ffF ft nar mrdl(H or oFsrd ror el. !( Ib$.$, $. &ildins or improvaot is sE Nnhi. one )@
<br />r otlmddnn. rh. ()\L nd B!,BE $ill h.\ e rh. hrdo nr rovins rhd h.6r sh. did d b{ild or iq,or. lh€ Ptopdy tur lhc plrrrs of
<br />U[kt
<br />'Vll,6o$nft.rrh.propsl,.Met<iu$'.lyconrra(Ins{irhli.d*dconlretoutoconslrucllh.p.oj..l(S<.7044.Bains
<br />and l\oa.ssn Cod.: The Contacroas Licmsc Lr* do6 nol spplylo an ownd ofp,op.ny sh. build5 or inpro$, thddn.
<br />and Lvho conhacts lor srch roj..ls \1(h i C.nrm.tn(s) li!e.s.Ll pu^udr tu rheconrackx-s Licme Las)
<br />OECLATATIOX
<br />I hercby amfln unds p.nallyoapdjuryoncoarh. aollo*ing ddl .rions:
<br />I h,v. and s,ill mai.rain r Cdificar. or Consi ro S.ll-lnsure for r ork6 comp€.slioh. d Forid.d for by SElion lr({ ot lhc
<br />libor Cod., for rh. pdfomd.. of th. sol{ for which rh. Fenn b issu€d
<br />I h.veond\rill rnninlain worklG conpc6ation ituurucc, s r.qun.d hys(rionl700oflh€ LaborCode. tor rhc pdfomd.. of
<br />lfie Nork tor which lnis pmir is ised My $ork6' .orp6.rion insurdre c.d6 ad policy nunb( a.:
<br />Cui6:-
<br />/y.::
<br />ry thar in rlE p.rro' anc.orrh.$o* aorrhichrhispdnrir isissued. I shallnol€nDloranype6oninanyhmnd
<br />mp.nsotion l!\rs ol( alilomia. and trs@ rhar ill should h..om. subjal ro thc
<br />i01 17u0.,rh€Lrt!'..Je, I \hdl'. f,.nl's h(omd\ \ihrho*rrcrsi"n.
<br />v' 6 ro becofrc sulrat to rh. $o!tm co
<br />Mrld co,npm.l ion pmvisions ol Sal
<br />WARNINC railure lo scur€ s.rkcts .d,np.ns nn cover8c is tnla$lul. md shallsubld dnpL)s lo aidinalFlalrid and
<br />.A I nn.s trp h nc hundrr rh.usmd d.lLrs (S irtr|00). n,ol comp€aelion. denagd a providcd for rh.
<br />SN1un.1076 ofrh. hhtr Cdd.. int.1.! alrd au.m6
<br />u^.,' ttl lJ t4 noo,,*,,I'r'l r,( r.rsr:r) ( ()\llr\( l(lll
<br />DES/NAIIO!
<br />I hercby alltrm nndd poalty of Frjury lhat I m licdu.d undd Ftvbionoachapt6 9 (commocins wnh Sdion 7000) ofDilision l
<br />ol rh. Busind md Pmf6ioN Codc. od ny Iic.N is in tull forcc dd .rd.
<br />carllaucrx)!_LlitDtxc-acEtcr
<br />I hmby amrm unds psEhy ot pdjury rhar rhm i! . co*tocrio. lmding asmcy aor lfic psaomdc€ of lh. *ol![ for which nri3 !6nir is
<br />isu.d (S(. 1097, Civ C.)
<br />AIIUCAII.DES.AAAIIAX
<br />I hddy amm unds p.flahy oa p€rjury o.e ol th. followins dedalio.s
<br />D.mohion Pmns-Asb6los Nolificalion F.dml Rcsulatiotrs (Tnk 40. P.n6)
<br />Rcqu ed trtt6 of Nolifi calion
<br />. ! Jccni6 rl-d !h. led.6l ,.x ,1, irN rerddinE 6b.{o\rmo\,'ltue nar app''cabl.r.' rh's preJd'
<br />l,/.-,n ,n, , n
<br />' "
<br />.-l ,nmnpr,c",.n *a .r"r. rt
<br />"r
<br />rt'c ,ln\. in ronn.rion is con6r I aarr ro conply wih arr (1r, od ( ounr!
<br />''d'nr.'6rdsuretlqsrLrinsrnbu'lorngcorfr!r'o(nJld.b!rrrhoirzcr€pl6ordtr6olrhhcl)dd.6Jnr)ro-'dur.n,h.
<br />aba\. mcnroncd DroDd! lo 'n\DcctnnrrD)* I
<br />^;,,,..",..;,;..;;.,.." i4 Qu^t<a.**Z- *" , tfurltj
<br />rrniremnerprinrr:,F AJU kh
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />,nl
<br />Life Safety /Low Voltage I I
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under SIab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners rAr
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lt4eter Release af?.a.-,,4
<br />Rough
<br />Service lt4eter
<br />FINAL tl-B-ta,
<br />Notes, Remarks, Etc.
<br />I s'n.ietrd md6 Sdrion
<br />*," , nilrukl
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