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ELECTRICAL-INSPECTOR RECORD
<br />DATE rD/slG.COMMENTSAPPROVALS
<br />Site-Work
<br />Pole Bases
<br />ht StandardsL
<br />, Pool, FountainsS
<br />monumentSiNS
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Buildin
<br />Under Slab / Floor
<br />Bondin / UFER/ Groundi
<br />Transformers
<br />To uetn
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To ul mentE
<br />Facto Wired Unit
<br />Walls Conduit
<br />Walls Rou h
<br />Ceilin Hard & Solfit RouS h
<br />Meter Release
<br />Rou h I
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc
<br />OWNER BUILOER DELCARAIION
<br />I nerchy alltm hJo ,.nrty ol pcrjury rhtr I m crcmpl rhm rhc Conr&xtr! l-dnsc Laq tilr r,t rolbwins rca*'n (h'?011 5
<br />Businc$ aBr Pioa.$on Conc): Any Ciry or Counly ,hich tqun's r Pcmir b consn'.r. alrcr. inpio! ',.@llsh or EIEtr 4v
<br />drurkq I,br ro ils issuaec. dv! rcquirc\ lhc lrplic r lor such ncmlr iJ tilc i s3ncd sr.r.hcnr th h. or \h' ir liccns'l ,Buad
<br />lo rhc p^,visons of lhc Conrta.tr \ Lic.nscJ I{w (Chanrcr 9. ConnEn ing wnh Scrlnrn ?l)(X) of D'rision I ofth' Ausires sJ
<br />Pnna$DsO c)orlhar trflr\hc i! crcmpl rhcr.fn, andlM t'a* turrhc dlcecd crc'ntri(,n Anvvi(nlxonotsc'rbn70'll'5hvanv
<br />dflrlr r lnr a lcmir srhjes rhc lori'canr k, , civil Fnrlry ol nor n$rc th livc hxndrcd dolldr\ ($500)
<br />-1,
<br />x\ owncr or rhc l,or(nr, or nry cm!'lolecs wnh wng.i ar lheir $k ('nlpcnrdti,n. wiu ,lo rh. work a rh' (ulurc is nor
<br />i,rro cd orollted nr sh 1se.?u14, B!\tu$dd Prufc$bns clrl. 'Ih. (\nlrettr'r Licc.sc L.w 'r'$ "r amlv b an own'r ol
<br />rhc p!,Iicny wh builJs or impn,ks rh.B,n, drl wh' dx\ sch mlk him\ell or hc .ll{rlhnrShhhorhcro{nc'plovces.
<br />pn,,nr",r rr,or *.h rq).tmNs m mt inrenLd orotfcsJ ir eh li ho$wi lh. buillirs or unf,oveNd h $ld *iihfl onc yce
<br />;I u'nlpht on, rlE Ow;r BoiLLr wrll hrrc rtc tutdo ot ltuvis (ha1 h ot \b. Jii tur hrilt o. inDot dr thrFnv t& rh' Fqrxc 'i
<br />l, !r o*ncr or rhc P oI.ny. rm c(lunvcly .onlrd in! wir h I'r.n{n nrntudor t', !}n(dd rlt Fjc'r (S'c 7{}'r4 Burncs
<br />rtrd lh,,c\snn codc: rl he co.ka(oas Lru.ns.l,a* JMr nor.t'lly rt, rn ownd ol pnrp.nv wh. huil& or imlbrcs llrrcon'
<br />&d who conrtkrs td nrd f!+.rs *nh , conlmct)(n li'en*d tlli (ur n' rhc cont'cttr s l'ircns' Lrw)'
<br />I anerenp( undc! Sculi'n-. B & P C. ntr rhi\ ren,'
<br />tVOfu(ERS' COMPENSATION
<br />PIEIABAIIO!
<br />I h.rchy3llnmu cr pcniliyo,pcrjuryon. o,lhc ItUo,ins Jc.lnrarirnr
<br />l havc aJii *ru mrtain a C:cn iliarc ot Cone.r l. sclfln\urc Lr work.' a conlEnsat b!. ai r,tuvdctl li'r hy scLlNn l?(t' ol rhc
<br />Ldtrtr Cqt. n, rh. p.rromc of rhc wolk Lr which th. P.mn is ilsuc{
<br />Ul ha\c Jn'l u'll tr'rm,em s, c
<br />/r. \! l l,{*l'n,'rhrn rmtr s
<br />mFnsarnnr i.\urM(.. rs rcquiNJ hysc.li('n lr00of rh. L .rCinh nrrlfPenomrn<ol
<br />My workcG dfrpc srliin msurmccdtricr dd[x,l{y nun$cr m:
<br />L\pt.\ :Q -t4
<br />I c.diryrh,i inlhc n .iormnc. ot lhc wo* io, whichrhisPcrmil n ssucd,l shall nor cmtl(rvanv!.Bon in 'trvmurer$ dsn, t'ccom srbi.cr ro rhc w()rts $hpcnldion lawsoicaliroin'. and a3rc har rl t shrul'l hconr suhicer t' rlE
<br />urkc6 .ohr.nsarion Frvni.nr or sccrio. lrt[ ol rhc Llitr airlc, I shrll rodhwnh drml'lv wirn rhok Pmrhion!
<br />IIARNINC: Faillrc ro s.curc workc6 omFns,lnln covcEs. '\ unlawlirl. amt \hrll suhFtl an cnllov'r to !nM!l IEMltrs ud
<br />clvil lincs ul n, onc hundtcd thousatul dolldr (SI00,0OO), in addnon to lhc coi of conrPcnsarion. dDEBcs !s lnlvi'lcJ tur rh'
<br />LICENSED CONTRACTOR
<br />DECIASAIION
<br />I lrrchr.1fr6undcr pcnilryot Frjury rhal, am lienrd undcr n$vniotr o, ChaPtcr t) (@6tumin8 with S'criDn ?l)O0) of Divirion l
<br />o, rhc Bosn*$a, Pn,ic$bnr Codc, ,nl h, li*nr is io tu ll roie in i cftftr.
<br />L-(J
<br />CONSTRUCTION LENDINC ACENCY
<br />I h.Fby alrtrn utulcr Fnahy or Pcrjury lhal rh.r. ir r coNtucli,fl lcnJiis agcn v turhc perturrokr oi rhc work tbr shichrht IEmn is
<br />isq'cd rSc. l0r7.Civ. C.)
<br />lrtrJcr's Nrmc.
<br />t n,l.i\ AJ.!c*
<br />-
<br />AIIUCANLIIII,ABIIIIAN
<br />I hrchy.riimr utullr F.alty ol P.rjory o.c otthc,oln,rine d.cl&.rions
<br />Dcfrolnon Pcrnrik-A\ht{.c Nolifi.llion F.d.rxlR.Sularnns (T L 40 Pd6)
<br />-Required
<br />L€t.r oa Noliirqtir
<br />-l
<br />{enify rhrr th. fcdcnl r.gularions E8ardhs ash.(d nmval Md ,rtli.lblc ro rhB prujc.t.
<br />-l
<br />ccr ify rhd I h,rc rcad lht appli.alio. utj sral. rhar rh. abov. inlomrion is loNrt. I a!@ lo onPlv wjth ![ City and Counlv
<br />.,,.r*a*", oa Sr"r" r"*r etaroiio hlildins colsntrdiol!.,rl hcrchv rhrrc EprcsenrlriEs or i Cirv ed Counlv lo cntcr ultn trr
<br />$.vc nEnrrnnl ftupcny & insli.crion
<br />ADpli.ant o.AlcnlSifnaltrrc
<br />Underqround
<br />Lile Satetv /Low Voltaqe
<br />Ceilinqs (T-8ar Rouqh)
<br />7
<br />wMtu41il lt 4 t/\
<br />s.erotr 1076 ofrh.lrhtr cl\lc, inrcR{,nd r onry's lccs
<br />\-1t.44Dircr / -
<br />looyct 7
<br />o"", TLl-tat
<br />^,"
<br />-4zH n
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