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APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />D\
<br />Rough -4-r,Y.V-$il
<br />Service lvleter \l
<br />4\^.ivt<FINAL t0 rrvlt[t6i
<br />Notes Remarks, Etc
<br />: J rlo !'u^,1-a oLl+el
<br />ELECTRICAL-INSPECTOR RECORD
<br />OWNIIR BUILDI]R DELCARATION
<br />I hcrcb! afilrn undcr Fnalry ol F.tury lnll I 0n cnnDr lmnr lh. 6.lroclo,i Licctr$ L!* for rhe folk,wins fuson (SN.70r1.5
<br />Busnrcss &l Prolcsion Codc): Any Ciry or Coutrry *hich rcquires 0 pcnnir k, onsrtucr- ulrs. inpR'vc, dcmolish or rcpan my
<br />drucrlrc. p.hr ro irs hsume. !l$ rcquid\ rhc lpplk0nr fu \rch Frmir b filc i \i8ncd ,a'.mnt rhol hc or rh. is lianrd flruur
<br />to thc pmvnions of rhc Controctols Liccnscd ljw (Chstrc,9. Commcmins {irh S.crioi 7000 ol Division I oflhc BusiNss strd '
<br />Protessions Codc) or rhor hco,she is cicry,r rhcrctlom!"d,tc balh lor rh. sllqcdd.mrrion. Any vnrarionolSdio.ToJl 5hluy
<br />,mli.!.r r(r a Frni' \rbjNt lhc arplicatrl Io ! .ivil I'.mhy or tr.r ft,c rhnn livc hundEd dolli,s (S500)
<br />-l-
<br />0r .Nncr ot lhc pop( ny, {r my .nDk,rce\ *irh wx8.r tr\ rh.n $k ohrNar n'n. will do rlr qtrk aod Ihc (nEre i\ nor
<br />id.M.d or olhr.d lnr s lc ( So.7{141. Ausincs\ rnd Pr ofc$i'rns Cod. I h. Conhctois t.iccns I iw do6 nor ,prl, r, a. o$ ncr ol
<br />rhc lmpcny wio buil.h., inurov.s rhcNn. aJ $fiod(trssuch$orkhi'nselforhcr\clforrhbu8hhnorh$oqtrcmfhyccs.
<br />F)vtlcd rhar su.h inpn)lcnrnh irc mr dcrkt { r .flc l f(tr ",lc ll llosc\cr. rhc huildi,l3 .r irqrrorcnrtrr is v'll * iihin o c ,ur
<br />.lc.'Jrtrri{n dr Owncr Brikl$ willhxw thc hunln ol frvnr8 rhtrr lt or rhc did nn huih.r ill{Fvc rhc pnpdy a{r rhc InrFl{ of
<br />l.,rowidofrhc pnrlrny. rcr.lusi\rlycotrricir.ssnhh.cnscd.offndoFrocon(ruclrhcDr+cr(scc70.!-Bxnnc'r
<br />lnd h)!i\(ir Codc: Thc Conra.rol\ Liccnsc l-aN docs not afflyro rn o*ocr otptr,pcny who hxilds or i'nprclcs rlr.con.
<br />rnd rho conlmcrs ntr slch pojcrh *irh n Conrncron r) licen\.dpunuan' brhccotrhndors Liccn* Lnw)
<br />.l r .xcmpl urdcr Sccrion .B &P( lnrrhntur\nr
<br />Dolc: (r$n.r
<br />rvt tnxrm' r r lltt t,t,:t.s,ritoI
<br />Dlrl:l ATIIIA!
<br />I h.rcly rllirn undcr ncnrlry oftf,rry ok nfrltr tull,rvirt dccl r rid\
<br />-l
<br />havc !frj will minriin ( Ceniftde ot Conscnr ro Selt hslrc t'or sorlss .dmpctrstrri.r as rovidcd n, by S(l ion :l?00 ol ih(
<br />l-ohor (t)dc. to, lh. Frfornmcc of lhc wort,or whichthc fqnir h isucd
<br />I havcrnd will nrimnin work&s .onD.ns t'nin\uan.c.Nr.qundbyScclion.lTlX)ofrhcltr'horCodc,tnth.P.rfornu.cof
<br />lh. qork rorwhi.hrlri. !.nnii is nsxcd My workcrs' co'nFNrrnnr nsurm.ccinier orn lolicy numbcr dc:
<br />l'(,li.y Nun$cr:-lxpircs
<br />-l
<br />c.,lilylhil ir lhc p.rl'omflncc olrhcsork li,r whichrhi\ n 'nrir i\ i\\ud . Idrlltror cilPk,yrny P.t$r inntry trnnncr
<br />n) rs t, ttuonr \uhacr t, rh. work.h Rnntl.nqhotr hws .r C rlir,min. {nd +rcdh it l \houl(l hcconrc \uhj.rr h rlr
<br />sorkc^ conll'cn\!ii,nrp'ovisi(in\.l S..rior l7lX)olrh.l hr(inld,ldull.lidhNilhconrflysilhthoEtrrvi\ins
<br />civil ftEs u! lo o.c hunded I
<br />::":yl;qib
<br />r iri ,brhr!^r!f.o lf,tr\(i, . dinkgcs r\ rrnni lnr rh.
<br />I hcNby (flr nndcr rc0dllyolp.rjuy lhrr I ur
<br />UiCI.ABAIIQ!
<br />IunderpovnionolCnrprcr9(.onn*n.inswirhsccrion r0OO)otDivisnnrS
<br />,-,-"*"O*,9 q
<br />I hc[hy affin! undc. rEmlrrofp.'jrry rhnr
<br />hsucd (Scc 1097.Ci! C ).
<br />ri!flrriD lc.dire recRy for thc pcrfornrncc nfrhe $ork fnr shi.h rhi( ltmir h
<br />A.IfUCANLDECLAIAIION
<br />I r.nby rmm undcr p.nllry of FdDry om of llE follo{in8 dcchral ions
<br />Detun bn P.roih Asbdlor Notificdion Fcncr.l R.gul,rions (Tnb40, Pnrl6)
<br />RcquiEd L.ncr 6f Notiicdion
<br />'"\, "r/"
<br />'r""''-"7\'rn'"
<br />nnx Eguling !\hcdo\ rcnx,vll !r nur +dicahlc to rhh I(
<br />c.rionr sttrlcrhar th.!t vc irloirnl(inr i corccr I lsre
<br />burldinE coo(rclion. and hcrcbyaurhori/ rcprcscnui!€s o
<br />t>Tgt"^"a/
<br />b conDly wnh oll Cilt otrd Counr]':'{f;i;ii;**
<br />ID/SIG.
<br />Pole Bases
<br />Ivleter Belease
<br />wARNING I;riluc ro ecurc {orlcr coarF-n\rriotr c.\trsc is unh$rul. trntl shrll \uh.ic.r ,n cmtlo-\tr to rinriml FNlrics xnd
<br />of rh. Btrsi,,.$ rid P(,ri$i,rN Codc. iftlnrt lkcrn n $ tullLn rlclli.r
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