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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Unde round
<br />Pole Bases
<br />Fountains
<br />monumentSiNS
<br />Life Safe /Low Volta
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Buildin
<br />Bondin / Groundin / UFER
<br />Transformers
<br />To uern
<br />Sub-Panels
<br />Air Conditioners
<br />Roof T UI enlE
<br />Facto Wired Unit
<br />Ceilin Hard & Soffit Rous h
<br />Ceilin S
<br />Meter Release
<br />Rou h
<br />Service Meter
<br />FINAL
<br />Notes, Flemarks
<br />OWNER BUILDER DELCARATIONI ncrcby amrm un&r pcmlry or pcrjnry thar I m crcm fmn rhc co.ra.r66 Liccns tjw tor rh. folowins rcamn (S(.7o] I t
<br />sorincss rnd Pmrcsion Codc): Ary Ciry or County whih rcquircs o Fjmn b hndtucr. alr.( inl,mv., d.mliii or Epair lny
<br />sru.rrrc. lrhr to n! isiu,rcc. aho rcquiEs rh. lppticanl ror s$h Fnnit to itc a siSmd satctunr ttor tE or sh. a ti.cnscd pu^annlt' thc pmvhionr ofltf, Conka..or's Lienscd L{w (Cha/cr 9. Commncine sirh Ssrion TOur of oiahi.n I of rhe Burinc* n.d
<br />Por.sioN Codc) o. lh ne or shc t crcnll rh.rctom and rhc bask tu rhc atlcscd cxcmprion An, viohtion otsccr,on ?Oll tnyatryanlh. ntr ! |.,nrit{br.d\rr. sFrticanr to Jc'v.t[Icnokyotnor mn,e rhrn n!e Fundrcodo e\ ls5tur)
<br />ffirr,r:lr,*r,Jil,l::l'J"".:;r',;"f:#irHllf,r'rfirlr'#;r',r#tl'h*:HffH,.I'r,.,
<br />rhc lr(lllny whd huilds or inrprews irEftn, ad wlb d6 shh w* hinsctror h.rctror rhmuslr his or h*o*;;dpby.s.
<br />Iirclidcd rhsi such inlroEmnb ft mr inrcndd oroficnd fo.sh Il. k *chi rhc tlildins or inphhmnr G std uirhin nnc rroronpkrioo. rh. Os,rer auirlq wi!, nls llE hrd.n nfrovinS rh,r lx.r sh. did mt t{ild or irlhh rh€ pmFny aor llE l)Urrs{ or
<br />l. r!.wncrolrhc nror.ny. ! crch'\ivcty.otrkrcrins wih tNrscd.nnrrNru\ lo cotrslrucr rh. pmlc.r lScc.704,t. Busin.sl
<br />fhfcssiJn Codc lhcConracrtr s l,iccnsc Lra dllc\ hor apntylo nnosmrofrorcdywho huit s.rnnd sho conlmck ror su.h ltrojdF wirn a Gnrmcro(9 ticctrsd pursued |o ric Coorrodof\ Lic.nrc L!
<br />I h.rcby arfirn undcr lcn,htorI€rjuryonc orrh. rdkrsins
<br />I h!!€ andsill hEimain a C.nificorc of Consor ro S€lt-lnsuB for *ortcm compcns.rion, os pmvided fo!bySeion3T0ooftheblnr Codc, aor fie poiomne of thc wor* for *hich lnc p.mt h nsucd.
<br />_l horc and will maintai, worrcB c.fipensarion iosuratuc, as rcquicd by s..lion 3?OO oflhc Labor Codc. ro, rhc rj.rformncc of
<br />rhc work ro. whth rhn tsnil is isskd. My vortcB onip.osarion inslErc. cei.r ajld Flicy rumbs ml
<br />I'D r ! fr'!n: i" itry n,rnai
<br />worlc^ compctrsurion pmvisi,,ns ofSc.tn,tr 37m.frh.Iitnr Codc.I\hrtt. ionhwith conrty wirh rths prnvhions
<br />rii'allc'
<br />coalP.ns nnr ..!crxgc i. I w{nl, Md \hall rubicr !n cnl,',orrr ro 6in nal rculras rnd
<br />ion. daruCus as providcd lor rh.dolhr (SloO.{XX)r. in ld
<br />I hctuhy rllt'! undcr pcn{lryofp.rjuy thd I nti.cnscduoderpmvistunorChDrrer9(connmrcinSwirhs
<br />ol rh. Busirc$ !M Profc$ions Codc. nxl nry ticdn{ G in lull tirN od dffccr
<br />CONSTRUCT(IN I I'NDII\(; A(:FNCV
<br />I lrEby ulilflnundcr p.nalryofFrjury thot rh.ic h a.onnrucli.tr hnding {cocy i'or lhe pcrtorna..c orrhc work ior which lhh p.rni n(sred (Se. 3097, Civ C ).
<br />APPI,(:ANT DFCI AR,{TIoN
<br />I llatby nfllm onner pcnnhyorF.rjury onc oirhc lottowing dcclir0rions:
<br />I)cmnIion Pcrmirs-Asbcar.s Norificotiotr Fcdcrat Regllations (Tirtc 4t], pfi 6)
<br />-Rcqutcd
<br />Lcxs of Nolificxrion
<br />I cniryrhrr ihc riicrolrclutal(rn\ rsstin8 !\bcio\.cmvltarc ml{fti.,blc kr rhis pmjccr
<br />rhd Ih !c rcldlih amtic.r tnr d nrrr lhnr rhc dtbvc ini{nnDli,rr i(c.rc.r I rlrccr,cor
<br />rnd Srar. IjRs retarins ro bui rizc rcprcsctrhllcr.rrhh C
<br />atn,vc nEtrrbmd pnrEny for i.sn .rn,n
<br />ApDlic{nr o. AXent Signatuft:
<br />dt con{ru.rioD. itrd hcr.6r-
<br />ply sirh nllCtyrM C.trfrv'"^;lilitr^*
<br />Liqht Standards
<br />Spas, Pool,
<br />Under Slab i Floor
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />(T-Bar Rouoh)
<br />t tl
<br />Etc.
<br />rJdcfs Addrcs: _
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