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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.OWNER BUILDER DELCARATION
<br />I h.Ehy .,rirm nnJcr Fn.lly ol Frjury rhal I m .rcmfl h'n rhc An rr.r,^' Lf,chk L2w ntr rh. lollowin8 rclqln (SR.' r0.!l 5
<br />Bunh.\! ,ft] Pn,r.ssrn, Cui.): Any C y or Counry wh(h rcqur.. I p.m lo c.nnd.r, rlr.r, imlrrov.. &nri\h or ml,n .ny
<br />(N.rur.. Eitrb iis nsuarcc, alro rcquircs lhc applcMr li'r suchFmrrt' llle ! \+md {ar.mnt rharrrur dr ir li(nsJ nuru.nl
<br />t, rh. pn,vi\i,nl ol rh. Contrcty's Lic.nscJ trw (Ch!flcr 9. (l,mnrRin! uilh Sctli'n 7(XX) ol tJivtion I of rh. Busik$ rnd
<br />PsL$rhr G)dc) rthrrh.orshc t c\cnrpr lhcrclil,manJ rh. h.rs nrrhc alksd cr.hflon Anyvd8tonolS.cli,,n70.!1.'5by!try
<br />qTli.,nr l,tr ! pemir cuhj&t rhc amhanr b a civ 'l pcuh y ot nor n)(- rhm avc hun l.cd dollas ($5({)).
<br />l.!\owne!olricpn,r--.ry.ormy.n0k,y..\wrrh*xI.\r!(h.rv,l.$.,Fn\arn$.wldorln*(vki rh.{G-nmrBn
<br />dcnlol ornli.rcd tursrlr (Scc 7044. Buiin.$ rnJ Pn,lc$(* C,klc IlNC.nrd.ntrsl.(cnscliw'loc\norlt)rlyr.riowftrol
<br />rhcl['Irny whu harlds or mp!*rs rlrR)n. l wlx, Jf,s \u(h R)l( hnns.ll or hLr.ll orrnou3h h$.r hcrosn cnn!,y.cs.
<br />pn,v crl r hnr su(h npr,snrnr rE nr hlcftlc'l .! oir'Gl lar \!b Il hwcv.r. ilI huillliry or in{R^tnrd i\ q,Ll wirhtri dtrc }!rr
<br />ol conlnhr i,n. rh. (]wn.r Bui[.r w]l l v. rh.hordctrofln,vn,Bthr lr or slr drl nr hrl!orrnDn,vr rhc pmlidy tu rtt Nqr,t ol
<br />L 3s owmrolrh. pn,Bny..nrct(luqvcly..trrr&rtrr3 wih lrucnRl (,rDrnx n, .otrsn'.r dr tn,Ar (s.c.7(}l4. frunN$
<br />i hrnisir C,xlc -l h. C',,nkacntr'\ t-'ccnst L.w d,f,\ not amly b !n .wncr .f pr)!.n y who huilJ\ or imlrur. hcre$,
<br />lnd wh) ontr.( r lar such pn)Frts *rrh . c]( Bn)n n li.cne'l F6uinr b r h. Ci,htJrttr'\ l-f,tnsc Ldw ).
<br />-l
<br />amcrchr'{ un ls Sccr!,n-
<br />D.: Os
<br />llaf,KE85:(0UfENtArIA!
<br />D"CLANtrIION
<br />I h.r.hy rrltrnrnd.r t^.nrlr!olp.rjurydnc ofrh. t(nk'wnt J!(ld Dns:
<br />_lhr!.arlw'llnE'nrrnrC.n,liurcolCo nr n, Scll-ln{rc ntr w {kcr' (nnll.Nlrur. ,\ o.v'Jc'l nr hy S.( ton l7(n .t rlE
<br />lilrtr (irlc. ,nr lhc Frti)rm{Ee ol rh. *qt l,r wh'rh rh. r-, nnr N tr\t.'l
<br />I hrvc rnJ willmrinrrin work.r\' onF_n\rnrn nNrrN., r\ kqtrrc.lhySc.rtrr ll?lxr.l rhc l-,hor!id.. n,rh. P.firnnRcof
<br />Irt!
<br />P,,1,.1, N*,h*,12 L --l-tq
<br />I (ctrrlyrhil rn rlr |ld'trnrE-.ol rh. work l,n whi(h rhN n nnl tr trnrc'i,I \h.llnd cnrd.yinyl.son in lny mrnn.r
<br />(, rsn, hcconF {'h]..r b rhc k,*cr\ cofrrn\dn,n ldws drcrl'lnnxr. mlr ilEc lhar ir I sh,uli hcd,m shj.d (, rh.
<br />$ukcr\' drn,I.nvton on,vn('n\ Df S.crim !r00 ol rh. l-.h, C(xlc. I \h!11 hn h$irh d,mply sirh rhN lt,v,!otr\..
<br />.tr'r rnr\ nI r) !nn hrtrll'.J rhoi\rnJ Jollx'\ r1l(xrr(xr) tri rnlrn!r ri ,( .l .onIEnsli,)n. drn,agc\ r\ I'r!r'd.d t{ rlt
<br />S..rn)n l(t?6 o, rft l.rhn (
<br />D[cuBAnoIi
<br />I h.rchy rrltm undcr J'cnalty ol pcrjury that t am liu.nrn lBhr I'nvni,,n of Ch{ .r 9 (@nmn.re wnh Scd nn 7uI)) ol DNnii,n l
<br />of rhc Businc$ an,j Pn,L$ioni Cird., r nry li(.nr.6 n hlll n'ru. anl .lIccr.
<br />hh
<br />CONEIA!!:TONIENIIICIIiIN!;}
<br />I h.rhy dlltrm unJ.r FndlryotFrlurylhll lh.rc k a.r'n(d(ron knJin! ryctrcy t)r rhc !.nbme. ofrhc work tar whih rhn rtm( s
<br />ilucd (Scc. .r0r7. Cir C ).
<br />AITUIAII.IIEIJ.AtrAI]!]!
<br />I llEhy ullim undcr Fnalry ol p.rJury oN ol rh. Lllowin! d&lmtun
<br />DcNniDn Pc,arih-Anrdor N{ri,i..ri,n F.dcrai Rc3uhrion\ frirt 40, Pd6)
<br />Rrqurcil lx(cr ol N,i'tu,h,n
<br />w
<br />l..n'lyr,B( rh.,cd.rrl guhrtr'N r.pd,lrn8 i\l{( (rcn,vrlrr. mr r0nli.rhl!' n, rha I,!,jr(r
<br />rnrlv rld I hr\. r.ntlrln\.flrr'.nkr.'nll (ri. n I rrr.r t,\!nnflr s rhilL( irvrr(l (ind\
<br />.hvrnrl$"r( ktnr.. rn,\.\ o, rhr ('rry trtr1(,n yn,.nrr' (txrrlrtr(.( rtrd Srrtc I-rw(nLtnr8 n, huilJint..r
<br />n'.trrrD(d nn,!('ry l,i Ln\|[.rrrr
<br />'t|,Dli(rnl rAxMl Six nh'fr ..(,l-)?t9
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solf it Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Meler Release
<br />Rouqh
<br />Service [tr]eter
<br />FINAL tl, /,c
<br />Notes, Remarks, Etc.
<br />COMMENTS
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