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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondino / Groundino / 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 />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release
<br />Rough
<br />Service [/]eter
<br />FINAL -7/z< t 14 -.k ,-1An
<br />Notes, Remarks, Etc. I r- -S
<br />--)
<br />OWNER BUILDER DELCARATTON
<br />I hcrchy orfm tnder fcnrlry of Fdury U'ar I d ciemo fDm rh. c.'nr.don Li(nsc taw for lhc fdlowioS rq$n (Scc 7O3 l 5
<br />Busincss aDd Profcssion Codc): Any Cily o, Counr, which rcqlircr r pcrnrir h conen.r, ahd. improv.. d.mlnh or E!!n any
<br />srtudurc. plior x, ns issuai(. aho rqun srheppliclnr fo! ru.h pLimir ro lil. a siERd slalcmtrl lhal hcor she k liccnrd purornr
<br />ro lne F)vGions ofrlE Contmcrols Liccn*d LaF (Ch.prs 9. Commeocing qirh s.crion 7{xr) of oivision 3 oilhc Busnrc$ and
<br />Ptrlrcsk,nr Corjc) o. rh,r lt or rh. is.xcnDr lhcr.rom a.d rh. blsis ror rhc,llcgcd cxcmplion. A.y violllionofS.cti,n?0115 hya.y
<br />optlic,trr lor. p.flnil subjNts rhc alllicanl lo acivilpcnlltyoinor mrcrhan filc hundrcddolh^ (5500)
<br />_l.r\osncrofrhcnroFny.,trmycnrrk,rtcssith*agcsa\rhrnvrd.o'nP,nsdnr.willdolh.worlandlncnMlurcisEn
<br />inrcndcJ oronaEd for sle (SLr 7044. Busimss lnd Prorcasn,n\ Codc Thc G,ntacrois Liiensc bs docs nol apply b 3n osi.rof
<br />rhcpmncny wlx, hurlds or inll,ro$\ rhcEn. lnd who lms slcn nnrk hin,scl{or hc^clt.r rhsu8h hh or hcr own cmployc$.
<br />pn,!id.d rhdr such i'nllrtJkm sm( imddcd doltarcd f.r $h llho*$s.rhchildingori pmunrnlis$ld *irhin rc]ru
<br />oacotr{'klion. rhc Ow.cr Builcr till halc ltE hu cnorrrDvins rt l b.o!\nc dil hr briB or i,r{mv. rhc pqhy n rh!puqDeof
<br />I. ns own$ .f rhc topcnt- trm.Klusivcly conk0.tir3 wirh licctrrd conrrncron ro co!{rucr rlr tDjMr (s.. 7044, B im$
<br />ond PDlts\im Cod.: 'lhc Cotrrracroi\ l-iccn\c li* dms no' rpply k, an.wncr.fpiotr.iry who build\.r imlrovcs lhc.con-
<br />a.d wh..onh(cinrsu.hr,Jc.rwirhrcontr,.krnnltutr*dpuruunrrorhcConrracroirl,iceiseltrw)
<br />I rm.xcn1pr und$ S..rn[ .a &PC lorrh]{r.rs.tr
<br />Ih(e ()*n.r:
<br />]IOBtrItsL1;OUTI'NSAIION
<br />DEg.InA-lIg!
<br />I h.rchyrffirmund.ri^-mhroln(rJUrio colrhcfolk,si'rEd.clxrarn)n!
<br />-l
<br />hrvc$dEillnuirrainaCcrrificarcnfConent to Scll lnsurc ror workc( .onD.trs.tinn.as FrovilcdlorbySc.rioilT00olrhctitu Codc. aor rhc pcrfolmrcc of lhe wrt for *nich lhe lmni h nsucd
<br />rc. ricr tu rolicy trunrbci m
<br />f'o "v4 5
<br />I 1
<br />I ccnily rhrr h rhc tl.rfofllMncc of rM work lor ehi.h rhs rErnrir h nnEd. I shall rcl cmpk,y trny pcr$n h rny nrtrn$
<br />r !s r(, hecom subFl lorhc$orkc6 con,pcNari.n lxws ofCrlilnrnin. d l3(r lhd il I should hc.om bjcd rorht
<br />wor*cr\ compcn{r ion povisbns of S.crnn, :lT0O of rhc LJh)r Codc. l \h l. fodhwirhcomplyeithlhos prcvi\i{rns
<br />WAtrNlN(;r Frilurc ro {curc woricr coDrFtrs.rbn covcrrtc i\ unh$tu|. and chtrll suhjccr u.nlpbrcr t) diDrirrl pctrrlrics tnd
<br />.vil tnr.s uI !{r otrc hundr.d rhousand dollan (S|0O,UD). ir,! ilion lo rhe con ofcoipcn\rrhn. dunr8cc rs ftuvdcd li,r lhc:::lfrW
<br />DIt t.,rRl',t Ir)\
<br />I hcrcby al6rm undcr pcoally o, pc,jnry rh,r I ad lien{n undc! p,(,!iri.o ufChapr& 9l.umrncinS wilh Salion ?00)) orDirkion l
<br />of rhc Busnr$and Pot$nnsCode. md myltensc is in lullftEc arlcl'iccrg 97a38
<br />Z E ...,"""..,x 19u ,[Z7tk;
<br />CONSIBIj TOTIIEIDINC-AATNCI
<br />Ihcrcby fiflnundcr Fnalryofp.rjury lhll liN n a onslMlbn lcndins ascrcy lor lhcFr,omtc olih€ *ork aor rhi.hlnis pcm n
<br />hsu.d (sft. 1097, civ. c.).
<br />dtttlcANtDEcLAEauo!
<br />I ffiydamlndd p€n.hyof p€rjury o.c of ttE folk ritrS delualions:
<br />Dcnx,lni.n Prmns-Asb.sros Nolificarion F.d.ml RcSulalions (TnG &. Pd6)
<br />-Rcq!ncd
<br />Ln.r ot Norir*ri..
<br />/ Ld'lrrhd'h.rcdcr0lr.Eularion"rcg,din8,"h.ro"r..rJl0EtrorumlicJl,hlnrhnnnAr
<br />lllccnify rhd Ihr( E0d rlnsamlEauntr! {orc r tur rhe atrre inlbrmurn,n n c.tr(r I dgm ro.rnDly wilh lll Cily ond Cou.ly
<br />ordinaftcs nnd Sr.rc rlws rchring to buildins cotrsldction. ! h€re$y aurlsrir rcrr.sc.rati!.i olrhir ci'y rld counly lo cnts utbn llr
<br />rlxrc Df,nrtrnrJ f'otrnyror i'NF.r
<br />AppliunlorABenl SirDltrr.ZLPcmii€en.ne(pn ): )(' KeV;4 t3 44tr
<br />tD/stG.
<br />Under Slab / Floor
<br />I.nd'\ \ddc.,
<br />tt
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