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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / 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 />Ceilings (Hard & Sollit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Belease
<br />Rough
<br />Service Meter t
<br />FINAL i "2(-/g J/ctd+'drr)
<br />Notes, Remarks, Etc.
<br />(,WNl]R BUILD'R DELCARA'NON
<br />I hcrcb, afirn undcr l)cn.lry (,f pcrjury lhdl I m cxcnpr irom rhc (\nracloF Liccnsc Law for rhc iollosinr ,.av,n (sc.7o.rl 5
<br />Businc$ and Profcssiotr Codc) Any Ciry or Colnly which Equncs r fcrrrir lo conslrucr. rlrcr- imrov.. dc,mlidr .r rcI)dn my
<br />srrucrt,r- ri(trr, irs i\slatuc. al$ rcqlnc\rhc upplicanr t]r su(h Frnrirb fil., signcd {ar. rnr rhar tror shc is liccnsed t'urulnl
<br />to rhc provisions ofrhc Conrrocrols Liccnsd La{ (Chtrrrcr 9. ('ommncin8 wirh Sccrion 70(D of Diri\tun.1 ot rhc arsinr$ itrd
<br />ProrcsionsCodclorrhar tE o, \h. ndemrr rh€rctrom !!d rhc hnsk ror rhc alL8.d crtfrprn,n Any vn ,rionolS.cliotr 7011.5 hyiny
<br />rrpli..nl ror a pfifrit \ubjdr\ rhc omli.anr lon.ivilrcnnlry.rnot morc rhan livc huxlrcd dollns (tsm).
<br />-1.
<br />$ oqncroflhc pmpcay. or my cnrplorrs wil,r qrscsosthcn sh.ompcnrarnnr, willdo rhe w.rt od rht srmrm is.ol
<br />inrc hn or ollc..d for slc (S( 7044. Bnsin6s and Pf,,fcsion\ Crld. 1 h. Coikrcktr s Liccn{ tjw docs not trPrly lo !n owncr oi
<br />rhc rmrEny whohoildsori 0mws 'h.mn.
<br />md sk, d(B ilch w'l( himscll o! hcrclf or r hr"ust hh or hcr o*n enplortcs.
<br />providcd rhnr such inprcRnrnls m n i.rcndcd ororcEd fo! elc lL howelr. rlr bxildiigor ingtuvcmnr k $ld wilhin onc )r.r
<br />ofsrl0brhi. rL Owncr BuikLr sill hav. llr hrd.n or ptuling dd hc dr shi dll mr buih or itr{,roh thc lmtdy fo. llr purFs ol
<br />l. r\opn$ofrh.lropcny. aD c xclus irc ly conrtrcr inS qnh lic.n{d ...rrr.^ rn con{n'c[hc proFr (Scc. 7(]+'1. Bu\irc.\
<br />xl hDri:sirCodc-lhcConlndoisLiccnscLr$docsnortrlplyro!n.*ncroflr()pcrryNhobrildsorimtn,vc\rhcrcotr,
<br />rnd whn conrB.c tor such pr+ck anh a Contrbrl9 liccn*d prrsurir h rhc Conra.i(*\ Li.cnsc bw ).
<br />-l
<br />rm.ieftfl undcr Seri6
<br />I hr.bt.frlnn undf !.nrlr! of ,crlury
<br />DECI,ANAUON
<br />l hrvr rnd sill fui'rrdin , Ccn iturrc oa G,n\cnr t, S.ll: ln\urc tur work.^ .omlcn\uri(,n. N rn,vidcd hr by Sccrion l?0l ol lhc
<br />Itrtx, (.xlc. tor rhc !.rrorroncc ofrhc $ork f{r which rh. pcrmir is issu.d
<br />I hrvc.nd wrll,nrn rin workcrl co.rrcN0lion insunncc, rs rcquncd hySccrnnr ST(Doflhc L,borCodc. r(tr rh.lBrortumc or
<br />lhcworkforwhichthnpcflnilishsucn.My*ortss.om!.nsarioniNunncc..ricrandpolic,numhcruc:
<br />P',1tr'yNumhrr Lrtrc.
<br />-
<br />-l(cnilylhlrinrhcperloimnNcofth.workforuhkhthnlcrnlisn\rcd.Ishlllnorcn'pk,,Diy,'.8.ninrnymotrrcrs,arbt..'ftsrhi.rrorhcwork.scon!.nssrionlrw!olCalir(rnir,rtrdlgrccrhorifIshuklh.comrubicrl.'rhc
<br />sork. ' &mF.nrario. pmviiions ol scrion ]7m of rh. tlhr Cfrl.. I shrll. fod hsilh omply R irh rlnc pmvisions
<br />NrtRNIN(; l.ailurc t, {cur. *lrk.r conllfn$l orcra8c i\ unh*rul. rnd \hrll \!hj.{r r. c'npk,rr ro dDlnal p.ktics a
<br />civil linc\ ut ro otrc hundrcd rhonsrnd dolhrs
<br />t)t.( t, \t \t t()\
<br />I hcrchy alItrm ulldcr pcnahy of Frjury lhal I ! liensn undcr provision of Ch{ptcr 9 (drdmn.ins enh Seri,n 7000) or Divnio. l
<br />of rhc Busincar and Pof(sions Cod., arxl my lk.hr ir in tull for! dtd cfier
<br />Liccns€ Numbcrl
<br />AITIIqdNIDECIIIIAIIO!
<br />I Hlyllim lndcr p€nohy of rErjury onc.f ihc idlowins dccldarions:
<br />Dcmlilioo Pernnis'Ashcslos Notificoliotr Fcderal Rcsulations (Tillc,l0. PM6)
<br />-Rcquircd
<br />L.llcr oaNolitidlion
<br />N togeling rltr{os rcnnhl arc norrmlirdblc to rh^ flojccr
<br />i,nr md e rc rhxr rh. xh)vc i'rl(tr hri, i\.oa..r I r$ccni cnnrnly !,irI rll Ciry rtrJ C.unry
<br />ht Ciryrnd Counrrh cnrrr trFrnrh.t,i d.lion, snd hcrcbyaulhorie rclrcsd0livci oIt
<br />t-/t/8
<br />COMMENTS
<br />co{ or.omp. \drion. drnngcr as lmvidcd Inr lhc
<br />IONSIBIJ{:E)TiIEIDINCAAENCI
<br />l hcrcby effin.uDdcr pcnaltyo{rcrjlry rh lh€rcisaotrsltuclionlcndinsoscrcynrlhcp.rr.nu.ccotrhcworklorqhichlhist'.rnrilis
<br />issued (S(. 109?. Civ C.l.
<br />IrnJ.i\ Nimc
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