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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Rool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ce ilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />I\/eter Release
<br />Rough U>r/ta '+Ft''-qVA
<br />Service Meter (
<br />FINAL tdt<lt(An6tW lrr'
<br />Notes, Remarks, Etc
<br />OWNTR EIIILDER DELCARATION
<br />I hcrcby affirm undcr pcnulry oi pcrjur, rhar I m cxcmfl frcnr rhc Conh.'on l,ic.nc l:'$ lor rnc follo$ins reN)n (s.c 70.11 5
<br />Buri.cs and Pn,lc\si{,n Cndc)r Any Ciiy or Cou.r, *hth rcllircs o pcdir tr conntucr. drcr. imln,vc. d.noli\h '{ rI)Jn !try
<br />iruchr.. priur ro n \ k\unn... trls. rcquircs rhc +!li(ror itr such Flrir i(, fiL r \ign d {arcmnr thd lt or shc i\ licctred puru!trr
<br />r, rhr pmvnn,ns or lhc 6nrrack, \ l,icenrc{l t * (Chrntcr 9. Connncmirs wilh Sccrion ?o(X) ol Divhn,n 3 of rht 3!\inc$ and
<br />Prol.srns Codc) or rhdr h.oish. i(cx.npr rhcr.fio.rrid rlrbrsis fd rlr allcsdd.xcnrJ)lnrn. Anyviol i,'nolSccrion?0.11.5!'yrny
<br />ifplic.nt for. p.nni suhjNr lhc aptli.inr to..ivilp.n,lryornor rrerclhM livc hultrltrcddollnrs (S5m).
<br />I. ,\ ownf of rhc ptupcd y, or my c'nployccs sirh wagcs rs rhct eh conp.n\arn,n, will do r}t work ,ild rtr (MUc n k
<br />inrcndcd or o,Icrcd for salc (SN ?0.14. Busirrs and Prolcssi.ns Codc: rhc Conrracrols Li..nsc tiw docs nol amly Io an.srcrol'
<br />rhcpn'l*nv *ho blildr or in,rovc\ rrrfr,.. Md $lnr dEs ssh $olt hnnsclior hcrslfor rhou8h hh or hs own.'npk,yc.\,
<br />p.oridcd rhil su.h nn8rvcnf,nk e n.r inrcndLrl .r onaicd lbr sL t( ln$rrcr, rhc ttuikli,rg or i,npmknrir is s,kl *irhi,r onc Jr*
<br />of.o,rplcrion, rh. Owncr Blikcr will hnr rhc burdcn ol pmving lh.r h. or snc dn d huil1 or irqrot lhc pmFny for rlE purF,{ ol'
<br />-1.
<br />is oqncrofthc ro|rny. amcx.lusncly.onkdir8 wirh li...scd.o racrm ro constru.r rhc F)jccl (Sc.7o{,{. Bu\incs
<br />md lh'ics\i Codc lhcConrrocrn\ Liccnsc Luw does nor applyro 0nowtrcr., propcfly wlx' huilds or impmvcs lnc.coD-and who.o.trr.krdsu.htmj.rrswhhaGrnrturrc)licco\cdNsunrrorhcConrlcltnrl-iccn*ti*).
<br />I In.i.trmr nftl.r S..r
<br />Date O*n.r womrgsl filuPENslrltrN
<br />DICI,AIAU(rN
<br />I hcrcbyam nund$ Fnrhyofldjuryom orth€ rollowing dc.ltr ions:
<br />Ihrvcd wrll lir airlaC.nifi.nrcofC.iscnrkr S.lf li\lrc ntr *orkcs Lrnnttri{dhr, $ pmvidcd tur bySs.^ti{ lrmolrhc
<br />trbr ('odc.l{r rh. ldr(ntrrnN.frhr work fir *hi.h rhc pciinir is i$r.d
<br />I havc and willhainrai'r workcrs .o,hp.nrdrnrn i.surrncc, as rqrncd hySccriohlT0Oofrh. bbor ctld.. fir rhc pcrto rtrftcof
<br />rhc work fttr which rhk pcinir is issucd. M y sorkc^ conrFnsrrion in\ntun.c cdicr md tx)li.y nun$.. dc:
<br />lccdifyrhbr inrhc pcrtorronccorrhc work a{tr *hichrhh p.rni is nsucd.l shDll hor.nl,k,ytrnylc on inanynmnncr
<br />h .s b b...nr subj.rr ro rhc No cs conpc.s.ridr lrw\ of CaliLrnir. ud a8rcc rh rfl should heom subjsl rorhc
<br />vorkcF' coq,cmd ion pmvhions of Sarion 37uJ af rhc ttrtb. C.dc. I shnll. fonhwirh comnly wirh rlns pmvnionr
<br />WARNIN(I trrilur h {cur. $orl(.r\' con,p.f\rri,r (rvcr Ec i\ uthsln]. md \hrll \uhi.cr , .nlnk,ycr h d'n,nrl lfmlrd nil
<br />rnil 6Dc\ trp lo otrc hutrd.cd lhou\rnd Jolh^ (Oo.mO). in uddirt l. rhc c6\r .f coht iunr, danrgcs 0s lrovidcd rn (h.
<br />S.crion .ll)76 ol'rhc tiktr Onc- i'rrrrc
<br />I h.rhyainhu .rItnrlryrl pcrjrryrhxr I n,I 'hrprcr 9 (connfui.ing wnh S..l
<br />of rhc llu\inc\\r Pnni$n,n\Co{h. tmd n,y licctr!. is i', rnllnncc rndcft.cr
<br />L\0
<br />I h.Eby lrtrm undcr p.nlly of pcrjury ll',1 lturc is ! oistruction lcndin8 !8cmy for lne p€dolrMe of lhe sork ro. whi.h rhir Fmit ir
<br />isskd Isd. 1097, cit. c.).
<br />APILICAI{LDDI;LAEAIIO!
<br />I lrrhy {ninn undd p.alry of r.rjury oft of rh. fououin8 dn-.hhr io..
<br />Dctulilion Pcrnilr.Asb.nos Notificarion Fcderil Rc8ulorions (Tirlc 4{. Pm6)
<br />-Rcq!ircd
<br />l.ncrof l'.lorifi cdion
<br />Lm'[7d rh. rrJe,n 'cpularion\ rlar,iinE J.hc{.s rem, !alD.c r,i,'pnli ahlc n, rhn pn.t.r
<br />\+l lcn,ry r#r, hNc rcJd rhF irN',arFn trM qarc,h{ rh. rtnE rrni,,ur.tr r c.nN, I lsR,o.nmr
<br />),fdra\. # skk tj",Er,rm* r.bu,rdmF con{rucrbn. r hc,cb},urno,k re|lc<cnrJrnct nr rh,}.ir,hic 9(ircd nml,cn, ri{in\pccri,n nuqrsc\
<br />ly wirh rllCiryad Counry
<br />y rnd Counry l,i ctrlcr uF,n lhc
<br />ADDlirli'l or ,{lcnl silnnl
<br />"^"/""'0{Y\4
<br />b.1/o \*
<br />rD/srG.
<br />Transformers
<br />Lrndq\ Adrlres.
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