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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER AUIDER DELCARATION
<br />I h.r.by afilrm undcr Folry of p.rjury Ihar I m crenpr fmn rhc Contrrcro6 Liccnr bw tor rhc f.llowing rcN'n ( S(. 701 1.5
<br />Busincs alld Prorcssion C.dc) Any Ciry or Counly whkh Equircs i trmir lo conirud. alt... inprove. (lcmlish o! rcI[n ony
<br />iru.ruE. priu t, ir. issuancc, rko r.qrim rhclpplicanr lor such rEnnit ro fiLa sisned srarcmnr rhlr hcor shc is licn\.d pusuair
<br />lo rhc Imvkions ollhc Conl!.clo.s Liccnscn tjq (Chaptcr 9. Connncrcins wilh Scction ?0 ) of Division I ol lhc Businc$ ad
<br />Polcslionr Code)or rhar hc or sh€ is eienpr rhcrcfromand rnc b,sn rbr rnc nllcsed eichprion An, viohrn,nofSdli,nT0ll t bFny
<br />4,?--;: ;.:"; :, ;::;.::::'; :::,t *:.::- :" :*::::*.*-,,-,. .,
<br />ftrrckl orun rcJ htr slc rs\-. ?r rc.{ Buvics and Pr.rcr(nN C{xlc Thc G)nkrcr{tr\ Liccn* hw dft. nor rp/y lo mownd or
<br />rh.rmIcny whn huilds or in$mrcs ltFFn. ond whn d{s such Mlt himsclior hcrsllo. rhmu8h hir or h.r o*ncmplorcc\.
<br />Providcd rh such inprohm.h re nx i, cftl.i or oficrcn ftr ele. lt howcwr. lhc huiUing or imrrcEmnr ii $kl *irhin o . ,tdofsntllkril( rh.Owncr Buiucr willh3vc rhc lrrdo olpmviq lhd hc or shc dil mn tuikl o. inDmw lhc r'$Isy f.r rhe puqnc ol
<br />_1. is oprcr oI lhc ,!o!cny, :m cxcl$ivcly.ona.r ir! w h li.cnrcd..nr,.ros ro cotrslrucr rhc prolccr (S(.7014, Bunnc$
<br />a.d lhf€*id Codc ThcConrmcrois l-iccn\c l-oa d.cs nor flDpiyio m os ncr of prorcny sho buildsor nnprovcr rhcr.oi.
<br />aRl wh. coflr r for such pmrtk qir h a Comndr(\) Ii.cnscd ruburnr k,rh.Cbnrn rois Li..n* Ira)
<br />;1,'"'"'tl,Ii
<br />Itt+
<br />I hcrchy lffinnunnq lenrlry ofpcrjuryonc ofthc iollow
<br />Ih.rcdndsrlltruinrnra(tnificarcofcorscfiros.lflnsur.t,,w.rtc^.otrlP.nvlntr,,s pr.vid.d fo. bySsrn'n 3700 olrhc
<br />Lnhor G)dc. for ihr pcrlbrmatud .l rhc sork t{r which rh! ncrnrir i\ issucd
<br />I hrvc and wiil nuinlaio sorkers comFnsarion insur.Nc. ns tu'quircd hy Sccr ion l7(D .r rhc ljbor Codc- iq rht pcrrormrrc or
<br />rhc suk rir which rhn I,trnir is hsud Myworkcn co'npcnelnn iNUrsrucstrt, rBl E,liy nunfi.r dc
<br />in Ihc p.rfoirnm.e nlthc qork fttr rhi.hrhh n rn't is irsucd.l sh0ll not cnployonyF6on iranymlnncr
<br />sohF.t h rhc {orkdi con,F.\rrion law\olCdili'riir. rnd aIr.r rhrr ifl \hould h...nr \ubj..r b th.
<br />w.rk.rs NrnpcNrr i.n pd!i\i(,n\ ol Ssrn,n :l?00 ol rhc lrtxtr Cdlc- I lhall, rodhwirh oilply wi rho$ t)(,vi\ions.
<br />WA|INING Idrlurc n, *.rrc sork${..nr!cn\nrn &vrrrac bjc.t rtr cnlpb]q lo riminrl
<br />,r,", U
<br />I hlrhylnnm undc! Fn.lryolpcrjury rhnt I am liccnxn u cr Imvhbtr of (llllplcr 9 (commnc ins wi
<br />of thc ausifts ain Pnna$iorx CGlc. ed 'ny li..n$ is in lull nnc. 0*l cffc.r
<br />COISIBIJCIIONIEIIING E
<br />I hcntry af6.fl undcr Fhahy of pcrjury fi{ th.rc t , .$nntudirn bndinS n8cmt for llE psfonumc of thc *orl ,or shich r,ris lcrnril ir
<br />hsucd (S.c 3097.Civ C.)
<br />AfIUCANfDECT,ASAIION
<br />I hcrd,y !ffirm undcr p.nah! ol p.dury onc of th€ following dNlsations
<br />ocmlirion P.rmir$Asb.sos Nolificalron F.dcml Rcgularions (TirL 40, P.n6)
<br />Rcqun d knfi of t{.dllalb.
<br />/AA;
<br />iry ! har lhc rcdcnl r.Sulorions mBrdin8 ,shcsros .cmval arc nor amlicoblc lo lhG projc.l.
<br />rhd I fiavc red rhi\ xrtlicarn,n,Jd (ar.rhd rtc atx,vc ini(,rori.n irc. tr. I agre lo..mply wilh rll Cily lnd Coutrly
<br />ornn,an.c\ rDd Srrrc lr\rsrlrri'rE k' btriUtr,E
<br />rhovc f,nrtrr.tltk,Fny lnr in\Fcri{ni ptrrB
<br />Appltcanl or &eni Sis@lue
<br />Pedile Mme (pnnl):\Puk
<br />:,'-'d"lr lf*
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />!!!e Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Boof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />[alls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rough
<br />Service [/eter
<br />FINAL /-zt-e J)c{r ?fr)
<br />Notes Remarks, Etc.
<br />APPROVALS
<br />Site-Work
<br />Under Slab / Floor
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