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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE
<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 / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)/r\
<br />Walls (Rough)9-',t^,K N"\L471,
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />It/eter Release
<br />Rough
<br />Service l\ileter
<br />FINAL sA
<br />Notes Remarks, Etc
<br />-..,
<br />OWNER AUILDER DELCARATION
<br />! h€rcby rflirm un<lcr pcnllry of pcrjury rhar I an .rcnpr lion hc Conra.roN Licctrrc tiw rb, rhc fouowing mrsn (S(.7o1 L5
<br />Blsincs .tuj Pn rcrb. CoJc)r ny Cily or Coxnry which rcquncs o Fmrir ro onrr ct- ah.. if,fuvc, dcmolish or EPrt 6.y
<br />slfl.turc. rir ro ns hsu.ncc. dso rcquiEs lhe aplli.unt for slch Fn.it ro fih a \i8n.d sarcm tnar nc or shc t li..i{d rurual ;
<br />r. rhe pdvirion ortu C.nh.rols Lions\l llw (Chapr.i 9. Crnmcmins ,ilt Scction 7(Xx) of Diviion 3 ofrh. Irusincs rnd
<br />Pmr.esn,ns Codc) or lhnl h. or shc is cxcn{,1lncrcfron'and lh€ tEsn lor lhc lllcscd cxcmflion. Any vblalhnofSsri,n70115 br rny
<br />q,llicd lou pcrmi subj.ru rh. aptlic!trr ro a civil pcnolry ol nol 'mr.
<br />rhn fiw hu.drcd dollom ($50)
<br />-r.,s
<br />osrcrolrhc nrortny. o. mycmtbrcs rilh wag$ as rhcir elc c.nFn\olion, willdo rlt rbA,nd rtr sME i\ fr
<br />i cnlcd or oficrcd ror sk (Se.7014, Busircss .nd Pmfcssions Cn c: thc ConrBcrois LicnE bw docs ml aml, ro !n owncr of
<br />rhc pmFny *ho buih\ or inlpmha rh.Gr. dd wlb dc\ skh mrk him!.lror hc^ell or lhmu8h his or hcr own.mployc.s.
<br />providcd rhar su.h inlpmftctrh m nor hr.nd.{ or olf.Eri ld $k. l( ho$rwr. rhc huildins or impmwntnr is s,kl wirhin nnc ,Ltr
<br />ol con{,htion. thc Owmr Buiklcr uill hnE Ih burdcn of pmvlr8 rhnr lr or rhc dit d huild or nqtow lhc pmFny tor thc pulF)s of
<br />L r\ .wrcr .fihc Iop.dy, rm.rclusivcly contmdirS pirh liccn$rl conrracb^ t, con{tucr rtf, r4ftr (se 704-1. RuvEss
<br />ern Pmfc\si,. Codc: Thc Conlrrlols l,i.ensc li* docs nol aprly kr Nowndr olpropcrl, {ho nuiBs or imlnlcs rh*.on.
<br />lnd *ho conh.i\ror such p6.ids r,lh r Co.lr!.ror1, liccned pusuotrl lothcConrra.ttr\ t-i.cns. tf,w).
<br />-l
<br />imcxcmpl unds Sccri(
<br />Ovn.r:
<br />]]OBf,&BII1;OIIIENSAIION
<br />IEILAAA.IION
<br />I hcrchyrifirorundcrlEnrhyolpcrjuq.m.lrh.tulL,$'insJ..lax nnN:
<br />I havc onl v'll ,miN rJClnilj.rr.olCotr{nrloScll'ltr{trcti)rno'[c cunrFn\dridr.,spmrdcJli,rhyScclidr.17(xIolrhe
<br />ItrtnrCodc, turhcFnnrmrtuc.f rh. work fr whi.h rh.Frmir i( tsucd
<br />I havc !.d eillmJintlir workcrl coflrpctrsoli nNunrn.c. $ rcquircd bySccrion.lT00ofrh. L.hor Codc. l'or lnc 0crforoErcc ol
<br />rhc work lor wlrich rhi. p.rmir is issEd. M y wortcG con!,cnsolion insulancc crfti.r drd |blicy numbcr mSln# l,,,to
<br />5
<br />I.cniry rhar in rh. lcrrormRc oI thc *ork lor which Ihh |x nir is issucd,I shrlt nor .'nnloy iiy !.non itr m! m0nnc!
<br />q) a. ro hcmm suhFcr ro
<br />'h. "ort(s\' .onncns,r nr n h*s.rCaliromin, oM rBrc hlr ifl should l[sm sul,j.d kr rr.
<br />w.rlcB conrpcnsarion ,r,vkbns of Sc.tion l?lDofrhc L$or Codc.l sh.ll.lonhsirh ootly qirh rhos pmvhkn$..
<br />WA|INING: Fuilurc r. s.urc $orkc6 conrpcnuriur ..vctugc k u.lawrxl. rnd sholl suhjccl utr cmfLrlr ro aitunrl lctuxi.s dnd
<br />civil nrcs up lo onc hundrcd lhousand dolluh ($l00,ilo0), n[ddkion to lhc cosr oi conlcnelioa. damgc\ ai Porid.d tr rh.
<br />Sc.r'on lu76 ol rhc LJI!tr Cndc. mrcrc.l ond ah{rE)\ fN.
<br />nnn.."lit*r;kss
<br />DECIJEAIION
<br />I hcrcby amrh unj.r p.nalry or pcrlurr lh,l I e,n licn*rl und$ pmvision o( Chor s 9 (onrftking *nh Sccrion ?000) of Divhion 3
<br />of lhc Busincss ad Pmfcssions Codc- lrd ny ltcne is io lull r.rc. ,,xl cficcl.
<br />BL 37Ll l
<br />,,,",. s -v)- ll t-&
<br />ra!$f,llltl)xrilDtNc-alj.EN1:l
<br />Ilrrchy.lljmundcrpcMllyorp.rjuryrharrh.'cis!codncri,nl.ndi.8n8!Nylotthcplliomaneofrh.eorklarwhi.hrrislEnniiis
<br />i*u.d (S...:l(n7, Civ. C )
<br />APPIISIINLIIECLASAIIA!
<br />I lIR'$y nmnn undcr |Enrhyofpcr.juryone ollhc hlhwins dc.ludn,ns
<br />Dcn)lirion Pcntrik sb.nos Noritl.dnrn [cdcrrl RCBUlnti.ns (l illc 40. l'ado
<br />Itrq!trcd Lr11d.l Nor Tl.niidr
<br />l.cnirythd lhc ttdcrilrcr!lllt,n{r.BUdiigrsb.skNrcii,v l c..rimli.!blc rorhis proj.cr
<br />e,..nrdy wirh illCiryrnd ('onnry
<br />lrhir Cirylndc.unryk,cnrd u,x
<br />'h(
<br />lAl(o^u, 'n ,n^" *'o
<br />'ntr
<br />omri( rrn'r J.lt Jr.rhr rhc rhr.,nroi,nn on | !,,ncc, IJErr
<br />;;::: :k:
<br />w::it'%_ n hc,.hyrd hc,u.,.,,c\cn {n.c.,,
<br />p.m...nrm. pr,n,,: * Al fq[a l/zhptu.
<br />*,, 5-/)_F
<br />zlEEtr]Iatrfitl
<br />ID/SIG.COMMENTS
<br />. l' I '?o/q
<br />tJrdci. AJJr.\
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