|
ELECTRICAL.INSPECTOB HECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<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 Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service Meter lt
<br />FINAL ,1L6
<br />Notes, Remarks, Etc.
<br />OWNER BUTLI}Ef, DELCANATION
<br />I h.r.by altirm undcr pcndlry or p.rjury lhd I on crcnlpl fmm rhc Contruclos Licensc Llw lor lhc folb*inE r€a$n (Scc.7oll5
<br />BusnEss nd Pmfcssion Codc): Any Ciry or Cou.ty phi.h rcquncs ! lcrmn to con(dcr- altcr, in0tuw. &mliah or Epair any
<br />nocluc. lrior ro irs hs!{tuc. al* requtct rh. umli.anr for slch rE.n ro fika \ismd arcftnr rhar rEor sh. ir liccncd puNanl
<br />ro thc provnions oi rlf Ontr0clois Li€cnsd ljw (Ch{prcr 9, Connenci.s with Sccrion 7m0 of Oirirhn I or rh. Busincs and
<br />Pmfcssions Codc) or rhar tE or shc is crcmpr lherctor atd rlE h1sil tor rhc alt8cd cxc,@ri.n. Any violrrion ofs.clion 1031.5 by any
<br />r,ffi ;;ild;;ffi*;ffi;ffi fi #;ir ;ffi r :T, .,
<br />rhc rbp.ny who buildr or in ews trftn. ,,xi *ho dds sch H,t hin*lf or hcsclf or lhrcuBh his M hcr o*n cmllottcs.
<br />provacd rnd such imrmrcmnls !e mr inicd.rl or olTs.d ror $h Il ltrN.q. rc luildins or inrprowm i\ eld *irhin onc ,6
<br />ofcorpLri'o. ltE Owncr Buildcr will heE lll ttrd.n ol pmvin8 rhar tr o. shc dil ml tdild or irqrFw L'rc porqly tor trE purFs of
<br />-1,asosnerofrhcproll.ny.anexclusivclrconr.acrinswirhliccnscdconr.dont.i,.qddrrhptuixl(scr.?04,1.Bu\im\\Md ftuLssi, Cod. ThcConkr.ror'sLiccnscLaw&rsnoraftlyb.noadcroffrropcayshobuildsorimnrowsrhcrcon,
<br />rnd *kl ontrrcrs lbr slch pmicls wirh ! ConlBcror(n licenscd pusruor ro rhr C.ntucroii Liccns. Ltrw).
<br />I h.r.hyrlftm!nd.rp.nrlrtotPcrjuryo cof rh.aol
<br />-l
<br />narc und will rointrin a CcnifEltc of Consc ro Scli.lns!rc for wls o6p.nerion..s Imvidcd ior bySclion l?OO ofltc
<br />tihor Cod., for lhc lErformn@ oflhe wort for *hich thc n.mit is tsucd.
<br />I h,rc dnd will frrimain worl.6 comp.hslrion insur.rc. rs ft.luircd t y Sclion l7ln of thc L!6or Codc, for rhc pdrormnft or
<br />thc sork ior whi.h lhis Fmil is i$u.n. My workcs omp.trsrli.tr iflsumnce cMicr ad Flicy.rih€r @:
<br />fIrtfnr,"' ,,* *,.-u,trc.r',hc $nrr rh, vh'(h rhis pci,ni, is issucd. r shrr no, .ntpk,r ,ny p.^on han! nrnrcr
<br />\rta.h h.nrr uhrd n, rhc w.rl cn .,'mp.nvrn'n r,$i orCrliromir. md 4rcc Ihd if I slu,uld tr.onE suhicr k, 'ltso*cri.ompcnsari,'opn,visi.fiotS..rionr70).rrhclibrC(xt.,lshlll,lnnhwilhconrllywilhlhocpr.vi\ion\
<br />WARNING F,ilu.. tu wrrc wo,kcr' omrEnerion corsaSc is unlaetul. lnd nFU sul,Jc.r u cnfhytr t, dimin0l pctrohics.nd
<br />.ivil fincs un ro oft hundrcd rhousnd dolles (Xiloo.()(xl). in uddition ro rhc co{ of$mFnrdll.n. d{m8.s 0s trovidcd for rhe
<br />l"o'[i"t"'","1
<br />I h'.hyrlrl nrn d.' n.tr'lry.lt^-"!nryll r lxn,lrrn{l sirh SLrrion ?(rx,J ottrilhion:l
<br />oi rhc Busirc$ rM Profc$ions Codc, ffil my liccnsc is in 6ill rb.e lnd cfccr
<br />Corlnctor:
<br />coN auqu(arED[iclcBr]
<br />I hcrcby amrm !od( FMlry or p.qu.y rhnt lhd. h a .ob{dcrb. k.di,8 lecmy for th€ l)crformN ot lh. wotk for which rhi Fmil ir
<br />issucd (Scc 1097. Civ C.l.
<br />APIIIIAILDEI;I.AXAIIQN
<br />I hdrty !,nm udcr pcnllry of pdrn.y orc of rhc rollo*ang dehB' ions
<br />D.nDlilion Pcrmih-Asbesros Noriliclrion Fcneral Rc8lhriotrs (Tirlc40- P!n6)
<br />Rcqut.d t ttcr of Nolifi c.lion
<br />,
<br />-l.d
<br />D rl-r rh" x.d-',r,cprlr,n,n\ n.emi'ns a\h.{n\ rm r rl rR' mr ,fnl'.dhlc to rh^!n,F
<br />ffi*:*lrrrr,'-tr;rIfl[ii;l#:"r:;;'.rilL'fr:"-iljTr,iJir.'l"l']i"i,1i-"T".irtr'i!,'i]ll'dt'.:,'iilrffi::H",*
<br />rh,vc nrdri,nRt pnip.nyn, nilfc.riotr NrF:c
<br />Applacrnl or A8enl SiAnnlurc
<br />I
<br />,.,", ololg
<br />Ifi!EZIF,EI
<br />b
<br />t ndc AJdEs
<br />-
|