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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Iv'leter Release
<br />Rough 1'u"t0 J,,tfc /
<br />Service Meter
<br />FINAL '/-q-,/B ,)7)
<br />Notes, Remarks, Etc
<br />OWNER AUILI}ER DELCARATION
<br />I hcreby ltnirn und.r FMIry of p.rru.y rhur I rn cxchfl lbm rh. co.r6dor' Liccnsc bw for Ihc followiry rcls,n (56.1031.5
<br />Busincss antl Frofc$ion Codc): Any Ciry or Counr, *hich Bqunes o Fnnil ro con(rucr, rlrq, iopr6r, d.mlhh or Epan any
<br />rocruc- Iri{trro irs n\!an.e. aho rsguircs rhc lpnitlnt lor such lErmn to filc a sisncd srdcftnr rh h. or slE ir li(.s.d l[nuanl
<br />to lhc pmlisn,ns of rh Contmbls Li.c.*d llw (Chnpr$ 9, Comming wirh Scction ?olx) of Divhiotr I of thc Businesr ud
<br />Pmfc$ions Codc) or rhor tr or shc iscicmpt rhcEfrom snd rh. hosis fo! inc !lle8.d cEn0rion. Any liolariotr of Sdhn 7031 5 b, any
<br />applicanr forrpcrmil subjNls rhe apdi.BnrroacivilpcnalryofnolmrcthanfivciundrcddollaB($500)
<br />-1.
<br />os owrc! ol lhc pmFny, or ny cmplo)ccs eilh w,ecs is $cir $le onrlEnsll bn, uill do lhc wolk and lhc (trlr G not
<br />idc,xL\C ordff.i.d torslc(S(?044. Busincs snd Pmfc\snrns C.dc, Thc Conrrcn \ Li.cn* Law dfti not rpdy ro M owncr ol
<br />rh. !.opcdy *ho hoild\ or iqmrcs rtEEn. ald *ho de\ sEh wo,k himslfor h.r*lfor rhou8h ht or t.r o*n cmpi,ycc\,
<br />providcd rh such inJmrnEnrs e mr inred.n o. oficrd frtr slc. ll hrqcc, tlE ttriu,n8 or inpmrrmrt is sE wnhin om )re
<br />ofcoroLlion. tlE O*tur Build.r will harc rhc hhl.n of pn,ving rhar hc or sh. dil mr huiki or i.pmw tlr tsFny inr rlE lrqDe of
<br />t. rs ovncroihc !n,Nny,,mcx.lusiv.ly.onrn ri,r! wirb lic.n\dd conrturorsh.onnru.( th. pmrc.' tscc. ?014.lruqncs
<br />arn hDfcs\hn Codc ThcQ,nrracroisLicenseLowdocsnor0rnlylonnowncrofprot rly qho huilds or inrprolcs rhcrmn.
<br />nnd who co.rrlcrs ft, su.htojcch wnh n Conrrd{,(, liccnscd ru6@nr ro rhc G,nr&kr'\ t,ic.ns.liw).
<br />lrn,clrD,Jn u ..s..roD .ll ,!1,( ttrrhr{cr{,,
<br />I) tr ()$nrr
<br />tl!)4f,.E&r.!i:qu[ENta.u0N
<br />IECI"AX{IION
<br />I hcrcbyafiii utrdcr tcmhyotp$juryotu ofrh. followi']3 dcclnrrrhns
<br />lhrvcnnd willnrxn ni'raCcnir{d..lc.i\c rhScll ltrsurctrwork.B'ro rrcn*nrnnr. rs thlidcdlorhyScdion1700ofrhctihr Gnl., i(tr lh. pcrlonrutur.frhc Nork tnr !hi.h ihc pcnnir ir issu..l
<br />_l havc ind willmairrli| workcd conrpcnsllion iNurrncc. as rcluncd hyScclion 3?(lr ol ri. ljhor G)dc. fo.rhc,crt rtutucof
<br />lhc aork tuehkh rhi\lEr.rir i\ i\!k1l Mysorl.n co rFnsllion insurancc.rri.r and F,li.y numh.r-cl
<br />Ic.nityrhrr if rhc n rtun'un..olrhc fff{hi.hrhir!.mir k i\\urd. I \hrll nor cnlPh,, rny pc^otr rny nrtri.r
<br />$ as b h..onk subjc.r k, rhc wDr* oJ .o nra.nsar n, n ldw. orcdliroma.,nd +N rhar ifl should bcco'rc ubjcd ro rht
<br />w.rkc^.omlcn$rn,npn)v(ir,n\ofSNrbn:lT0Ootrh.LatrtrCodc.l\hrll.fodlBirh.onrdypilhlhostmvisioos..
<br />W^RNNC: I:lilurc k' scurc sortcs comncn$tioo.ovcrlrc is unl!$iul. lnJ \hrll \lhjccr rn cauk,yr b cirninll liMlrics dnd
<br />.ivi lincs up ro otrc hundrcd rhoulrDd dollrr (SI(x).(x in addirion ro rhc con orconp..sarion. d,nD8cs rs lrovidcn lor lhc
<br />s.cri{)n _1076 otrh. l]htr (i)d.. inhmn rd mtrtrry \
<br />"".,'d/6//K
<br />I hceby,Llnn xnd.r pndryorlc jury $d I m [an{n und.r !^,vErn orchnDrs 9 (oummms w hScdion 7uJ0].lDivkioi 3
<br />. (r,0", ,* ., ,."u." *,.,rrr',".* -a"n*,
<br />LiccnscChs:-
<br />€ /'r //a
<br />I hcEby afilm undcr lEnslty ot Frjory rhsr rh.rc h s mnnrudbn lcdinB dslncy for rhc rEfolfue ot fic e.k for whih lhi\ Fimir is
<br />issu.d (se. 1097. civ. c ).
<br />AISLICAXLDICLABA.IION
<br />I h.r.byrnmund* FnDhy ofp.riury om ofrhc folbwin8 ddlf iohrl
<br />D.n{rirn,n Pcrn rs AstEskx Norifi.triion Fcdoll Rcsuhr ions lTir lc .lO. Pd6)
<br />R.qun.J I dricrol Norili.rii,'n
<br />-l
<br />ccniiy thor rhc fcdcra! rcSulntions rcsudinB.shcslos rcmvnlarc not lPlltohlc ro rhn poj(l
<br />l.cnifr rhtrrI hrvc resd rhis mli.,bn tuxl snr. thir rhc rh)vc i.fd Drdr ic..nct. I +rc ro .omfly qnh .ll Cny lnl Counly
<br />ordiM Ccs rnd Sttrrcllws rldinBro buildinS c.inrudion.0rxl hcrby thorizcrcprcscnrari\rsofthisCilyandCounlylocnrcruponthc
<br />"h,vd 'ftnr nnnl pn,pcny in i'l
<br />,\ ppli.nnr or ,lgetrr siaMr *;, 6b1/L
<br />,z?)
<br />Pole Bases
<br />l.cidcr's Addrcs
<br />i=-
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