|
ELECTRICAL-INSPECTOR RECORD
<br />APPBOVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER 10- r- /1
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough idlJt{ld- r-l1
<br />Service Meter ril- t -/r
<br />FINAL ld-K-r1 \
<br />Notes Remarks, Etc.
<br />OWNER BUII,DER DELCARATION
<br />I hcEhy arlm unJ.r p.nalry dr !f,rjury lhar I m cxcn tium lhc Co rel,r' Lienr ljw f.r rhc lduu*in8 r.asn (Se.ilr.ll.5 (
<br />Bu$n.ss dfli Pofc*Dn C,rlc): Ary Cily or Counly whi.h rcquircs . pcmrir t' onsrflrr, dlt.r, rqrrovc, &nnish or rcpan any
<br />nrudurc. prul(' ils ssuak-.c. aho Equtcs rhc lrplicrd nrsdch Fm b uh a !^ncd srrenEnl lhar h.or sh. n intns.d pusuanr
<br />r' thc pruvtDis f rll C.nk[u s Lf,cnri ti{ (Ch.prcr g. Conrnrn.'n! *irh S.r6on 7fiD ot Divrion ] ofrhc Burincs!
<br />Irr.l.s$n( C(ic)or lhar lk orrhc i\cxemprrhc.clr nr Jrhchr$lorrtudllcs.JcxcmPtrn.Anyvidatn'trolSc.rir7o.ll5hy
<br />lppli.a ili,ral].rm suhJ.crsrh. r0tli(anr tu rcrv,lp..alry.tnor nuc rhm livc hundrcd.lollns ($500)
<br />:::lt
<br />-I.
<br />N lwnfi ot th. nrcFny. or my cry)loyccs * h *ag$ .r lhct q,L cont .erntn, will do rlr *ol* anJ ltE \t ulE n nor
<br />intcfrl.\l or olttBl tu elc (Se.7044, Buri*s ahd PRr.sonr cdlc: Th. a:o,lradn r Lrcn€ llw dE\ mn qDly ro o*ncr or
<br />rhc pn{Eny wlD bldds or ihfs)E\ rhc6,[ lrl wh,][s surh w)rt hinNcllor h.rclfol rhhu3h his or h.t owncmPl.y..s.
<br />pr,vrlcd rh{ ruch imPt}v.mnls a mt hrorlal .r oficrcJ ntr solc lr. t$N{r, rhe h{iBin3 or 'qrokmnr is n,U wnhh oE F!
<br />ol $'r{)ldrx,n. rh. Ow*r Builkr wdl hlr llE trrdo ol FUvinB rhlt tr or rh. nd nn t{iu or ni{rtuv. rhc pbFny tot tlE PrPs of
<br />l. a\o*ncrol rhc pop.ny, rm c(lu$lrly conrrchn! w h l(ctrxrl e.rLd.t)F t) !on(ru.(h. nrl)Jc.r (S.. ?{}44- Buinc*
<br />anl Pn)lc$rr C.J.: I hc C{ntrttr s Liccnsc l-rw doc( n.r lpnly h u own.r ot pn,!.ny qho hurld s d nlt)nrEs rhcrcon.
<br />rnd wh, contkk nn such n'('jc.h wnh. crunka(ron, k.trsc,l pusurtrlhrhcC.nr!a.n,'\ l,ircnsc l-rw)
<br />_I amcrcnpr undcr S.d
<br />!u85E8A!A!rE!$r!OX
<br />DECIIXAIIAN
<br />I h.r.hy rfitrnun't.r Fnalryol $rjury onc olrhc folk'w6e dcchrdlFnr
<br />-l
<br />hlv. lri *nl tu,nrin . Crcnifr.t. ofconscnt to S.lf:Insur.lor w .n' comFos{n,n, .s F.vid.d tur bySelm. -l?00ofthc
<br />Labin Cdtl., ldr rh. ,xdnrukc of rh. wod( fn *ti(h th. Il.mlil n nsu.J
<br />I hav. $d wrll md0lar workc e.mpcnsatnln inruriNc. rs rqtlircJ hy S(i on .1700 ol rh. tlbor Q c. Lr rhc tcrlolmne ol
<br />ich rhr J'{r.nr s issNl My *orkcr' .on{Ensaron surrn.c urrr iJrl Frlry Nmhcr d.
<br />t t-l-p
<br />{
<br />l.cnifyrhal in lhc ll.rhrmn.c ol rhc wo turwhtrhrhN It rhi t Fsuc,l,I sh.U fr{ cmnl'}y.nyI'cnon rnany mrkr
<br />\, a. b h.$m \uht cr ro rhc woRdr comFnsahn [u(.tCa nmn. lnd aEEe rhrr,fl sh)uld h(oft suhj.cl ln tlr
<br />work.^.rn,F_r\nrn,ntr,v'notr(olSccrrJnJT([,olrhcl-niitr(iitclrhrll,l,,nh*nhlundywlr
<br />WARNIN(;, l:r'lur. i) \.!uft sorkfl\ con,Nn\rrotr .!!v. !. tr r rr 6mlml mmlrrund
<br />flv'l llnc\ up t) oDc hun'lrrJ rh,
<br />ur!!:!-!!t!1r\
<br />I h.ehy.lftrnrnnd.r Fn.ltyol pcrjury rh.rI am lien$'l untlcr pfl)llnon orchafl.r 9 (onmftin8 q hSerm 1)00)olDivnn,n l
<br />ol rh. Busimsl d Ptuf.sions Cod.,.nd my lrcne r m tu ll tbr.! ard clfe-.i.
<br />L.t@
<br />l/'
<br />I hcrcby.rltnu c! Nnallyof pcrjuryrh
<br />NsucJ (S.r. 1097, Civ. C.)
<br />nnfl.rxr Ln'lh! +cn(y ld ihc Fr,nrnun.c ofrhc work l,tr wh(h rhtr ltrh r
<br />lrn&r't N,N'-
<br />A!&ICANLIIECI,IIEAII9!
<br />Ihc,$yanimn cr n nllryol pcriuryoncoirh.tull()wini J..lriLonv
<br />txnnn r'. P.rnnr*Asb.nns Nonrrcarrn r.dcal Rcptrl.ttr)nr (lirlc40. Prrj6)
<br />ll.!!tr.J IrrL! !'l N,i'lndiI
<br />I r.n'ly rhrr rh. r.nc'rl r+!LLon\ndr iplrlrc.blc h rhr p!)jccr
<br />lo.omtly wirh allCiry rnd Couory
<br />ol rhs Crly and CounrYb cnrs tli)nrh.
<br />-D3-( ?
<br />ImI
<br />r.l-0()l
<br />=
|