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ELECTRICAL-INSPECTOH RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />l\4eter Release
<br />Rough
<br />Service fvleter /L
<br />FINAL ,a)
<br />Notes, Remarks, Etc
<br />oWNI'R BUILDER DEI,CARATION
<br />I hcrchy onnn undcr pcmlty ol pcrjury rh0l I onr cxcnrpr nom rhc o)ntr0clorr Liccn* l,w lor lhe tnlk,sing rc8{t (Src 70.11 5
<br />Bu\incs ond ltofc$ion Cde): Any Ciry or Counry which r.luncs r rcnnir h con{flcr, olrq. inrrrcrc. dcnnrkh 'tr t]]Jt rn,
<br />crrucro.r. prnrh irs isru.c.rkdrcquncsrhclpplicrnrfuuchFrmirrolilcEsilncdrnrcrnrrh.rtBorshci\li.cn{dpunuinr
<br />ro rhc Dovisions o, thc (btrxodols Liccnscd Lrs (Cha cr 9. Commcncin8 with Sccrn,n 7()O of Dilision:l otrhc au\nrs rnd
<br />Pn,fcsn,n\ Codc)or rhar hcorshc iscicmpr thcrcliomlnd rh. hlsh fu rhe alhgcd.x.topri(,n An!vtnrlionofSR.'riDl03l.5byany
<br />appli.rnr rofu Fmir $hjNr rhc ripli.nnt k, r .rvn pcnaX, of nor m{ rhan fiv. hundrcd dolldG (S5U)).
<br />-1,
<br />N osncrofthcropcny.ormysnrplorcs silh uascsasrhcnsohdrmp(nsrn,n. willd. rh. sorl and $.ndE nn
<br />i, cnldl .i ofiucd trr sl. (se.?ltl4, a$itu* md PrDfcsio s cdL: Th. c.nra.rofs Lien$ tiq does nor q'Irly ro on owner ol
<br />rhcpmFny rtn builds o. in]IDvcs rhc@n. dd who doe\ \&h Mrl himscl{or h.^.lt.rrhmu3h his or h.. own cmfloycN.
<br />lmvidcd lh,r slch intmwrnhmmridc .d oroficEd lorslc.li howcrcr. rhc hiuinB o, irmmwmnl is su wirhin .ic y:d
<br />of..npLriod rle Osrcr alikllr will htrE rrr btrrdcn of prulins rhd hc or rhr dil Nl boild or iqn.vc lh. fmFiy for rhc l[rrx,s of
<br />L dsowftrorrh. ph!.ny, un.rclusivclycontacrirg wirh I i.cn{cd co tuacror k, consld.r ttE lmjcd rse.7Lr44. Busincs
<br />and fiDlssion Codc: Thc Conrracrols l-iccnsc l-.{ des nor lprrly ro !no*ncr orpron nywh. huildr.r inpn,vcs rh.rcon.
<br />and who &nth.B for such ptu1..!r *irh , Conb,cr.r(a) lk.n\cd Nrsuan( i) lh{ Conlrd.loi( Lkcns l-le)
<br />I r crr rl u d(r Sr.rn)
<br />ORner
<br />W(TRKERS' CoI!IPFNSATTON
<br />DECLAIAIIIIN
<br />I hcrcby afltmundcr p.n,hrolFrjury onc olrhc followin8 d(l,nrions:
<br />I havc rxl will minrain , Ccnifi.dc of Con{.r ro S.ll ln\uh fttr Mrkcs ompcns ion.as pmvided lorbySsrionl7U)olIhc
<br />l,txr Codc. tor rhe Frfomncc of rhe wo* ror whkh ihe pmir is is\ucd
<br />IZI'havc and will mrimdin workn conEnsolion insurrmc. rs RquiEd hy SNI ion ITOO of rhe L.hor adc- for rtu pcrfi,mncc of
<br />th. mrt aorwhichlhk Frn l is issrt MyworkdC $ft,Ifnslion insurlnccqntr rd,'.licy numbcr ac
<br />ogliorrll U ^b; l,71rc at, Co
<br />w o o.r',.,, o4orltl
<br />-l
<br />cnitylhul in llE pcrr'oflrorccof lhc e.rk l'or whichlhis pcmil is issucn.l shll noic )pl.yinytcndtr ir rnymDncr
<br />er astu tE..'m snbrcrb
<br />'h.
<br />wo&ds .ompcnsdion lawi orcalitorni.. aM lBrcc rh ifI should hcr.m sunjcr hrh.
<br />workcN onD.nsdt'n pmlkioN ofS.ciion l7lx)ofrh. bt iC.dc.I ihrll. lonhwilh conl,)ly wirh thos pmvnions..
<br />WARNIN(; Iirilutu n) s.curc *1 e^ con,pcNrriotr rovrtugc i\ unlr*ful. rnd \h ll \uhjr.r rn c'nt,k,ycr t, diriDdl tEnnllic\ rtrd
<br />civil finr\u!tiotrchundrcdrhouslnddolhn(Sl{X}.(XX)r.i',rddirionhrhrco{otcorttr\dn{,dr.r8c!a\pn,ridc(l lnrrhc
<br />Sccrion l076.frhc l-rtxn G'dr. inrcrc{ rfrl a(orncl s lt.s
<br />UCDISEDJQNIXAqIqB
<br />DECIABAIION
<br />I hcEby ainm undcr IEMlty of F€rjury lhlt I an licen*n undcr pmvision of Chrplq 9 {.onfteins virh Serio. 7000) of Division :1
<br />.l rhc Busi.c* aod Poacsbns Codc. lnd ny lic.ns n in fuu forcc and cff.d.
<br />-Liccnse
<br />Number:6o8;zto
<br />6 I 7lr ts c""^a*, fss,><.-t+<A EJ#{,1 -
<br />CANEIBIJ!.UANUIIIIING]IC.ENII
<br />Ihcrehyamrmrncrp.nrhtofp.rjuryrhdrhcrci\r.1,nntucri{n!Lndi'r!rlctu}forrhcnrlnnn ccollhcw.rk turshirhrhi\rarn,ir i\
<br />issued (Scc.3097. Civ. (:.)
<br />t trdci\ Nrm:
<br />Af]LII;ANL.DEI;LAMIIQ!
<br />I ltmby ljnnundci |tmhy oftErjury onc.irh. folk winS dc.lfrrlons
<br />Octulirnrn Pcrmik Ast{sror Norificarnnr FcderulR.g larions (Tirl.40, Pd6)
<br />I ccdirynd rh.lad.rtrl rceulJrions rcgtrdinS rstu{.s rcnDv,ltrrc nol al)l)lic{blc lo rhis D(+cr
<br />_l.cnifyrhri lhrc r.trd rhi\ lpplicrtnn, rd ( r.rtur rhc rh\c inlanuri,,n is.onccr lrgret,.onlllt*irhrllCiryrtrdCortrry
<br />$orc nrnlioftd prop.ny ior insF.lion
<br />AIrDli.!nt or l*ul Sig.alrrcl
<br />P€mire rme (!rir'): 1?d '-la ( li)o'lr
<br />^,.,
<br />6/r>f t8
<br />748/fltZ?:29
<br />6lrZJ tt _ noo,-*,
<br />Lcn.lc, \ Addrcs:
<br />-
<br />Air Conditioners
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