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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino i Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meler Release
<br />lA
<br />Rough ld-r"lc
<br />Service It/eter - \l\
<br />FINAL Io -z,l-lg k,\ryr[)
<br />Notes, Remarks, Etc.t,/
<br />OWNER BUILDOR DELCARATION
<br />I her.by ,ffinn r.d$ r.n.hy of r.rlury rh l arn cicmpr fmrn thc Comracror'l-iccns. tiw for rhc followLt rc!{,n (5<.70.115
<br />Ausinc$ md Proicshn Codcl Any Ciry or C.ury whirh r.qxn.s a lf,nnn h conslrucr, rllq. imrmvc, &fr,thh or rcpni, dny
<br />{tucru.c.rkrrons ir{uanft. aho nxtuir.s lh. rtplic.nl for such pcrlnil lo file r si8ned sr cmnr ih, h.or shc i\ lircnsd pu^uutrl
<br />lo lhc [ovisions ofrh. Conrncrois l,iccnsd Ln* (Chnl'r9 9, ConrEmnr8 sith S.clbn 7(ND of Dilhi,n ].rrhc susincss and
<br />Pmlcsi.ns Codc) or rhar lr or \hc k cxcmpl rh.rc,ibm $d lhc basis lor rhc allcscd cxcnpiio Any vidrlionoiscclionT03l5t'y any
<br />{pli.r r.r a pcrf,I subjNk rhe trlplicanr k, acililpcnllryolnor morrhan fivc hundEddollds (Sslxj).
<br />-1.
<br />!\ o{ncr ol lnc pmpcnr- (n ny cnPlort\ wirh *aecs r\ rh.t $lc conrrcns.rion. will do rlrc qo.k dd Lhc (Mu c i\ En
<br />inrc ld! oroff.rcd f.r slc (Se lo4,l. Busimssand PrnfcsioN (.odc: ThcConherofr Ltc.$ lj* d.es nor amly h ui o*er.f
<br />rhctmFny wto trildi or in{dr$ rh.6[ ard wh. des {ch eo himiclf.rhcs.lforthrcuAhhhorhc'os.cmployccs.
<br />pturidcd rhd such i irmrcmnrs @ dn iorcnddl fi oficrn fttr sh Il howcvcr. rhc lNildins or inDmvemm i\ qnd wilh onc ,te
<br />of.uuLlin, rlrO{tur Buibtr sill h.vc r hud.n ol pmvine rh.t hc or sh. did nol lDild or iqrck &d ptuFdy for lhc Puqns of
<br />-!.
<br />r\ o*rcr ol rhc pRrIkn). rn cxcntrivc ly co.rrlins snh liccnsd contmtB t, str{rkl rh( lmFr I Sc. ?(!r4. Suqms
<br />iffl PNfishn (-odc lhc(otrkncrois Liccisc Lrw d(B nor rrrly t, .tr oqrcr oltr)p.nyNh. t'uildror inrrfttrcsthcrsn.
<br />lnd *ho conracr\ f(tr \u.h pma.ls rirh r cbtrtn.ro( o li.rtrkd Nhurnr xi rhe coi rmtn \ Lii.nsc L.rv).
<br />-l
<br />aDcrcflplundcr Sccrn,n .B &PC.tarlhisrcr{nr
<br />TOBtrI&T:.COUPIiNSAIIAN
<br />Dl:!t A8AIlr]N
<br />I hcrct'y att trndcr p!dilrvorFrjuryotrc orthc follo$ir8 dcclffaliotrs:
<br />Iharrn'xlwill'on rin0Ccnilic.rcolConscnrroScllltrsurelo'wo'kcs.oqrns.rnr.i\ t'ovidcd t(byS(rion l7(X)oirhc
<br />Llbor Onlc. lor rhc Frfonnricc of rh. w.lk ior wh i.h rhc ncnnir n n\ucn
<br />Ihtrvcr d will nri[.ir Norlcrr coflrpcnsarion nruruncc. ]s rcqrncd bt SNrrn 1700.ilhc Litntr Codc. fir rhc Pcrfornuncc oI
<br />rh. work fd which rhn ptnnii is issucd. M y Norlcrr .omp.nsrri(,r i'Nr cc cnni.r fld Policy tunrhcr rc
<br />-l
<br />cenifylhar in rh. pclfornunccorrhc rk for whi.hrhis pcflnir is issucd.l shallnor.hlt,yrnylcBon ir anymlnncr
<br />n) r\ni hc.om nihjcrr t,rh. workcr\nrtr kwsofCalii,mio. aod {gr. rhar ifl shotrld tEcorft subjd i, r't
<br />workc (,nfcn\aln,n r,visio.s ntSNIion:l7u)oithc Lnbor Codc,I shrll tunhsirh.omply with rho{ Pm!i\ion{..
<br />WARNIN(; rriilurc h ccurc (orkcrs c. iFn\rrnr ro\crasr is rildLrtul. rtr(l shrll {'hrlcr U, ctrDl()rtr ro oininrl lEnllricr 5nd
<br />cnil litrcs uD b onc hundrcd rholilnd dollan ($l in rldirirr ro lhc d'sl or conD.nsarn,n. damgcs as [.vidcd tu lhc
<br />sr.rnn, lorar.ilh.l,'h (dt. i'nrrrnr r(nmv
<br />,",,..,--9f 1-7/28 --2--
<br />I )t,( l.\R\llr)\
<br />I hcrbt atirn nnd.. r.n yofpcrjurythal I mliensduMcr prcvision of Chsptd 9 (conlnrcNin8 wnn Scclion Tlxx)) oroirsion I
<br />of Ih. Busincs and Pmt$n,ns C{ilc. ard my lic.n* is h lnll rlrEru, cflecl
<br />rB 7*-*n**o/
<br />^r., 7nlr/ ^
<br />CONSIf,UCIIONIENIIING.>NqI
<br />I hcr.by dflirn und.r Fndly ol rcrjury rhar rhcrc n r €on(Bdi,n tndinr uscftt lor th. FrfonrBncc of ltc wotk r.r shi.h rht Frmn i!
<br />issucd lScc. :lm7- Ci!. C )
<br />AIIUIAII.OECI/3AIIQN
<br />I hcEby 0litm undcr I'enllryolpcrjlryond ofthc ldlowinS dNl0rtriotrs:
<br />Drmolirion Pcrmils.Asbcsros Norifi.lrion FL{.ralRcgulrrn)ns (Tirlc40. P.n6)
<br />-Rcquncd
<br />&rrcr oI Norifratit,n
<br />l.diftih llrc rc&l riir li(rri{nr ! (rrc rhrrrh.rh)k iir(tr Rrn i\.onNr l rgreroconrdt{irh allCir} rndCouDry
<br />d,liMtrccs d Srirc Lnw\ rchi t,huidi'ru.otrnn'.riotr rn(lh.,chtrtrrhf,n.r .klrrn.\dl I hk cirvsnd counrv ro cnrcr umn rhc
<br />rbvc trf,nlnnrd rro|{rty li,r *,J/27/a
<br />-) -u').9Z
<br />ENAta
<br />.-zh
<br />-l.cdiayrhlrrhcacncralrcgul
<br />ionsrcB.dinf6t{{osrcnDlalrren.lrpplicahLt,rhisJ)ft,rc.r.
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