|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER NUILT'ER DELCARATION
<br />I hcrchy rmrm under pctulry of pcrjxry rhnr I tuncr.nfl rro' rh. Co.lfu.()n Lictr* tiN {or lhs lnlnrwi'ig rcrlotr (Sc..7011.5
<br />Busincr a P..fesion Cdlclr ny ciry or Counry sh{h rc,tunc\ 0 pcirnil to coinrucr. lhtr, iFProvc, dcj]Nlkh .r rcp.n i.y
<br />sr .rurc. pritr k, i. isitr,fr.,,ho rcquncs lh. lprhnd Lrsu.h Fnnit b lilc ! sirn.d surd'hir rhd h.ot shc h liccnscd Irunuont
<br />lo llE rn)lisions ol rhc Conrractr's lj.cn*d ltrw (Ch{prrr 9, Connncn.inS wirh S.clintr ?0OO of Divhbn .l orrhc Busincs ,nd
<br />Pmt snnN Co!c)orrhar hcorshc h.xefDt rhcrchomrM rh.hrsn tnr lhc rllesed cic'nprion AnrYn,hrhnolSLrrbn?03l5hyany
<br />dpllic,nr r.r a pcilnir subjcck lhc a,'plicont io acivilDen0lryofmr mrcrh!. fi!c hundrcddolles(S50o)
<br />-1.
<br />!s owncr of rhc proFdy. or nrt .mpn,rcs wirh w.sc( $ lh.n s[ co pctrslion. siu do rh. work d nrnndurchml
<br />i cdcd or .rTceJ lor slc ( Sa ?l)44. Blsirc$ and Pnrt$ions Cod.: -l hc Cd m.rofr Liccn$ Luw docs nol arply ro an o{ner of
<br />rh pmFny wlr bnild\ or i.pows rh.s[ nM who dft\ such wo* hinNc!, or hcncla.rinDosh his ot h.t own.mfbyes,
<br />prolidcd rhnt n,ch inDro\sEnls m nor inrendcd or o,Icrn hr elc lI ho*$s, rlt hoildinS or impoKmnr is $ld wirhin onc )ru
<br />or6n{,Lti,n. rlr O*ftr auiHd *ill h(re lh. hul(kn of !&virS rh{r fu o. shc iil rn h{ikl or ir!'mk dE Ptu!.riy Lr th. l)utInrc of
<br />,. r(ownftoflh.pn)pcrry. rDrxclNivcly.o mcrirs $irh liccnscd ..irrldod i, (,'{tud rt€ Eojccr (Scc 7r}$. Bu{n.\s
<br />{al FDf.sin Co{lc Thc(:onrd.rorl Lionsc Lrwdods nor dfplyb rtrotrncr oftmp.ny*ho huildrorn.piovc\ lh.rcon.
<br />dnd who conrNrs lor such projccrr*irha Contlcl[(n liccnrd purur r{' rhc Conlftdoii l-iccnse tisa
<br />-l
<br />rmcxcm,,r utrdcr Sccrion
<br />f.zs"lx
<br />NECLARATION
<br />I h.rcby rflinn u dcr pcnalryof,'crjuryo.c olthc follosins de.'lmrn,ns:
<br />-l
<br />havc !d will minrain a Ccn iricarc of Cotr{ roScllrnsurcn w.rkcs conF.siirn, u\ t olidcdforbySccltu"37{xrofrhc
<br />L€hor Codc. for lhc pcrformncc ollhc work lbt shi.h dk P.nnir is igsucd
<br />lh.vcnMwillnrrtainwolkcracompcncarioniNur!trcc.!sEqlir.ihrSccrionl?fi)ofrhctjtnnCodc.turrheIi.rfonrBccof
<br />rh. *ork ror*hichrhn p.nnil is nsNl Mysorkcn .on{i.ns!rn'. nNrrak..ad.rdt policy rumbcr scl
<br />I ccnify rhrt i'! rhc Frn)nnrn.c ol rhc trurk for *hi.h rhir Nrnril i( i\suql. I shallnor c fby any Nsor ir any mnnocr
<br />$ sh hcont {bjcd x)rh.*oltcm roarp.n\!ri,n! h*\ or Calinmir. .i r!rc hir ifI sh.nld 6ecom sutjecr hrh.
<br />workcr! (onrDcns!ril[ !rovhi{,ns ofSccrion.l?(r,orrhc l-ihn C(xt.,I shrll.l.nhsirh comply sirh rlF{ Pm!i\i,,ns.
<br />IVARNING: Failurc ra scurc solkcr{, conrF.snrion coveEgc i\ .nllstuI. and shnll lubFcl m cmlloyrr lo nimnEl !.nalrics and
<br />civil fin.s nn t. onc hundrcd rhou{nd dollar (Sl0{).(xl)1. in addirion ro rh. co$ or.onlrnrolion. drtruges dr piolid.d f(tr rhc
<br />",,",:$:?*- I V taq-+
<br />DECI.dAAIION
<br />I hcrchy i,lirn udcr l]cn!h, orpcrjnry rhr I an lilrn*d und.r F)!icn)n ofchrpts, (coDmncin!,nh sccri,)n TU,rrrolDivision l
<br />or rhc Bxsnrss dd Pnifc$ions Codc. and nry lic.ns is nr tull tur.a ud cflatr
<br />catsrBuc ruDlltN{illi[ltr
<br />I hcrcbyaffirmunder p€naliy or ltrj!ry rhnr thtr. ir a ennflc(i,n kndin8 aScRy for it |ErlormEc orrhl*ork ror qhichihn Fn,ir h
<br />ksucd (Scc los?, Civ. C.)
<br />hndcr'sAddnss
<br />-
<br />IIIIIIdNLIIECLTBAIIO!
<br />I hc$yannmurdcrpcnrltyof Dcrjurynnc olrhc nilk,ainsdmlnn rnN
<br />D.nxrnidr Pc nirs^shc{os Notlficdion l;cdcral Rc8uhrions (liilc 4). Prn6r
<br />R.!!trrd tax.rol Norfi.di'[
<br />-l
<br />ccnily th0r rhc lcdcml rcsllnri.ns esadins asbcaros lomlal !rc .ol applico$k lo rhG pmjccr,
<br />9?"fi *, ,"* *, *is ap,,licarion 0d starc Ihoi rh. ot{rc inlomri.n ir comr I dgrE Io.onDlyeirh rll ciryaRt coonry
<br />ordirn..\ rd Sr.l. bws rclrli.S n) buidirs consrruclion. {d hcrchyxurlorh rrEcs.rurivcr ,,frhk Ciry rnd Counly b ctrrcr ulx n rhe
<br />xhov. n{nri,nr.d |ni,fc'r! ntr i'rtcrrionf
<br />'>l-r*r--rADpli€nt or Asenl Sisnalrre:X
<br />t,"-rr* *.",r;r,, X- t_\t'0't4 0t niul "f.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFEB
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Sollit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lvleter I
<br />FINAL //2r//4 .-&zn
<br />Notes, Remarks, Etc
<br />-+
<br />Communications Cable
<br />Meler Belease
<br />Sc.riotr.1076.frhc titry Codc. i.rcrcsl ond anormy s r.cs.
<br />t.trJ '. \rrr
|