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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />'thtrtz.r ),,.Bonding / Grounding / UFER 4tula A 6)
<br />Translormers ir I ut
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Sollit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lVleter llru(\.1;'\
<br />FINAL 41n'ltp(ft'W"tr{t9
<br />Notes, Remarks, Etc
<br />g\
<br />OWNER BUILDER DELCAT{AIION
<br />I hcrchy Nrtrfl lndcr p.trdlry of Frjury rnd I m crcryr fmnr rh. Conr,acroG l,icci+ bs tr ih. r.llu*ir8 rca{'n (Se(.1r11.5
<br />uusinc$ and Profcssn,fl Codc): An, Ciry or Counry shich rcqoirca d l.mir b onnrucr. nlrcr. mproE. dc.hhh nr tnun r',
<br />smdurc. Fi, k, irr issuancc. akor.quios rhc trppli.anr nr su.h l.mn ro filcn si8tred nrcrrcnt lhtrr hcorshc h li.tn\.d ,unuml
<br />r. rhc prolisions ol tlm ConrEcrols Li.ensd Llw (Choprcr 9. Co rmcmi.E *irh S..ri.n 7(xD or Division .l oI lhc Busincss and
<br />Pm{c$iotrsCodc)orlhrlhcor\hcncrc'nprrhcrcfromandlhcbusistinlltnlkgcdcxcnll,n,n.AnyliohtiotrofSsrion?0.ll5brdy
<br />lPrlicsnraorrF,nirsubjuckrh.,trtlicinlro0civilFnalryornormrc'hrtrfivchundred'lollos($50o)
<br />_1. N owmr of rhe ,,mrEny. or my rmrlortcr wnh wrgc\ as rhcn {,k L\,mFnsarion, will & Itr wolt ond ltf, nulm n n r
<br />inrcrd.{ or oficred tn eh (SN 7044. Buiin rs and Pr.r.s\i.ns Codc: tuc Conoclois l,tcnsc Law docs @r .rply ro 0n osrcr oI
<br />rh. pmFiy wh, hxilds or in{,mvcs rhcmn. and *ho d€s {uh *ork himscllor hcrulf or rhoush his or hcr owncmplo}ce\.
<br />proridcd rhar su.h i'nporn-nh m nor ir d lcd or ofltdl f(n slc. ll lniwcrrr. rh truihiry or irl{Drmnt h skl wirlrin onc )eu
<br />oico ltllclic,D. lhc owncr Buildq eill hrt rhe burdco ol provins $!r h. or \hc did Rn b{ikl .r inpnN! lhc pn'pcny t,r ihc NrFM or
<br />l, r\ o*ner ol rhc !$pcd y. dm .klu\iv.ly .onhrrinp qirh li.ch.d c.nrfi)n lo onsrrucl lhc In,F.r (S( 7IX-1, Btrnrc$
<br />i*l PioLsb. Codc Th.CotrrEcloisLi.cnsc Law (lcs mr anrlyr, Dno*ncr ofpion nywho huilds or iDnrovc\ lhcrcon.
<br />ind who cotrrrrcr( fu such proj.cr s sirh , A,nrr.t( \) lic.n*d nuNrnr ro thc Conr$lois l.ien* liw)
<br />ry:^zi
<br />OEq,ANAII,IN
<br />I kr.hy !fllntrund.r p.nalry or pcrjury onc olthc lollowing dftlarations
<br />I h.vc and * ill mirtrin a Cenifrarc oa Con* ro Sclf l nsuc tn $lftcrs co.lrns0rion,0s tmvidedtorbysdrion1700olrhc
<br />htrtr codr. rr rhc rcrrorm,ncc olthc work rbr which rhc pcirnil is nsrd
<br />rhc work fffwhichrhi\ n.nnn is i$ucd. M! *orkd{.otrrlE s[ion ir{trrnc. crEicr ]nd lx'li.y dt.rh( ttl
<br />Icc'lilylhdnrhc|{norinrnceolthc*ortftr$ii(hrhi\pcnnni\n\d.d.Isltallnorcl1,oytnyDcr!onirrnyn nncr
<br />{i r\h h.(mr {hicd i,rhcwork.* coD|fn\dn lr$ofcnLih r. rndr8r.c lhrl itl sla)tr](l hconf, {bjccl hrhe
<br />*nkcrs conf.n\xri,n,fn)vi\io sofS.cri( l7(X)ullhc Lrhtr(inl..l irll.lonh$ilh.onlnly wnhiN)!c frlNiotrs.
<br />$ARNIN(; lj:'ilurc r0 {.trrc
<br />rnil liN\ ul, r, oN h0iJrcd I
<br />S..ri,)n.l07a olrlI l:'htr (ii]..
<br />(o'kc^'.o rlf,r\nri(,r.o\crngc
<br />h,ru J,i,,r . i(riy'rr,r.
<br />tr crc{. r,l. ttr u'/ lre'
<br />Vr1fr,,,1",>
<br />i\ unhwtul. alt shlll suhr-ir m c'np k,ys ro aimin.l ,rcNlrbs and
<br />d.mecs as tmtucd tor rhc
<br />1- zz
<br />tn:(r\R\lx)\
<br />I hcnbt,filnn uM.r lcn.hyoip.rjur) ih.l I rr lien{n under 0o!hn,n orChapro 9 B,n.rncinS with Scclion 7l)($r oroivi\nnr l
<br />or
<br />'he
<br />Busin6s and Pbrcrsiorr Codc. lnd nry li..nsc h i.6ill fore ru crlc.r
<br />caxslnlJcuaNtENlIN{iaclNl:}
<br />IhcEby0finnn cr Fnahyofperjury rhlr rhcrc n a condtucrion lcndina a8cft, fttr rhc pcraornumcc o{th. wo r.r shi.hlhis Fnnn is
<br />ksrcd (ss :109?. civ c )
<br />AIILICANLDIiIjIAAA.III'N
<br />IlIfttyarmnr d.rrrnrlryoltrrruryotrcollhclolhwnrsdcclaruln,ns:
<br />DcnolirnrnPcrnik Asb.dos N.rin.arionlrcdcril RcAnl ion\(lirlc40,l'rn6r
<br />Rcqui'cJ I.(crol Nor'li.nrFi
<br />l.cnilylh lhc Jadcralrceultrrionsrcgadin! nshcnos lcnrorJl xrc ior rf|,li.$bl. rhG Prctccl
<br />-lccnilyrhsl
<br />I hrvc rcrd rhis applicrrion'rlnrrcrlrar rlr rh*r inhrn idrircotr(r I rgrr ro comply *irh rll Cily aml Counly
<br />ordinan..sa.dSrdcLaNsrclaringtubuildingcon$dion.irdhcrchylurlstrizcrcprc{nrrrivcs(,lrhisCiry d Counry k, cnrcr dlx n rh.
<br />rtrc nEtrrioncd nrorcny n,r
<br />/\pDli..nl or ,\,tenl Sit n
<br />l/
<br />l\4eter Release
<br />A & P( lnr rhr rci\on.
<br />24
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