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ELECTHICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNEN BUILDER DEL(NRATION
<br />I hcrcby alErfl undcr Fn.lry ol perjlry lhar I m erenyr amm lhc Coir6cl,,E Lien* U* tor lnc fouo*ing rcdsn (Sec.70ll.5
<br />Busincsr lnd hofcssion Gnlc): Any Ciry or Couory snich rcqui,cs a pd'ni( ro .onrrru.'. ,hci imProvc, dcmlish or EPan my
<br />{rudlrc. !.iu ro ns issuaftc,,lro rcqxiEs rh.lpplicdnr ar, s!.hFrfrir lo l'rlcasiStrcd statcn*nl lhal hcorshc n liccn\cd Nnudr
<br />to rhc prcvkions of ltr Conlroclor's Liccnscd t-3* (Ch! cr 9. Commrcins wirh sccrion 7uD or Divhion I ol thc Busincss .trd
<br />Porcsionr Codc) or rhar lt.r sh. is.r.ml rhcrerronsnd rh. bish nr rh. atLBcd.rcmprion Anyviohtioao{Sccrioi 70:lI5 hyd.t
<br />trptlic0nl fo. a p.nnit subjcch lhc applicanl ro scivill)cnlllyofnol nbrcthln tivc hlndrsd dollus(S500)
<br />I. rr own r ofrnc ptuf,.ny, or f,ycnDk,rc.lwirh w !.s r\ rtun \ob.onFnsdnnr, willdo ihc wo*.nd th€ srturue is nor
<br />i.lxlcd oroEcrcdrorsalc(sc.7o4,l.Businc$ dPronsiotrsCodcThcConlracn\l-iccnsLawdo.snoraprlyr.Mowncrol
<br />rhctmpcny Nho hilds or intpDrcr rtE@n. a.d sno des sEh *o,l him\.lfor h.r*lror rhtuulh hh or hfi own empkiyccs.
<br />p.olidcd rlmr such nnamrcnr.r aE mr i cn .r, o. oficRl ntr *h. It hr*vc.. rh. ttrildiry or in{mwmnr it mtl eirhin orc Jtr
<br />ofconrrlcrstr, thc()*trcr Buiklq willlll't thc burdd oapmvmg rhr hc or shc dld nor huild or impmrc rhc Inpcny tr rtrc purys of
<br />I. * ownff ol rh. totl.ny. ,m cxclusivcly conrocrir8 wirh li.cn\cd .ontrr.B ro c.Nrrucr rhc Imjecl {Scc ?0,14. Bu\i.c1{
<br />lln Prrt$ion Codc ThcConrr0crois Licensc Lowdocs n.r apply ro $ o,icr or tn,Ffly qho bxildsor improv.s ricrcon.
<br />rnd who.onrrccforsu.htroF.rs*nhaG)nhdro(s)li.cnscdtn^urnr!rrhcContncloirLkcn$ljw)
<br />I m.rcnrJ, rnlld S.(li,
<br />.MBEr!t5_1l)!t!!t llal!!!L!l!allLl
<br />I hcrch, afinnutrdd lrn,hroftcrjuryo.c oflhc rblhwnrS dcclnrrions
<br />-lhrvcd
<br />wnlminb a Ccdituatc olcotrsctrl ro sclf.ltrsurc rrtr workcrl rcnrP-nerion. !s providcdlorbysc.thnl7{Dolrh.
<br />tjbi Code. for rhc ,.rfomn.c oa ll* wo* fo. whi.h thc pc.mir n issucd.
<br />|[nn(n n{rd mv sorL conrFnslri('n insurrDrcrx cr u tx)lil iun$.r t.(
<br />-\
<br />-l
<br />ccniiylhol inlhc pcraorman.colihr w.rk lor *hichrhispcrnri k i\socd.l sh,ll nol c rfloydnylEsotr iD anymromt
<br />v, as ro h.{unk suhFcr ro r hc mrkcrJ .oq).n$rion l,ws or calir(mi.. aM !8rcc rhar if I sh.uB nccom \ubjd h rh.
<br />*or*.n.omp.ns ionpmvrioNofScdnn3?u)ofthct Fr Cdlc, I sh0ll. ronhwirh o,mply * iri rhds pmvisionr
<br />Sc.riotr .107( oJ rhc Lftor (i'dc. inlcrc< an,l ! .ar! s,",",5-\\-\q ^,,,,*,,\e kz-So\ct-I-
<br />uftl lttllo}
<br />Ihc$hyrflirduidcrp..rlrtort'.rrrylharIrflli.cnsiluMcrtlo\isnrnofChaprcig(commncing*irhSccti,nTUIO)oIDni\n 1
<br />of rM Busincss xnd PFli\\ionsCodc. d nyli.cnsc i\ i', inll f(ncc nJ cll..r
<br />IAISIaIqTONI.ENDINCICINCI
<br />IhmbyrflirnunrLi pc@lrtorp.rjury lhal rh6. isr onsrru.ihn LMinE oScmy forlhc pcrao,mmc 6frhc so lor qhi.h die lrrmn is
<br />ksled {scc. I)97. Civ C ).
<br />Letrdcl\ Narnc:
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<br /> PPLI(]ANT DE(ILARATIoN
<br />I tu.by lltim utuldr l,.nrlry ol p.rjury onc olrhc louowirS dc.l,rJrbns:
<br />Dcmoliri,,n Pcflnir\ Asbcslor N.rificiri.i Fr.drrrlRclulrrioos l'I'ir!d 40. PMa,
<br />-Rcquncd
<br />Lcllcr oi Noriltllnnr
<br />I.cdifyrhar rhc fcdcr,l rc8uldiotrs EgardinS rshcnos r.mul.rc nol{mliconb lo rhh prjccr
<br />-l
<br />lTnitylhal I halc rc.d lhharrplic{rion ud{ol
<br />ordinrEcs.nd St.rc tjwsrehriry ro h!iklingonn
<br />crhrr rhc rh,vc inlarrn rn Nr.rc.r.l+re !)conrplyBirh (llCilyrn{lCoutrry
<br />,k,rc rdn,ftd lnD.ny for
<br />it,plit nl or lsul Si[n ltr'r
<br />,.-rU**.",onr,,SOf,I t-o
<br />il-r
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / FIoor
<br />Bondinq / Groundinq / UFER 4,LQ'rb J)r.5rl--t4
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)I -l
<br />I
<br />Rough ,I
<br />Service [t/eter t(-7n t0 ,t).ah ?r'
<br />FINAL <-a-to,5be,#i d,
<br />Notes, Remarks, Etc.v
<br />APPROVALS
<br />Meter Release
<br />W RNING Frilurc ro surc sorkcrs'mmlcnsllion covcresc n unkltl. $d shrll \xbF.' atr.'nploltr r. diminal pcndrLx and
<br />civil fircr uo ro onc hu.drcd lhounrnrj dolhF (sl(xr.flx)). in iddilion n] lhe cod of.ohp.niarn,n. d,nDgcs rs Providcd for rhc
<br />II
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