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ELECTRICAL.INSPECTOH RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lighl Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Flough)
<br />Ceilinqs (Hard & Soflit Bouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />l\,4eter Release
<br />Rough
<br />Service lVleter l
<br />FINAL Cl+ llg ,Lt/,t(rt
<br />Notes, Remarks, Etc.
<br />OWNOR BU!LDER DELCARATTON
<br />I hercby amrm undrr penltry of rErjury rhlt I !m cxcq,l fmm lhe ConrrudoF l,n!os. Ilr r(r rh. ri,llowin8 rc.sn (Sc..701 1 .5
<br />Bnsincss dd hofc$krn Codc): A y Cily.r Cox.ry which rcquircs a f.rmir ro consdd. 8lrcr. inl,mvc, demlhh or rcIair 8ny
<br />slruclurc. !ri, b ns hsumcc.0ko rcquncslhc lptlicinl ror sucn lcrni h nb o skned stnlcmor lhat hcorshc i! liccnscd pnhu.r
<br />r. rhc pmvisions .Irhc Cunrdocs Li(nscd Ljw (Ch{r.r 9, Comnrn.i.g Rith Sccrion ?ofl) of Divkion I trflhc Busin€s ud
<br />Pmfcsn'ns Codc) or rhal hc m snc i cxcm lnrcfnn!.drhcbasisforlhcolkscdeicmplion A.yvidlrio..tserion?0rl5bya.y
<br />!D,rlicunl for a pcnrir subjcclsrhc amlicanr roacivilp.nallyolnol morclhan nvc huidrcd doll,r (5500).
<br />l. as owncr of rhc tIoFny, .r my .n!ror.\ wirh w+cs a\ rh.n e,h .o r|.trsd..tr. sill do lfu *ftk nnd fic nndurc h mt
<br />inrcndcrl or oficrcd lor mh rSa.7I)44. alsimss and Prolt$io.s Codcr'rhc ('onr6cror'r l.iccn* Iiw docs nor lPpl, k, dn.wtur or
<br />rhc pn)Fny who buikls or iq)ft)ws thcNn. and wl$ docs s!.h w'* hinr\llfor h.^clforrhrou8[ l,is or hcr own cntrl.y.ds.
<br />prolid.d rhf,r \u(h i'npDvrrEi*mRn i .ndcd or.ltttud fitr$lc li h.wcvcr. thc ttrildiu .r inlJ'mrmnl is eld sirhin .nc y.rr
<br />o, comtkihG rhc Owrcr tsuildg ,ill hlt rhc burdo of f,ovinS rhlt hc or stc dil nn l, ild or inpiovc dt pmFny for tlr pulr[s or
<br />-l.usowncrofrhcDrorEny.rnerclu\ilclrcoorracrinswirhliccn{dc.nrractnt,con{tucrthln)j*r(sc.7014,3u\iRsrrM ftits\irn Codc: Thc C.ntd.roas Li..ns. tjs docs nor +ply ro rn ownd ol lnopc y sh,, builds or imlror\ ih.rn,n,
<br />ond $ho contrachlo!suchpmjccls-iihqConiruclonr licctr{d punu,nr h rhc coDrrrk, sl-i.ci\c Lf,w).
<br />-l
<br />rncxcmfl uftlq Sdion-. B &PC rbrlhnre,soi
<br />ra[trcBrrauruNr ra!
<br />t)ri(:I aRAl t(rN
<br />I hcrrhy xlfnm unJcr nctrrlry ol ncrjury om olrhc hllosi'u d.clrrrri,n,\:
<br />Ih.vcdktNillnri.trinrC$lifi.rrcofConscnrbsrlllnrurcforwurkns.on{'cnsalion.!s nmvidcd a{, hySdii.i 1700ofrhc
<br />llhor Codc- for rne pcrio.romc of rhc $o.* fo, shih lhe lcrmi n n\kd
<br />Ihivcatrdwillnunanra.r**r..nrpenrrrnarinsuhi.c.r\icqumdbySRri,r3lLt)olllNl,at'lrCodc,forrhcNrfornri..of
<br />rh. work lor *hi.h $ir pcirnir is nsucd. My workcr'compctrsdion inqtrunccc.tricr !.dI.licy nun,bcr c:
<br />. S/a/, /ot r
<br />7r-3 //q
<br />Iccnil'_v irrhcpcrfoirndrc.ollhcworkturw[i.hlhi\pcrmir is ir\ucJ.I \hrllnor.mrby rtry tx^o i,ranyn]dnNr
<br />$ s\n) bc.on{ \uhjc.r k, rh. sortcn dnnpcnsdn,n h*s oi (-alinntrin. trkl x8rcc rrnx ii I shonkl hcco.rc suhicr r. rhc
<br />sorkr\ comFnsarion pnvisn,n\ ofS..ri(,n:l7lX)ofrhc ljlitr (hdc.l \hrll. f.nhwirh conr!ly wirh rho$ prcvhionr
<br />WARNING F,ilurc lo sue wo.kc6 coDpcns.tion covcnSc is nnlowtul- ard snull sut'rccr dn ehrl,,ycr k, dinrin,l l.tr.ltics ond
<br />.ivil lincs up b orc nundrcd Ihousnd do
<br />s(rion 1076 or rhc ,rbor c,rl9 int.rcq.trd
<br />",,"., 4-,/ 7 ^,/,,.
<br />llaF (llm.mo). ir lddirim ni r io'np. \arnrn. rlxn gc\ .\ t)n)vidc(l n, rhc
<br />D&I.:BAAI,!TN
<br />I hcrcby.f6.rn undcr Fnallyolrcrjury rhar I an liansd trndrr Frcvnion ol Chaflcr 9 (o rtuming wirh s(rirn 7filo) ofoivirion l
<br />of rhc Busines s.d Profesins Cod.. rJtl fr! licc.\. ir in tull ire ml cficct.
<br />C cz7o43
<br />=44ea\
<br />IANSIA.UEUANIIiNDAIj.ASiNEI
<br />I hcrcby nrfirmundcr pcnfllryorF-rjury rhr! rhrc t r ron(dciion hndi,rs,g.n.y n)r thc,rrr'onMncc oflhc work L, whth rhi\ If,rnir ir
<br />nsucd rsc. 1097. Civ C.l.
<br />AITUCANLDECIASAIIO!
<br />I Mry filrnundcr p.nrlry.fp.rlry om olrhc blbwin! dccl{r.rionsl
<br />Demolirin Pcrnrils Astcslos Norilicrrion Fcdc,al Rcsohl bns lTnt .r0, P,d6)
<br />-Rcquircd
<br />Lcncrof Norifr ioi
<br />I ccnily rhar ihc lolcr rcSulntiotrs rgrdnr8 0shcstos rc Dvll arc mr tptli.rhh lo lhn Dnr.cr
<br />-lccnifyrhallhrvcrerdrhnapplic(liooand(arcrhlirh.alnrcinri,rrurn,niscolRr
<br />I rFe t, .omrly wnh rI Cny.nd Counry
<br />ordinorccs{.d Stiic tiws Elatins to buitlinscon(rucrt L oBl hcrcby.urlxnizc rcprc*ndn$ (,rrhis Ciry{nd Counry ro
<br />rhJlc nr rnNd linNnyfd irrnc.rionfnrN
<br />Applicrnl or Aeenl Sigmlu
<br />Pcmftemnetplnrt: X 7;; 6"h44
<br />,
<br />L c""'-"*,2
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