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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.hhy ulfirm undcr p.mlty,)l Frrury lhal I n crchpl tbm rh. Ci.rr.cros Ltcnr La* fln rhe lhlb*ing ct$n (s(.70:ll 5
<br />Itusincs .,rl Prutt$ion Cinc): Any Ciry or Counry which FquEs r ltmir h onddcr, rlru, Blnr.vc. dcmlish or Epar sy
<br />{nkiuE, t'tur L, s r$uu.., aho rcquks th. .prltrmr tor \uh lErnxl b lilc a silncd dllcmnr ih lt n, \h. is ldnicJ fu*udr
<br />h rne 0('visioos oi ilE Coora.lu'\ LtcnyLt Li* (Chafl.r 9. Comhrtu,.! wirh s(urn 7000 ol Divnu I ol rhc Burine$ an'l
<br />Pnni\\n,i\ Cod.) or rhr h.orshc s.(.mfl lhcrcton rnd rh. brar tor rh. .llc8.d .xcmption. Any vi,'htn,n.fS$rirn70.1l 5 $ytny
<br />onlltrrnr foft Frmil suhr.chth. rmli.ant k' acivilpcmltyothot frtrc lhsn !ire hundEriJouus lsslx))
<br />l. is owncr .l rh. roFny. or my cmtn,yccs wirh *a-sc! ar lhct $lc .omp.n\d u,. w l Jo rh( *rk el rtr nnurrc is n.l
<br />mrcntl.d nronctud ntr sk tS(-.7044. Busft\s and Pnn.\s.h\ cillc t h. (l).t&ktr s l-Ensc Law doc! nor apply t, rowncrot
<br />rhc pop.ny wtx) tuifls or mlpn,rs rh.frn afll who J,s {'.h u)* h'mscll or h.rsclf.r rhniulh hi<.! he! owncmpl('y.cs.
<br />E)vidcd lh.i suuh impn)rcmds a ftn dcDlcJ or ollirc'l li,r slc I ll lD*.rr. rh. hn'tlmg .r mlllt,v.N r$ldw hurtrcF{
<br />olonlnld n. rh. OwRr BuiIcr wiu hrk rh. hunl.. of n$vn! rhart*or \hc dd ml tuill or inVr()!c rhc pn'Fit tur rh. r{,1tt€of
<br />I. Nosncr rlrhc pmJlcny, rmcrclurircly.onrrucnr3 w[h lkrnseJ..nln.br n].ondod rh. Fic.r (s.(. 7{}14. Bu$c$
<br />a'rt t\,lcsinrA,Jc: Th. Contac(tr \ I-itns. t-rw d,xr nor rltly !, s.snd o, fn'p.ny wh. builds or rmprlvc\ rh.r.on.
<br />and who co ri.h n)r xuuh fa)jc!1r wirh a Contacb(9 hccn{,1 pururd b ihr Conkr&tr s Lkn* Lrw).
<br />I rnc\cmpr unJcrSe..li,
<br />Frr.- o.n.r-lVORt(Ercm
<br />PECI.ASAIIAX
<br />I hcrby,liirm unJcr f.nalry of r.rjury om ot rh. Lllowng J.cbra.onr:
<br />_lhrvcanl*illmlinirinrC.drfi(ar.olConrnrrJSelllnsurcturwork.^-rdr{rcDs,lDn.isF}!i'lclti)rhyS..ri(r.1?(x)orrht
<br />LJhtr Cqlc, Lrlhc nc i,mE-.coilh.*o* ritrwhinlh.ramir s nru.d
<br />I hxr. ml s,llrnInrxtr, $ork.,\tr\rl(,1trNrxn(. J\ r.qni.J hy S$rr L-lxrnrrln , xho' (,i1..l,nrl'c
<br />\"T,rl
<br />ywork.r' comn nsrtun nsuDnc..arrcra Fnrynunh.r
<br />1
<br />l..nLlvrhir rnrhcI'crntrnNr.,,lrhc *o ntr*hEhrhNIf,rnnr r!snLil. I n,x ll tror .trlno!_ rrry Nr k,n 1n x,rv nDnNr
<br />\, rn, hdd'n'n$jc.r n' rhc work.^ .onrr{tr\rrnn hwrol CJhl(nd. inJ r!r. r1[rrl I \h\rl(l $c(nru {hFd hrhr
<br />Non\ ol Scoon l?otrotrh. hhtr C(r1..I \hrll.lonhw hconrplywrrhrloq pn'!r(,ns
<br />^ llnnp.n\rnon rovc,rSc tr ,i"L*ld x d \hxll {uht (r rtr cnrnlqlr n).nmmrl Fnrlrics nl
<br />t
<br />, hcEhy a rm undcr lcnahy oi pcrjury i hd I .m lienEn Indcr Frvnion of ChaPr.r 9 (.{mmkin8 wilh Sed$n 7(,m) of Uivnion .}
<br />ol rh. Busft* arll Pof.ssrns Cod., .rxl ny lf,.n!. s m tu[ rorf 8r] ctlc.r
<br />C I t{4
<br />I hcrcny rlltm ud.r Fnahy oIFrjury rhal lhcrc h r con,rtoclion Lndina,E.Ny nn rhc p.rrormkc orrhc w{tk rnr whrch rhn Fmi ir
<br />6r0.d tS&. .l(r7, Civ. C.)
<br />AftLICANLDE(lit8dII9!
<br />I hrchy rlllmuftl.r pcnrhy ol acrjory on! orrh. tuuow'n! d.cLrArdn(:
<br />D{m)l(!,n Pcrm vAsh.(os Noriir.,rion ljcJcrrl RCEUl,hons (l lc 40. Pd6)
<br />Rf(LtrtrQl I .rrLroJ Nd,n.(rtr,
<br />_l (. 'lyrhr rhc tcrl.tulrlUhr trdr !ppl( h n, rhsIn,Fll
<br />I r.n'rvrh, lhrvc rcrJrhr r ,n '\ronr(r I rprc.n'onlnly wnh
<br />rJtrrkc{rnd Sl^lc Liw\ rc k'I,.\.nrrrrr\ ol rhr (ir! rtrd
<br />lr'r nrnrrn.J pn,ncnyl,tr m v
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dam pers
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER 4"4-Y'W\tJ
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />F actory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)IA
<br />lvtetcr Release -fal4Jl '{ -Kl Ytl-IrL,
<br />Y,IRoush JaLhqasW /, -1-,v,wv,
<br />Service Meter
<br />FINAL 4-4.a y,aa\
<br />Notes, Remarks, Etc v \l
<br />Communications Cable
<br />/^\
<br />in adJion t, rhc .o( ol LonrFtrqr,on. !!ma3cr rs prwid.J ntr rht
<br />l,l('t,;Nsuo ( ()N I R!\{"IlrI
<br />ut!!a-8l.I!!Il
<br />LcnJcr s AJ&si:
<br />r<-' I \L.,/
<br />I
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