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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER lo8.r8 4,2'?
<br />Torqueino io+x-rB V/,erl g_U {le,4l ^_j\ ^
<br />Sub-Panels rti^ Lr^J+
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />It/leler Release
<br />Rouqh t0-tt-lb AdzD
<br />Service [tr]eter /oeg-tb QccD.
<br />FINAL ,2-3-/8 4c z?A1 Adr.r/
<br />?Notes, Remarks Etc.
<br />OWNER BUILDER DEI,CANATION
<br />I hcrcny afirm undcr pc.alrv ol l){rjlr, rnar I m crcmpr ,mm rhc Co ra.t,ft l-i.cn* hw ror
<br />'hc
<br />lollowin8 rcasn {Scc.7oll.5
<br />Bu\idcss nid Pnri$n'n Codc): Any Cnt or Counry whi.h r.qun 1 r pcirnil ro consirucl. olrcr. innmve. dcmlhn or dFn ,ny
<br />nDcrr., rbr to ns nsuaRc. rho rcquircs llrc lpt'licrtrr ior snch rcrmir ro filc a risnc{ {ar.ftnr rhll lr or qh. is liccnscd pursu{nr
<br />to th. pmvisions ol rhc ConlDcx,r's l,ic.n\cd bw (Ch,flcr 9. Comm.ftin8 wilh Scclion 70Ol) of Division:l ofrhc Busincs rnd
<br />PDrcsrionr Codc) or thar t!dishc i\ crcnll drrcriomtrdlhc b,ii\ ftxlhc sllcBcd crcmplt,n AnylnnarionofS.crbn70.1l5 bya.y
<br />rtplicnnlrorap.nntsubjearh..pllic{trrtoflcivillctr0lryofnolnorcthmfivchlnd,cddollm(t500)
<br />l. rs .wncr oI rhc pml.ny, or nry .mprorccs wirh wracs ns rhcir $lc comp.nslr ion- *ill do ltf, Bort d rlt srdm is nor
<br />inlcrddl or ontrcd lbr elc ( S(.704.r- Busincss and Prolcrsions Code: 'rhc Conradoi'\ Lkcn* tiw ddr no' spdy lo an o*ncr o,
<br />rhe ln,Fny *hohrildsorin tuws rhcmn. and who dms su.h wo* him\clf or hcr$lf or thmu8h his or hcr own coployd.s,
<br />providcd rh1l such i,nprorenEnc @ mr inrc.i.d or offcrln for slc li howv.r, rhc tnildiry or irymE Enr is $Ll wirhrn nm ]td
<br />or.omplclhn. rbc oemr Buil&i will h!rc rhc hrdcn of pnvinS lhd h. or shc dil mr build o, itrpdh E r,sFiy ror rhc pur,r* oI
<br />< sowrcrofrhcrn!f4dr. uf,erclu\ivclyconrr&rin! sirh licenar] c.ntNbB lo.on(rucl lhc poiccl (s(. 7rlr4. B!\in.sr
<br />,,xi [Itbr6sin cod.i Th. Conkdols Li..nsc Law docs not apply ro rn owncr.fp!'If,ny *l() buildr or nnprovcs rhcrcon.
<br />ond rho co ncls for such rmjc.rs *irh! Conllacx,(, liccnsd Durlu ro rhc Conkactor's Liccn* tiw)
<br />I anex.'nfl u d.r SL{r i(trr .B &PC turlhnrc!{[
<br />noaxEBllg)ufElsallgN
<br />IIEIIAaAIIAN
<br />I hcrchyatlirDu crpcMlryolpcrJuryoncorrhcnnhwir8dshrlrn,nr
<br />I lDv. drd willn,i,rilir sCcnilrcolc olcons toScll'lnsuEl *orkcF co'npcn\dio..!\ pmvidcd lor bySerion 3'7(x) oflhc
<br />tihr Codc. f6r rh. pdrormncc ofrh. work for Rhich Inc rmhn is nsucd
<br />_t hrv.!n Nillnrtri'rrxin *ork.rs co.V.n{dnD in\urrrr., r\ rcquncd hysc.ron lTrroolrhc La$or Codc. nrrh. !. orn'f.nr
<br />rhc work t, shich rhi\ p.rmir i\ (sucd Myf.ikc compcnsrrn,i ir{urrtrccc,iiiq a,i lolicy nunrbcr @:
<br />Extircg
<br />l.cniry rhrr in Ih. p.rroi,mn.c olt[c work lor lhnh rhn rcnnir n nsucd. I shall nol cmpk'y,ny pcron n'.n, m,nNr
<br />w s b tronr su$jd lo lhc wo*cc comlcnsar io. lnw\ otculifomi!. and,sN rh,r irI sk'uld b.$m {hjcct ro rlE
<br />workcrs cotrlPcnsriion provisionsolSdbn:17(x)oflhc LrtDr Codc.l shull. ronlNirh.onnly *irh lho* rmvhions.
<br />WAIININC: Iailurc to scurc qrrkcrl
<br />civil fitrcs up lo onc nund,cd rhotr\u0l
<br />S.crnn, :llra, ofrhc lrhor C.dc. inr.rci
<br />,"," J-'g' rg
<br />c.nyn\Jrion corcrr!. n lnlrshiL. i d dull subjccl ar k,rr l0 rimi'BlpLnxlric\ rnd
<br />olh* i!llX).(xx)) i', rdJii{,n ro rlr .o\ of nEE$ o\ F)ridcd for rh.
<br />DICIdAAIIQN
<br />I hcrcby amrm un<lcr,.n!hy olFrrury rh l an liened !n<!cr pFviioo orchap'd 9(.ommin! wnh Sdiofl ?O0O) orDi{hion -l
<br />.l rhc Busincs Md Por.sions Codc. dd my liccns is ir lull forcc und cilccr
<br />A.TTLICANLDLCI.dXAIII.IN
<br />I h.E5y alim undcr,.hnxy olFrjury oft ol E follopinS dekilions
<br />DcnDhbn Pcrin\ Arh{os Nuriflc,r ion Fcdcr0l RcBUllri,,ns (Tilc40. P.m()
<br />Rcqut d Liidrof Noriilurion
<br />I .cnilyihri rlr lcdcr{lrcsu]0rior\ rc8nrdins !\hcnos rcu,vrlarc nor rmh.nhlc k, rhn fojc.l
<br />I rcnilyrhxr llHv. r.xdrhi\ rltlL.nrn iscomcl lagrcct'(,ry'lrwirlrnllCiryrtrdCotrnty
<br />rcpr.\c aiilc\ olthn Ciry rtrd Counrylo cnler uton rtEorJinrncc\ aDJ Srdc l.rN\rhrin!ti h
<br />nvc nrnriuEd pnlxnr lnr
<br />,rDDlnrnr or \!0r Si{nirtr >:l:t?t
<br />Translormers
<br />'*)'""\a-r, .^*-, fj--z-
<br />-CONJiIf,I]gUANIETUMjAG.ENCI
<br />I hcrcby af,irmundcr penaltyofpciuryrhal fiere is !snsmcrion lcndi.S ag.fty Lr lhc pslorroncc oflhc sorl( for which rhis lEmit is
<br />hsu.d (Sc.. 1097. Civ C.).
<br />Lrn,lcr'\ Nrn'c
<br />-Lcndcr. A,i,[c-
<br />-
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