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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service [tr]eter
<br />FINAL {//q/f .*Wan
<br />Notes, Remarks, Etc.
<br />OWNER AUILDER DELCAR,{TIoN
<br />I hcr.by rlfim oftler pc trlry (,f Frjury rh,r I d cxcmpr liom rht ConrlactE License tnw tu rtc follouirs EN,n ( Ss.?031 5
<br />Susincs$ d Prcri$ion Codc): A.y ciry or Counl, whi.h Equtcs , p.nnir lo constncl. trkcr, inpr.vc, dcmolish or rcpdk any
<br />.rtucrurc. prtn r. irs hsuarce. also rcquircs rhc ar,plicmr lor sucn ,ermit ro filc a siEncd natcmnr th hc or nE n len$n pusuanr
<br />to rhc Drclisions of rh Co.I'rctn s Li.cnsd trw {Chapr.r 9, (-omftrf,in8 wnh S.ciion rux) ol Division ] ofrhc Busi..$ and
<br />Pmlcsions Codc) or rhar tr or shc is cxcmpt rhcr.from sfll rhc bdsh ror rh. rllcgcd crcmplion. Any virlari.nolSsl6nT0Sl.i by,ni
<br />aprlicotrr ior 0 rcrmil subjels lhc lprlicant loa.i!ilpc.,lryoffr, 'rcrcrhr. fivc hundrcd dollus 1S500)
<br />-1,
<br />ar .wmr ot rhe pmlr.lr- or 6, emplorl{s wilh *ases rs lhcn eb compcnsdtun- will d. rhc wort a.d thc {erm L{ nor
<br />i.r.*L.d ur of.r.d lor slc (Sft 7{X-{. Burinds md Profcsftni Cod.r Th. Co.rrbr's Li.c.\. Ilw de3 mt nplly h m owncr of
<br />rhc pn,Fny *ho h.ilds or inl|'n,6 rhcN'n. and wtr dms s.h *o,t hims.lfor hcr*llor rhmneh hi\ or h.r .wn .mtlottcs.
<br />p,ovAcd rhal such imrmEmnrs m nor idcndcd orotd iorst.Il ho'c!s. ttr hildins or in{mwmnt is sld *irhin o.c y@
<br />of conphlion. rtE Ownn Burldo wil haE thc hrdM of pmvin* rhnr h. or sh. did ml buikl or if,rrmw lhc pDpaly for lhc puqrs ol
<br />-1.
<br />.s o$rcr of thc l)lotcdr. am cxclusivcly controcr in8 wirh li.cird conrNrom ro con(rucl lhc pr+.r (Scc 70er, Bu\im$
<br />Md Pn,fsshn CGlc Thc c('nrrs.tn\ Lid.\. La* doc\ nor apply h an owi.r of pmtciiy who hu ilds or inrmvcs rhcron.
<br />mnlracF lhr slch prorcck *irh r Co s) licc.s.{ oununr ro rhe Conrracroi. LiccnB ti*)
<br />HJ&
<br />& PC for rht rcn$n,e{.o-d * (ac^-r'cr-
<br />Dfi I-,TR,\TI('\
<br />I hcrrhy rln0u ,lo rlnxlrtofI[ iLtry or rhc k,lL(N n! n..lxrr ,r
<br />I hrvr dl willtuinr{ind orniirllrolco.\. n, selflnslrd,,r workc .dtrlpcnernrn. r\ pr.vid.drorbysdrionl7motrhc
<br />tahor Cdc. hr thc !.{omurcc ol thc qol( lhr which rh. pcrnrir n nsucd
<br />I hNc utrd r ill mainllir workcn .omn n{{r tr in\u.amc. !s rcqutcd hy Sccr ion l?(X) of rhc ljbor C.d.. lnr rhc lrdonlmc of
<br />rhc w.rt airqhichrhis pc.mir is issoed My sorkcr' conlFnsllion insuran.c cmi.r rd plicynuntb.r*.
<br />-lccnilydurinrhcpcn'ornuncc.fthcwortturqhichrhisrnirislsucd.Ishrllnarem0n,yanynerrninanymrtrn.rv,dt,lf,co,c\ubj<rrorhcworkcricon,r.nsdn,nlassotculilnmia.andrgr.drharifl\huuldbc.omsubjccrtorhc
<br />sortc conlpcn\arion pn,visn,ns of SNrion:17(x)olrhc Irtxr Codc.Ishrll, fodhwirh onpl] w,rh lho* l)lovisiors
<br />WARNING ,,iilurc ro ecurc *orkcri comJEner n c.vcra8. i\ urhstul. ud \hall sulr]ccr rn cnplolcr b d'niml p.tulrics rfrt
<br />civil lincs up Io otrc hunnEd rhousand doll.rs in iddirion ro rhc co{ of conDctr\lrion- duma[cs r\ rn,vided nr rhc
<br />.rrhc L$or Colu. itrrcrc{
<br />Iz Ir2,S
<br />DE(:I ARATIoN
<br />I hcEhyrmr und€r p.ulry.r perjxry rhd I d li.cn*d unds tn,visiui orCh{rcr 9(.onmrn.nr8 wilh Sc.lion ?ur)ol Divhion 3
<br />of rhc 8usi.c$and Pmlcssiors Codc. ud nrylicctr* i\ ir lull tor.r dt cri:ccl
<br />lalsrf,ucuaNtrNDMi-&GlNcl
<br />I hcrul'y afiirm undcr rEnllty of Frjury rh.r rhsc is ! @nsrtucrion lcnding lgcncy roi rh. p.rrormmc ol rn wori for $hi.n lhh Fmil h
<br />hsucd (Scc.3097,Civ. C ).
<br />AITUCAN1DIgI.AXAIION
<br />I My dlirm undcr pcMlty of Frjury onc of thc lolloRing deld0lions:
<br />Dcmolirn,n Pcimir$Asb€*,s Nori,l.arion Fcdcml R.gulali.ns (Tnb 40. P.d6)
<br />R.qxird Lrtr(of Norifi cnri,.
<br />rcg{rdin8 asbcsros rcmovrl m not {dicablc ro inis proJc.l.
<br />fl and sl{ hal $c abovu iniormlion is corel I agr ro smpl, wnh all Cnyud Colnry
<br />inB.otr(dcrbc ald h.rchy authorne rcpEsnrltivcs ofith Ciry.nd Co,nrr ro cnrer oFon rlt
<br />1!r(+G"
<br />sig
<br />c}r'<^,Ct f;.l8q4l\sl?{ ts
<br />Pole Bases
<br />4,o*1<<.'o--"--
<br />(inlruc(,.
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