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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Sollit Rouqh
<br />Ceilinqs (T-Bar RouOh)
<br />Meter Belease
<br />Rough
<br />Service lVleter I
<br />FINAL '6lLq ra
<br />Notes, Remarks, Etc II
<br />OWNER BUII,DER DELCARATION
<br />I hcrcby aflnn undcr !cn(h, of perjo, rhd I !m .tmrl fr.d rh. Conrrrnns Liccnsc L{w lor lhc followins rcd$n (s..70.115
<br />Busine$ lnd Prorcssion C.dc): Any Ciry .r Cuunry whhh r.qurcs r F.mit lo con(rucr. alrcr. i.rtrolt. &fr,lirh or rctxn any
<br />rru.rurc. l'h. lo ns issuan.c, rl$ .cqutcs lhc trl)Fliconl for such pcr.nir h nh ! sisned {ar.ft.r
<br />'h,r
<br />rL or shc Ls lkcnrd puru
<br />b rh. provnions of rk CoorEcttr\ Li..nscd tiN (Ch,prn 9, Com lcncinB with Seclion 7lF0 of Dilision I oirhc Bnsincs and
<br />Pior.stun\ Codc) or rh,r hcorsh. t cxcry, thcr.iiofl ond thc bn{is for thc alhscd dcdtrion. AnyvioldionotScclionT03l.5l'yan,
<br />llplicrnt l'or a pcnnit subjcck rhs appliclnr lo!civilr.nlhyolnoi nsrcrh nvc hundrcd doll s(5500)
<br />l. d n*mr .l rh. pmlEny. ofuny carployes {ilh w.scs ac rhen st .ompcnsarion. sill Lh rtr sork ui lhc sltrruE is mr
<br />i cndcd oroficrcdl'orsalc(S.rT0.l4.BusincsMdftofcssn,nsCod.ThcConri.lor'sLiccnscli*docsnortrpllyronnoqNtoi
<br />rhc rmltny wlm huilds or ir{'mrs rrmn. dxl wtN d*s skh $1rk hinsclfo. hcilclior rhmugh hi or hcro*n c.iUloyccs.
<br />proridcd rhar su.h nnrtuwmnr m ml intcnd.n orollcrn lorelc.l[ ho*cvci rlt hxidine or iil1,orcnrnt k$E wilhin nr r{r
<br />ol conphlion, lhc O{ncr Buitlcr sill halc rhc tDldcn or ptulins rhar lr or sh. dld nor huild or inpmrc lhe tolEny r.r rlr pu{.s of
<br />-!.
<br />!s o*ncrofrhc Im)pcdy. am.xclrsivclyconrr.rin8 snh li..n\cd.onrr.ctus h canFlrucr rhc pmrlrr (Sc..l(}14. Busms
<br />Md Pllrs\ion C.d. Th. C'ontracktr s Liccnrc L0! docs n.l opply b m .*n.r or fm!. y qho bu ilds ot inDtovcs rhcrdrn.
<br />snd sho.onrBcr\forsuchpn,jc.(wirhrCortncrons)li.cnsLttumu$rrolheContsctr'rLiccn$tjw)
<br />I rr.r.nrJn urlc' S..rn)
<br />D.re: oBnd:
<br />rvonxois' ctrupmsltrur
<br />DICLIAAIIO!
<br />I hcrcbyamrdr.dspc alryof p.rruryoncotrhcfolLtrirEd(larrlions:
<br />-lhtrvc!.deillmlinrsinrCcdificrtc.fConscnrroSclf"lNurcforqortcnompcnsarion.!spn,vid.dfdbySNtnnr:lT0Oollhct tor Codc. for Ihc pcraormne of lic work ror $hich rhc llfnl n ksu.d.
<br />I hdv.,nd will nrinrdr workcrr conr.n(ltion insurorcc. is rcquted $y SNr 6n l7m of rhc hhor Codc. lor lhc P.rfontoftc of
<br />rh. {ork for whi.hrhir!.mn is is\ucd Myw.rk$ coqrtrstn,n i.sdrrncccrnicr Md lolky nunr$cr uc:
<br />I ccnily rhd iD rhc pcnonnlncc olrlrc $.rk 16r which rhk pcrn,ir n i\!urd, I drll nor.mPk'y atry Pcr\on in rnl mdNr
<br />n,rshh.com\uhjccrt,ihc$orko{.rnD.i\dmnhtrsolCrliLirin,s.gnclhrrilI\bul.lhcof,nrhlc.rrolhc
<br />sorkcr conrprn\ar nfl,visionsolSccriotrl7U)orrictrh{Codc.lstu,ll,li)'rhairhconidyNirhrho*lmvhioD\
<br />WARNIN(;: Frxihrc k, {.urc *orkcn omFnsariotr colcrrgc is unh*rtl rtrJ shrll subjccr rn cmfl(i,tr b di in,'! t^-nrhis rnd
<br />.nil rlr.r up ro oN ho nd rhor{l d.llnr( 1\l(r).rXX)).
<br />S..rtrr.llr?6olrhc I xhtr a-rx[. idcrcnxDd oi,r.y\ lcc\
<br />rhc co( orcorn|Eigrnii. dMrlcs rs lrovldcd lnr rhc
<br />'",",flzq\s (
<br />I h.rcbyanr undcr !.n!hy or p.rjfiy rhd I rh licn*l und& rorision uf Cnaplcr 9 (comnErcins *nh scrion 7 x))orDivhion3
<br />or lhc Bulimssand Pmlcssions Codc.ori myliccnse is in itrll nrcc rd.ffNr
<br />Ihcrcbyalitmutrdcr pcDnlryofpcrjnryrhar rhcrc ir acondtucri.n kndhg.S.nc) lor lhcpcrlo nancrolrhcsolk
<br />Nsuod (S.. :1097. Civ C.)
<br />AIIUCANLIIIICI.AAAUON
<br />lhcnbyairmundft rcnrlly orr.rjury orc ollhc followin8 dcclentions:
<br />Dcmlirion Pcrnrirs Ashcsros Norili.ario. Ft{.r.lR.gulaiioflslTnl.4tr, Pan6)
<br />-Rcqutcd
<br />lAtcr 6f Norilicdff
<br />l.cnilyth rltlcddrlrcguhrionsrc8xftli',9xsh.(o\rrnn,{lrrc nr nffl].rhl. ri lhis nnlccr
<br />-lccnilrrh
<br />l hnir .cd rhn applhr nn[ni {dc rha h. rh.vc inror nrarion h cotrc.l lrsreloconrrlywirh,llCitytrndCounly
<br />ordiMtrccs nn,l Srrrc l-0us rchri.g lo tD, di hcrchy rorhtrizc rcprcsctrrdncs ol thls Cilyod cl,ury ro cnrd uf.tr rhc
<br />rtx,vc nf, irionc.l pn)!Ln!
<br />Applicul or A8cnl SiEntr
<br />P.mrile nnn. ( prinl ):e-
<br />*,"sJztkt
<br />trEI.E
<br />Policy Numbcr:-Exlircs:
<br />-
<br />11
<br />L.trdc's AJdr..\
<br />-
<br />Communications Cable
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