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ELECTRICAL-INSPECTOR RECOBD
<br />APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si gns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundinq / UFER r 1
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment I
<br />I
<br />Factory Wired Unit
<br />Walls (Conduit)I
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh I
<br />Ceilinos (T-Bar Rouoh)I
<br />Ivleter Release I
<br />-Rou gh I -7- t J/abl z@
<br />Service I/eter
<br />e-rB--lg SAeE*{t+r)
<br />Notes, Remarks, Etc
<br />(,WNDR BUII-DI]R DEI,CARATloN
<br />I h.rry aflir r rtulcr Fnilry of p.!ju,y rhlr I ! cxcnpr fmm thc conr,.Ms Li.cn\c l-lw forlhc ftnk,wiog (rq,r (sL!70.11.5
<br />ausirc(s and Prorasion Cod.): An, Ciry or Cornly which Equncs 0 Frnil n, conitucr. alrcr, impflrvc. d.nni\h ,tr Rtxtr Jny
<br />(ruclurc. rior ro ik issuamc..ko rcqutcs rhc amlicB tu such pcirnl lo tuc I siBn d $.tcnrtrl th.t hcor shc h li$mcd pu!\uani
<br />tu rhc lmvisbns ordt Conracd\ l-iccn*d tjw (Chaprur 9. C.imrturnE * h s.d'.n 7r,rrr I D'vrr,n Inlrhc Businc$ ond
<br />Prclession\ Cod.) or rnd hcorshc is cxcmpr rhcrcrnrmlnd rhctu\t r,tr rhc rlicsc.t c\cnfln,n( try !nlornilofsc i,i 70.1I5 bt rny
<br />,pplicaor for r Ii.rmir subJcclsrhc aff,lica loacrvilpcnrlryof.orm,crhnnfivchundr.ddolla6l$5CD)
<br />I
<br />-1,
<br />as ownn ol lhc tml)cny. or my cnplorr.s wnh wascr !\ rtcir $t conFnsri{,n, willdo rhc wort( dIhc(urE G nor
<br />inrcndcd or ofcrcd to. sl€ (sc 7l)4,,1, Busimss snd ftorcssions (:odc: Thc ( onradols r-ken\e bw dd! noi +rly lo an owrcr o,
<br />ihc F)p.ny wlb tdild\ or imtmrcs thcFn- ud sk) dcs srh *on hrmsellor hcrrcllor lhmuBh his or hcrown cnpl{'yccr.
<br />prclidcd rhdr such iDpmk,mnk m mr inrc.dsl or olrcd ttr sL lt horercr. ltF buildinS or irn0rovcnEnl is rcld ,irhin om jru
<br />of conrplcli,!. lhc Owrcr Buikcr will htrvc llr budcn of pmring lhd hc or rhe dil frn hniu or itr{,(,vc th. I,oFiy rd rh. l)ui?.* of
<br />L aso*hcr ofrhc pnrl).dy. !m.r(lu:iv.lyconk(rine wirh lic.nicd contrrt(trs to t'mlc lScc. 7(I,lt. Businc$
<br />huilds or nnnmvr\ rhcrcof.irl Ilnli.\\tu(irlc lhc(iintxdr'\ l.!..tr\. I rB,n)c\ n.rrnJ,lvn)xn.rf
<br />rid {ho .ofuJdsntr \Nhnn+.r wirh rConkrcr{(n liccnscd pu
<br />I rn'crcmd undcr Scclion
<br />^,, O/ete -*,-,8
<br />! hcrcny rfiflnundcr Ffl.hyoipcrjury orc olrhc lrnlowin8 tl&lni0rions
<br />-l
<br />h$c an<t will mrintoin ! Ccnific e ol Con€nr ro Sclf- lnsrrc lor vorkcr' ompcnsdion. a\ pmvid.d ro by s(r tun -1r0o of lhc
<br />rj&n Codc.lbl thc !.rforron.c ol thc wolt Io. whi.h lhe psinir h hsucd.
<br />-l
<br />halc and willnrainluin *orkcrs c.nrFnsation insur0rcc. tr( requtcd hy Sccrio.]700 orrhc Labat C.dc. rd lhc t'.rfonMmc ol
<br />rh. wo,k ld *nichrhis pcmir is issEd My $orkcs .onrp.nsrion insur!'rc.!dd ml lilli.y nun'hd r.
<br />-l
<br />ccniiyrhd hlhc tErioirnonccolrhc 'ork lo, whi.hlhis p.rmit k is\ued.l shall nor cmrk,yrnyr.is.n in rnyn'.nrcr
<br />v, ns r.' bconm sobicr ro rh. s.rldn co rl.h\srid hwsorcdlif(mid, and o8rc rhd rf I shoukl b.com suhjNr l{' rh.
<br />wor[cA co rp.Dsrrion pm!i\i.tr\olSccrn,n.]7(lrol rhc l nhtrC{ilc.l (trll.l.nh$irh
<br />IV^RNIN(; I;olurc (, \c.urc \rolkcr\ .onlrtr\rto .r\r'r8c a u ln !n crDloyrr t, qi'nn'rlrnihic\ and
<br />(vil ,itrr! !p t) on( hrnddl ihuusrfd .lh^ lSllX).UX)r. n tr(
<br />sc!rk 1176urrh.l,'htr (irtt i' $.{,nJ
<br />L/rultc
<br />CAdiIBITCIIONIENI}IN GEN.CI
<br />I h(Eby artrD uBlcr FMltyoip€dury dal thcrc is a.on(Nction tndiaB asercy tu rhc p.rformftc orih. wrk for which lhn [Ermi n
<br />nsucd (scc.1097, Civ. C ).
<br />AITLIqANLDICI.ANAIION
<br />I rL1$y dtim undcr lcnrliy.frrjuy om ollh. rollowinS dclaralions
<br />Dc.$lirnro Pernir\ sh.{o\ Nurifi.lrion Fcd.rrl RcSuhn,n! lTirl.40, PM6)
<br />-Rcqrncd
<br />Lcuc. of Norificarjon
<br />I c.ni,y rhtrl rhc riddrrLrrguhri()n\ rcg:trdi',9 n(x(o\ rcnlrxlxr. ror
<br />l..,rilI rlhr I hr\r r.x,l rhtr Odl.nri,rr ,urior is.otrc.r Irgr& ioc.mply *irh all Cn! atrd C.unty
<br />odi'rncc\ rnd Srrrr Ils\ rhrnrStu ives olrhis Ciry sid Coutrtyh cnrq u,nn rhc
<br />rh\. nrnri,trr.d fn|tny lor n,
<br />Appliunl or Aaenl Si8n.t loltslrZ
<br />DATE
<br />Under Slab / Floor
<br />FINAL
<br />t h.rch, amonundcr pcnaliy ol p.rjury rhar I sn liened !nd.r px,lirioo olChnp!& 9 (connm..in8 wnh Sstion 7O0O) ofDilkion.l
<br />ol th. Busincssond PmicsiotrsCodc. a.d nry liccnsc t in tull6rcc orncfrccr
<br />Li.cosc Cla$:_Li..n* Numbtr:
<br />-
<br />D{re_ .. Conr{.ror_
<br />Lrndcr\ Addr.s'
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