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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 />./,Ld/{/r_Spas, Pool, Fountains t9
<br />Signs (monument)
<br />Lite Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />,lffiislab / Floor q/ut/,i tE rer*+
<br />Bonding/ Groundino / UFER >L&Ae- rt /-,u^r-l4E
<br />Jransf6-rmers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solf it Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/leter Release
<br />Rough
<br />Service Meter ,,
<br />FINAL 1l*lb ,(w9t 9)
<br />Notqs, Remarks, Etc.\-rt'
<br />OWNER BUILDER DEI,CARAI'ION
<br />I h.icby aflir'n und.r pcndlry or Frjurt rhr' Lm.xempr fdm rhc Conr,cto6- t-iccn* hw for lh. foll.win& rclson lss.?0:11.5
<br />Eusincss and PmLssion Codc): Any Cil! or Counly whhh rcquncs 0 pcnnil to coNrrucl. alrcr. improlc. denFlnh or rp+ uny
<br />srtocrurc, rior to irs hsurrcc. lko reqlncs rhc lpdtanr tor such Frmir ro fiL ! risned ftrcmrr rhar he ot sh. i5 li.cned pursumr
<br />ro lh. pmvisions of lhc conh.rors Li.cnscd tir (Chrpl$ 9. connncminS *irh S.ction 70m o{ Division :l ot rbc Businc$ ann
<br />Pofcsrions Code) o, thal heor sic is cicn{,r licrclronlnd ltc hrsn fo.lhc allcscd crfln,n Any lnrlarion of S{rb 70ll J hy my
<br />afrlicanr ror a p.rnrir suhj(k rh. applm ror.iviltcn,lryorfr,mrclh0.riv.hundrcddollars($Ju))
<br />l. u\ osncr of rhe prop.dr, or my .frpk'ycds wilh *!gc\ !\ rhcn soE contl.nsar i(,n. will do rtE w{* ard lh. nf,riurc is nol
<br />i urlcd ororc..d ror sal. (5(.7044. Busimss.nd Pmr.$ionr C.dc: Thc Contradols Ltctrs tiw dms ml anply ro 0no{ndof
<br />lh. popcny sho buildr n irymEs lhcFr, a.d wno drc\ ssh w* nrmsell or n rsll or rhmrsi his or hcr oBn coployccs,
<br />trclidcd rhd su.h inl|. nMrnr3 N !F i, cndcd .r otr Ed f.r {lc. If. tx)swr. rtr h{lhiry or nqmtnrc n sld wihin om )rr
<br />oroifkrioD. rlE Owndr Buit|r will htrvc rhc t{d.n ot Jmving rEa lr or rhc ilt n.r hnikl or idprcw rhc poFry for thc ,lorrrs ol
<br />l. ii ownf or rhc rrupcny, a.rcx.hsnrly..nra.rinS wnh liceiscd conta.k,s k, .oneru.t ih. pn+.I(S(. ?044. Bu\incs
<br />nnd Fbfsshn Codc Thc CdrrEclor's Liccnlc La' docs n.r amly lo an owncr of pmrcdy *ho htild\ or innrovcs rhcrcon.
<br />and who.o.rra.cfdsu.hpmj.rh*i'hr('onr6d.ns)licctrsdpu6u,nrt,rhccontndoisLi*nsebw).
<br />lr rcrc rtr utrd.r Sc.ri( .B &P( nrrhi\.cr\nr
<br />Drlr ()wnrr
<br />/
<br />TOBtrI&II;I}MEENSAfIQN
<br />DECLAI{IIO!
<br />I hcEhyllllrmund$FnrhyofFauryoncolth.fouowinsdu.l rrn'ns:
<br />I hrvc dit willtui dinrCcdii.arcolCon*nrbsclrln\Lr.n,.workcis.onrNns.rion.0s t'.ovidcd lorbySccrn,nITOOoirhc
<br />Iihorc(xlc. rirr rhc r{rlbrnumc . t rhc work rnr shi.h rh! pcrnril js hsncd.
<br />_l hivc rnd srllnmi rinwo*cn compctrsrrion insurrncc..s Gquncd hrScdi,)n.1700oflhc tzh.r Cod.. foi rhc p.lfonENc of
<br />r hc rok for which tht pcrn l is isucd M y sortcrs conFnsar io. insuranc .nd.r $d F,li.t iumhcr uc- S ttFZ n.,>
<br />l!-s?c s I
<br />lccnily rhal in Itrc pcrt'orronc orrhc sork a{tr *hich thi\ p.lnir i\ i\\t.d, I shrll nor c.!t,y rny lx6on in lry nunmr
<br />$ as to hl()m subjer fir rhc wo*cs snvr.sarion lawsofcnlifd.ir. nnd 4rcc rhlr iIl shoul, hccotu subjer tu rtr
<br />wortcrs .onrDctrsrion DmvnionsofSarn,n 3?Ur oflhc Llt . Cod.- l \hall. {onhsirhco 'tlt wirh rhos povsionr..
<br />W,\RNlNo: Frilurc n, srrc *orl.ri conrrcn\di("r Lrvcr Er i\ Lihalll. nd shrll qhl..r 0n cnlioycr lo crirniml jurlri\ ni,l
<br />.iril nne! up io nnc humlrcd lhotr\rnd dolh^ rSloo-fiX)). i',dan{gcs as F,vidcd lu lhc
<br />l-ffifi-^'*^
<br />I tur.by aminundd r.nslry ofFrju.y rhd l rnr liftn*l und.r ttr.rhion olC-tut,rcr 9(commNitrA wilh Sccrinn 7fiX)) ofDivkirn l
<br />of rhc au{ms\ hd lin,Icstunr C.dc. aM ny liccie ir in full tme sd}tl*ra
<br />17t z1Y <:-->I
<br />E7,E,R
<br />Ihercbyrmrnundcrpcnahyofp.iuryth0rlficrehsoflstrudionkndinsa-q€n.ytorrhcpcrr.rtumcorrhcworkltrwhichthis,E,nlis
<br />hsued (S< 1097, Civ C ).
<br />AIELICANLDECI,AAAUUN
<br />I hrlrydtn ru.dcr lctrrlryorNluryotrcolrnc hlowinS dc.lnrarmns:
<br />D.molirion Pcrmir! Aslf,so\ Norin.dbo F.dcal Rr!trlarionr (Tirlc.l0. Pdn6r
<br />Rcqutcd lrtrc. oi Norifrrkn
<br />I..niryrhd ttu rcdchl.c8ulatiotrs rc8ddinB isbcno\ rcihvalm rcr trnlrli.rblc lo thh n(iccr
<br />I c.dilyrhd I ha\c rcod rhis ion hcoral I rsle ro.oq y snh aU Cny rnd (bunly
<br />ordiir .r\.'rd Srrrc Lr*\tc rcnrcsntarivcs olthn Cirylnd Ci,rnryi, c.r.r uB,n rh.
<br />.brd trf, nri,nrcd In,pcn, f{tr
<br />,",. s'/('/t YADDliu,l rr ,\[rnr si[trrlu _-d111C{
<br />v
<br />. Frnn.{:
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