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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER /0a-B ,
<br />Transformers
<br />Torqueinq i0.2S-tB S,( B 8pe
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rouqh lo.1l-loa 7c 4,1
<br />Service lt/leter /2-zt -1$4e zl
<br />FINAL /z-t'-/6 ZO<*,rzz z?..-,X?.
<br />Notes, Remarks, Etc
<br />q
<br />OWNER DUILDER I}ELCARATTON
<br />I hcrc$y alfirm undcr pcnolt, otF,jury rhrr I dd cx. l,l fn,6 rhc CotrlEcloF Licensc Llw ror rh. ftrlowin8 rcawn (Scc 70315
<br />Businc$ and Profcssioo Cod.): Any City or Counry which tcqui.cs r Isnir ro .ons .r. dlrct. inprcrc, dcmlish or drair any
<br />{flcrrr., D.nr (o nr issunNc. lle !.qiireslhc trtplicdr tor su.h l.mir ro 6lc u siAmd dlt ntnr rhai h.orshc il lien{d pursunr
<br />k, rh. pmlisions or lhc Cotrtsctor's Liccnscd Las lchaprer 9, (:.nrmmin! *nh Scclion TuOl) of Diltn,n I orrh. Aucirc$ and
<br />Pftn'csbns Codc) or r har hc or shc is dcntl (hocrro ffd thc bdsn for thc allcscd cremprio. AnyviolarionolsNlionT0ll5hy,.y
<br />applicrnrlora!.nnirsubjccr\ihc,pplicanrlorcivilpcnillyofmlmrcrhrnriv.hundr.ddolltrs($500)
<br />L rs owNr of rhc pmJEny. o, my cdplortrr wirh "!sc\ !s thcn $k .onilcnsal ion. will do rlr woA dn dx df,r:iE t ml
<br />inrcndcn or oficrcd for slc isd.7014. Busincs Pmacssions Codc Th€ 6.rr,.r.r's Li..n* tjw dcs ml apd, ro d owrf ol
<br />rh. nNlcdy stx) huilds m inrpmrcs lhc@n- anl {lm d{rcs \rh so* hnffcllor hcr$lfor rhmush hir or h6 o*n.nployccs.
<br />trovid.d lhar su.h impmrcmds e nor imcnddl or oftt d ror sh. li howcvcr. lh. hilding or inlprorcmnl ie $ld wniin nnc rtu
<br />or complcrbn. th. owmr Buildcr will harc rlE t{d.n oa pmlins rhnr h. or sh. dil ml hrit or in{,m!e lhc l,otEry ror llf ,D4ns of
<br />14. u.o-n* "rr* n-n"ar.,mc\ lu!v.lyconkhrdB wirh trc.Ncd !ontr!cx,^ ro cunqtu rh. roFr't( 1044. Bu{nc$
<br />dndEt\bncodc:ThcCotrt0ctolsLkensctiwdocsnoruprlyro,n.Rmrofpropcrtywhohuildsorioprovcslhcrcon.
<br />and who contffls for such lr*ds wilh a C.6r.clo( , lic.nscd puru! lo rlE Contr'.rs Liccn* tj*).
<br />I rmcrc.fl u cr Sccri,n-. B & PC.lbtrhis rcn\on
<br />WORKTR$ C(}I\IPFNSATIoN
<br />D[Ct A.[AIlr]N
<br />I hcr.by lfinnr!ndc. rEnalr, or P.rury onc orrh. r(rbwin8 d.cl.rd,ons
<br />Ihavc.ndwillm0i oiraCcnil-rrnrcofCoii.irt,Sclllisutntrworkrs comPcns.lbn. rs lnrvid.dforbyS!-tion17U)oIrhc
<br />I-itxr Cod., ror lhc p$rortu.cof thc wo* ior *hich rhc pcrnrn is nsu.d.
<br />I hrvc a.d will nrinra in workcri compcn{dnnr in\rran.., rs rcguncd hy Scct ion :l?ffr of I lt ljbor C(dc. for rhc Pcrf.nurcc of
<br />lhc qork tor phich I hh nemil i\ i$kd My wo*.rj ..mpcnern i.sur!rcc dtrhr nl B,lty nu mb.r r.
<br />(-r'i1r _
<br />-lccnilyrhar
<br />inrhr p.iroilmncc of rlrc work for whichlhis tcrmil i! issucd.l shnllnor cnlPloyanyp.ron inooynl ncr
<br />", as ro bc.o'ft subjccl to Ihc workcr oftp€nsdion l!{1 or Crlirnnia. md i8rcc th*t ifl should hccom subiIl lo llt
<br />woltcn conrFnsdi.n pmvtions olSccrion:lT0oolthc bhn cld.,I sh!11, bnhwith.omrly wirh rh.e lovisions
<br />WARNINC: Frilud ro KUrc wortc omEtr\rrion covcBsc i\ unhwtul. ntrd drll subjc.r 0n cnPlo)c! ro Giminal lxntr[ts Md
<br />.ivil rirc\ !n r{r o c hundr.d rhotrsrnd dolla^ lsltro.ooo). nr adlirion n. donNscs r{ trovidcd ntr lhc
<br />f. e.
<br />trhtr codc. inlcrcst.nda onEy s fcc(
<br />t9
<br />DECI.ASAIIQN
<br />I hcrchy,fiirnr nnd$ pcnany of p.rjury that I ah licensn !nd.r prcvision o{Ch{Fd 9(commncinB silh Scclion 7filo) ofDivision 3
<br />of rh. BusiRss atrd Pmacssions Codc. and my It.nc iq in tull lom en cfi(r
<br />f't- tg
<br />caNglaqquaNIldDllcaliENcl
<br />Ihccbyliirn:!icrFn,hyollcdu.ylhalrhcrcisoconsrdcrirnbodin8lg.myforrhcFnbirllNcoflhceorkrorNhichthislqnnn
<br />nsuc{l lS€.1097. Civ. C.).
<br />APPLICANT DECLARATToN
<br />I Hry lllmlndcr pcnalry oa rcrlxry om olitu lollopin8 {ccleariotrs:
<br />Drnn il,o. P$nrils-Asbcnos Norilicarn,n Fcdctul RcgnldrioN lTirlc 40. Prn6)
<br />R.quncd Lctrcr of Norificarion
<br />_l.cdily tlDi rhc rcd.rrl rcgularos rSrdiU i$c{os rcflrvrrnrc nor ipdicrbk b rhi\ pfl,jc.r
<br />lc."ily rlLr I hrvlrondrhn xfplriri(rr ion hcoret.I og.e rocomdyvirh lll Cnyand counry
<br />rrize hE.snlalnls ol thn Cily a.d Counry to c.lcr upon thc
<br />D"t . -9^- g_ lS
<br />oxli',aN.\ atrtl Srrrr l-n$s nL[irC ki
<br />xM nrnriorud pru|r.ny fff
<br />Applnin! or,\,l r Sixnrlurr
<br />APPROVALS
<br />Communications Cable
<br />1121t7
<br />t d.lr Nam'-
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