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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Bu ild inq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER 9:28 18 2/2,))
<br />Translormers ,-.,.
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh -.."1o.4t-ro ./-/r,1 t"1Service lt/eter
<br />IQo /u,4/(-.,
<br />Notes, Remarks, Etc.
<br />OWNER BTIILDER DELCARATIoN
<br />I h.icbt alfifln undcr |*nolr, ol pcrjrry rhll I ! crrnrpr fmrn ltc Coikdh* t.i..tr* Llw ror rhc fol,o*in8 rcosn (Scc 70.115
<br />Busincss llxl Pmlcssi,)n Codc): Any Ciiy or Counry whih r.quiics a Frnrir ro mnslrucl. alrcr, n.pmt. d.nt,li\h r rNir rny
<br />$dcrurd, tlnnb irs hsnM.c. iho rcquncs thc rt'tll.ant lor such ncrmit lo rlc! xisncd (olrmm rhrr h.or\h. is liccnscd punu.nt
<br />ro rh. noli\n,is of rhc Conrdkr's l-i.cn..d ljw (Chrfl.i 9. C.nnmkirg wiri Sccrion 7(XX) of Division :l .f rh: Btrsincss 0trd
<br />Pr)rcsst,ns a)dc) orrhar hc.rshc hcicmfl lhcrcl'm and lhc blsis r'or lhc dlcg.d cxc.rrridr Aiyviol.lionolSdi,nT0ll5bya.y
<br />rpplicadfo'rpcnnilsubj6..lsthcrfplicaniloacivilpc.rlltoln.rn,kihrnriv.htrndrcddolhs(3500).
<br />-1,
<br />as owic' .frh. F),.dy. or my cmtlotccs with woSc\ nc lhct soh compcrslrion. wiUdo rhe worl Md rlt efum n nor
<br />i cMcd orofitrcd forslc(Se 7014. tlusincssatu h.fc$ions C.nc: Tlt G).rsdor! l-kcn* Ltw dms nol lodyromorncto{
<br />rht F,pedy wtx, hlikls o, inqn,rs rhcm[ mi who dfts skh eork hinls.ll or hcRlf or rhmuEh hh or hd oen cnPloyccs.
<br />lmvidcd thor su.h impmrcnrnk m ior inrcldcd or offercd lor sL. lt no*cru, rh. huildin8 or ir1l,n'vcmni n sok wirhin om ]tg
<br />ol coD{,lclion. rhc Owrcr Buildq vill h.E llr tudco of |()vin-q lhal tr or \he dil mr hditt or nBmk rhc ,mFny fot rhe nurtmc o,
<br />1.0(osncrnrrhctripcdy,rnrcxclu\irclyconrraclinssirhliccnrcdco0rfucrrtr\hdNrrucrrhcta)ic.r(S$ 7rx1. B!\inrs
<br />rnd PmGssh Codc: Thc Conl,aclor'\ I-iccnsc t-r* rloc\ tror rprl, n, ri.$ncr 01[opcrlywho buinh or nnproh\ rl'.rcoi.
<br />rnd *ho coiracr\ rui \u.h t ,jccls wilh r conlBct(tr(\) li.ctr*d puruml lorhcConrr&tr \ Lkctrsc l-rs).
<br />litr,r\rnr otrdd Sc.ri(B &PC n,lhi\ r.ann'.
<br />D q Oam.wonxrts'cotrpmii ritw
<br />IECIAAAION
<br />I lrrcby afiirn und.r lcnrlry ol'pc,jury onc ofrhc folk,$in8 dslnrnnms:
<br />I hsv. dd sill Einri. a C}n iicarc ol Consc k, Sclll trsurc lnr qukcis co.rr.nsdn,r r trovidcdforhyScclion]T(noflhc
<br />tihor Codc. lor rhc p.rtomr& of rh. wulk f(tr whi.h rh. |xnnir is i{sucd
<br />Ihrlcrhdwillnlrifirinu.rkcrscotrrErsari,rinurncc.rsrc{lirrJh!Sc.ri{ 17(Xr.frl[t-rhor(tdc.lo!lhcFrforrut.cof
<br />rhcworkforwhnhrhhp.nnniri$uciMyworkcsconf.nslrioni'r\urrncccxric.nMB,licyflun$cruc
<br />Exfircs
<br />I(cniillhrl irrhcrurntrnHlccolrltvorkl,nshi.hrhi\pcnnit i\ is{cd.l nMll Nl clnplo, rn} jtrvnr i'r trynrtrncr
<br />n) 3\t, h..om $hr.rh rhc$orkcdco |xns riotr 10tr s rt C.lilor.ir. rrl 4rcc rhrr if I \ldrld h.onf, \uhi.l h il'c
<br />s.rkc co rlf,nsarn{Oo\inotrsoiSccriorlTll)olrhc Lih.r (ttc.l d ll. 6n h*iih con{ly wirhrhot novi\inr\
<br />WARNINC Failllc ro {cxid *(*.rs .onDc.\mion ovcn{r is utrhwlnl md \hall strbF.r $.n{'lo}tr ro aini0rl pcnllrts aid
<br />.iril lnr.r uf n) onc hunJrrd rlru\xtrd dolln^ {$).ur). ir ldirio ro rhc cod o
<br />S..ri{$ l(r7().lrhr l.xlxtr C{xlc. I.tu{
<br />".,",01-24-l<ti
<br />I hcEhy afilirnundcr ncnultyof pc.jt' y rhsr I ar lidnsd undfi rovi\i.n orCh,/$ 9lcommmins wirh s{ri.n TuDr.rDivisintr l
<br />of rh. BuriN\s trnd Pmic\sions Codc. a my licens t in rull forc llld clt cr
<br />10 2w4-t I <1n--- 1+
<br />I hcrch! rflnnrnDdcr rEnalry olntriury lhd I i\ r.otr{n,cri(r lorli'rL rrcNy lhr rhc |[r,nnrr...irh. Nork lnr trh'(h rlns |[nir i\
<br />AIILIEANIDECIABAUA!
<br />I lrn:hy rrm undd p.nahy of pcrjury onc of thc tbllowin8 dcclomrions:
<br />Dcmoliriofl Pcrmirs AstE\ros Nolifrari.n kd.rnl R.!ul iods lTilL 40. PM6)
<br />-Rcquired
<br />Lcrtcr o, N{{ifrlrion
<br />l..nilyrhd rhc fcdcnl rcgulnriotrs regr in8 a\hc(osicnrnrlnr. iorrmli.rhlc r. rln( Pmiccr
<br />nnnnn otr is.on(r lrgre h con{ly Niih ill( nyrnd Coutrry
<br />hy.urhorizc rcrrc€nhrnrs of rhis Ciry ! d Counry h ctrrcr ulx lh(
<br />)doalc
<br />q-2-4-=tt
<br />tD/stG.COMMENTS
<br />Site-Work
<br />FINAL
<br />hsu.d lsec. 3i197. Civ. C.)
<br />Lcndci\ N,mc'-
<br />I c1'1. ' \ 4.1'1,P..
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