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ELECTRICAL-INSPECTOR HECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Condilioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Flough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />l/eter Release
<br />Rouqh
<br />Service l\/eter
<br />rt\r\rQ l-^rAtol
<br />Notes, Remarks, Etc
<br />OWNE[ AtIII,DER DELCARATIoN
<br />I herehy nlfirn undcr pcnulry or pcrjury rh,r I n.rc'ryI an)n rh. c.nti.rom Liccnr L.w r'or rhe hlli,Nin8 rc,sr ls.c 70ll5
<br />Bu\in.\1 .nd Pmfcshn C.d.) Atry Cily or Coumy wni.h rcqun \ d lrnnil ro Nnslruct. alrcr. ingr{,vc. .hixnhh nr rctnn Jny
<br />(rucrrc. lri r, irs nsuancc. nho rcqutes rhc appliclnt ior such licflnir lo lilc a sig'rd itrr.ft.r rhar hcorshc h liccnscd purslmr
<br />t, rh. ptuviln,n\ of rhc Conta.r.fs l,i.cnscd bq ((h.ptcr 9, Commncirs silh Scdion 7lx)O of Divni(,n ] .f rhc Busilc$ ond
<br />Pdtssiofl\Codd orlhrrtEorrnc is cicnpt llrrcriomand rhc hisis |orrhclrlcEedcrcnpri(,n Anyvidtrn,nofScclionT0.ll.5hyotry
<br />r!Dlicnnln)rapcnnilsuhj.clsrheap!licanrrou.ivilprn!lryornornnErhanriv.hudrcddollsB(5(xr)
<br />l. s owncr or rhc tE,frrly, oi nry cnfloyccs wilh wre.{ N rhct srL onrt--ns.l io.- sill do lhc aork dl rhr sfl.tue k nol
<br />ir.trJcdorollcrcdiorlalc(Sc.-701,1.Busirrcsandftorc$ion\Codc'rhccrinkrttrsLitctrtL,wd..stror0pilyroanowncroa
<br />rhc pDlf,dy *h) hrilds.r i'r{,(,!csrlrNn. a who dcs sk h *.* hiosclf or hcr{ll or throu[h hir (, h$ oq n c,nfkDtc\,
<br />pmvidci rhrrsuch inrprn\dftnh rm nor inrcMelDrullcEd fir silc.ll hosc\cr. rhc huiklnls or irltuwntnr h bkl wihronc rir
<br />ofcorylcthn. rhc o$ns Bnildcr sill hnn rh. l rtlcn oi tmvins rhd h. or rhc dil mr huikl or nnpmrc rhe pF[rny to. rh. purrx,{ or
<br />_1. isosncrolrhc nn,Ii.nr. rncrclu\ilcltcotrkrcrirE *irh lic.nscn .oftn(nJF k,.on(rud rhc lo]ccl lS$ 7OJ4. Br\inc\.
<br />M,l t']joacsini Codc: Thc C. hNtn\ Li.ctrsc Lawd.cs nor dpfly ro trn osncr oi prcFn, *ho buildsor nnProvcsrhcrcotr.
<br />0n,l qho conrmcrs ror such lmicls wirhrConl.rcr.(s)liccnsd pu^lanr k,rhcCotriB.ktr s Licctr$ Lns)
<br />I an.xcnrnl undcr Scdior-. D &PC ntrrhisrcr{rn
<br />Dnrc oBmr:
<br />1!!f,S!:BlLrAUIl:NSA.ur.)N
<br />DE!:I,dAA.IION
<br />I hcrcby rflth undur pctrdllyolpcdury om oIllt,nln,wirE dL{hrrlt,n\
<br />l hnld andwill nDnndin n Ccrlific.rc ofConq roScla.l.surclorwortcn omn(n\atino. !\ F,vidcdforbyS(lion3?(rOollhc
<br />lrhr Cod., turrlr pcrloiinan...frhc work lir wii.h Ihc lcnnn is hsucd.
<br />,lhrlTrndwillnrinlrinworkc^conTrn{riorn,\unncc.r\rcqD'\_dnyS.(n:lT00.lrhclnhtrC.dc.nnrhcp.rfonnt.cof
<br />rh. *or[ nl! shichlhnFrn,ir ir i\!td Mywo*c conh-tr!]rn,n i'nuran.c.t,ricr..dt,li.ynunrlEr!rc:
<br />Icunifyrhi inrh. l,cnbnMh.-c .f rhc work for shich rhi\ t'trmir ir issucJ. I\hallnor r [kJy]ny Pcron innoy manncr
<br />$shhc rc {bjccr to thc Norkcs .onDc \urion hwi.fcrlif.rni{. Md oBNlh0t ilIdnuld bcconrc suhjccr t,Ihr
<br />uukns.omlcn$tiotr[ovisbn\oiSccri,,n17rX)otlhetjllrGnt..I\hlll.ronhwirhcon9lywilnlhoslrovisn,n{
<br />civil fin.\ up b.nc hui rcd rh.us. d.lli6 tsllx).(xx
<br />Sc.rnr:1076ofrhc lrlrr Codc, i crc\l rfd rnonry s l.cs
<br />rBScs or lnvidcd aor lneIt-/w
<br />Ihcrch,orrflnuMcrlcnullyoapcrjurylhxrIBdlienscdLndcrFovhionorChdprcr9(.oDnl*niuwirhSecr
<br />or
<br />'h.
<br />Busiftssand PmrcrsionsCodc. run my Ucc.se t in fullaorcc dctfttr
<br />-Lian*
<br />N
<br />tg c-r.*r..,( \
<br />I hcrc$y rtrirmrRlcr rf,drlry or pfijury lhd rhcrc n d.on{ru.riUn Ltrl lorrnc pc,@ncc olrh. w.rk turwhkhlnh pcnni n
<br />l\\'cn rs.. lo9, ('iv a I
<br />I c.nilyrlrd rhc fcturrlr.gtrhrnna rcgrrdnr! n$cio\rc $rlrr. tror it,pli.nhl.l,i rh\ |m,tc.r
<br />I .cniry rhrr I hl\r 6d rht apllic.r ion and {atc that tte atnvc inrbrnul ion n corNr I r8ft ro 6mply snh 0ll Cny and Counl y
<br />.',li' nrc\ xnd Srrr.l.rq{rhring n) hriL(h g.of rnt hcr.hy nurloizc rcflc*nrnrivc\ nfrhis Ciry r ilCoutrrtrocrrs uF,rlr
<br />ltx'vc 'm$ioncd prcpcny hr in\pR1
<br />,^mliunl u. Agrnl Sicnnlurc (E*,\-{Aiar-+'.,"!-/tg
<br />APPROVALS
<br />FINAL
<br />AfILICANLIIESAAAII9N
<br />I nqEtly Btrm undcr pcnrhy ol pcrjury on. olrhc nnhwinC d*l@rionil
<br />D.nmlirion Pcrnrirs-Ash.slos NolilEltion &dcral RcFu l.t ions Onh 40. Pan6)
<br />-Rcquncd
<br />Lcttc, ol Nolificalion
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