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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION
<br />I hc.cb, amrn !nd( Frohy ol pcrjury lhrt I m cxent lmm Ihc Conlmcron l-icc.\. Lnw for rhc rdlowin8 rcasn (Scc 70ll 5
<br />Busincr{ and Phrcssn Codc) Any City or Counly whi.h rcqutcs ! Frn,ir lo .on$fl.I. rhcr. i'n[ovc. demlhh nr mntrn rny
<br />irucru.c. pritr ro ns issuancc, als rcquncs lhc 4plicanl for such rrmir ro 6L . sigftd $.t.'m $01 hc or she is licen*d p!^unnr
<br />lo lhc [ovisions otltE Conlrsckn i Liccns.d trs (ChDl,r.r 9. Com'ncncine qilh Scction 70OO ot Dirisn,n ] oi rltr Bnsints a.d
<br />Prcfcssions Codc) o, Ih0r lE or sirc irexcn9r lhcrcli.'n6nd rhc hNi\ forthcallcBcdcrcmolion Any!iolar6..rscclidl?0ll.5hyany
<br />!!plic! tu!pcroir suhjdk rhc appl,.rnr to 0civil!.nrlryofnor mrc rhan fivc non&cd dolldr($500).
<br />-1.
<br />N osNr oa rnc phpcny, or my cmFbr.cs wirh wr8.s as rhci slc corr.nsul ion. will do rh. woA .ti th. srtrtut is Dr
<br />n cfthd or o,Iercd for $lc (Scc 7014, Busines ud tloac$ions Cdlc Thc Conrmht s Liccns Llw des nor apdy ro in oatur ol
<br />rhc lrfl)peny who build\ o. invnits rhcrco.. and who dtus su.h work hnnsclior hersltor rhrcush his orh$ oen cmfloyces,
<br />pmvidcd rhar nkh nmorcmntsm nor inlcdcd or otcNl nn sh. ri hoqlvq rrr lflili.s oi in,oE.Ent is $ld wilhinoN Sr
<br />ol complcrhn. rhc OBncr Buikld will hnR rh. bunlcn of pn'vhg rhar h or shc dn fr, tuikl u inDfl,rt rh. tmFiy for llE Nrlre ol
<br />l. l owrui nr thc pirr.ny. 0 cxclusivclyconlracrins wirh liccnsedcoitact^ro.ntrnru.r rhc 0roicl (Sec.7oit. Bonn.s
<br />a' li,ltssk'nCodc:IhcC.nkrcror'sl-iccnsct-awdo.smra|flyroinowncr.iDropenywto$uildsorinprovcsrlNreon.
<br />,nd who cotrhch tu such roicl\ trnh a CorrEcron \) lienscd pu^urni ro rh. conra.lrtr's L.Ins I !q )
<br />I an.x.npl undcr Sslio
<br />w( )RxFtis. c( TNTPENSAT!()N
<br />DECIdAA.I]A!
<br />Ilrrcby,mrnr uMcr pcMltyoItE juryom ollhc nnh$irs ds.'lururn rl
<br />-l
<br />hrrc snd will tuinrdin a Ccnit*arc or CoNc to Sclf.lnsurc for rorkcr' co mlcnrar ioo. a\ pbvidcd lor bySccrion 37m or'hd
<br />Llbor Codc. for lhc pcrlorronc otrhc wo forwhi.hrh.lcrmn i( irsucd.
<br />rndsillm.i rin wotkcr' .onrl'.ns.rion insuran.c. as requtcd hys.crnrn]7mofth. t ta,rCodc. hrrh.Frrornu c.oi
<br />My !u[s i con,,).nsrri{nr i'rumi(.rnid.nd Bnicy nnDhc
<br />..-S qlq -7.2;\b ,,,,*-'\rl Lbltt'rs
<br />_l ccnily ihrr in rhe pcrronnrnc. orrhc work r(tr shi.h rhh pcnnil n i$ucd. I shrll nor cmpk,y tri, lcMn in rny hnnncr
<br />$ N to lE.onr subjNr h, rhc sor kcr{ co'npcns.li,,n l!w\ .l Cllif{ris. "id nSrc rh0r ir I shuld hccom suhjcd ro rrt
<br />sorkcs' L_onlpltrs.l ion povhn,ns ol Ssr ion 3?(x) or rhc lf,hr C.n.. I shtrll, rod h$irh onrnly * ilh rh.Y Pmlisn,ns .
<br />WARNING t_3ilurc k) {.uc *(trkcr( cnnDcNfiotr..vcmAc i\ unh*1ir]. rnd shrll srhj.{r .n cmflorcr ln oiminrl Fu[hs 3trd
<br />livil fine\ ut b on. hrndrcd th.usr d dollrrs (S100.fix)r. ir .ddilt,n lo rhc co\r of.o rfl.nsarion, drtrmgcs as Pmvidcl for rh.
<br />S.cinn, .1076 ofrhc Irhtr C.d., inrcrc( rnd rtl.aEy's l'e\.-qltLtltq
<br />IIECI4EAIPN
<br />I hcrby dEnnu lfi pcnahy ol,rrjury lhd Ian Iiccred under pmvnion of Chafld 9 (.onrmncins wilhScclhn 7000 ol Division :1
<br />ol rhc Buriiess and Phrcsions Codc. oi my lic.ns h in tull lhrc and cfiNt.
<br />t1 CA 113
<br />,,,",.q1 lq ltg ..,*,o.K
<br />IQNIIf,UEIIONIINDING.AIiENCI
<br />I hcrhy !ftrn ufldd Ftrrlty ol pciury rlur rh.rc i\ s con{dcri'd lc*lin! iecmy ln! rhc ,). oflnaNc ol lhc hrk ftn which lhis |.iinil is
<br />ksucd (SN :1097.Civ. C ).
<br />I rrtc,'. NJrnr
<br />dEfucalfD[st axArlots
<br />I h.n'by rmm uidcrycndlty ol p.rjury onc of thc followinS dslarrr ionsl
<br />Dcmlirion Pcrmik Asbcsros Norirrcarn,n F.dfdl R.Sulsri.ns (Ti1.40. Pan6)
<br />-Rcqutcd
<br />lxxerof Norifi .irioo
<br />_ l..d'ly rhrr rlr kd.ml rceulrlion. rcSsdinS hbc{,r rcm,olarc n,i atpl'.ohl. ro rhr lmJcctrlu Ll Rn riy rh,r I h,vc rcad r hi! rnnlicah,tr !d {arc r hzr rhc ltnN intormrion n codccl I o8re ro smpl, wirh sll Ci', ind Counry
<br />ordinonccs lnd Stllc L3ws rcbrins lo bxilding con{dc(i.n. @d her.by aur horiz rcnrcscnralires ofrhis Cny Md coxnry'o cnrcr upon rh.
<br />dhorc NIrion.d froDcny lor in\plcrion
<br />applicnnt or Asent sistr.r,r. X
<br />pcmi,rmnE,pr, ,:K &nqa iCA E)ttwvvtq
<br />1L{rq
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lt/eter
<br />FINAL qtulk f4t4 rt'/+-lI -r-Notes, Remarks, Etc
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