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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Slandards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Sollit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />Meter Release
<br />Rough ("*IL (.<)6 ,Dffi l " ffo.r R.(. ,.1/4{1
<br />Service Meter
<br />U
<br />Notes Remarks Etc.
<br />FINAL
<br />OWNER B('ILDER DELCARATION
<br />I hercby allirn xndcr Fuolry of pcrjury rhal ! onr cxcmp' fb,n rhc Conrrrron LtenE Las tor thc following e,son (sc.7o:ll 5
<br />Businds dnd Phrcssioi Codc) A.y Ciry or C.unry which rcqrircs a ,.nnir ro .onslDd, altcr. imnrovc. &.nlkh or Eprn any
<br />srrucrurc. prhr ro ns ksuatrcc- aho rcqutcs rhc lt'Irlicanl lbr sucn Frmir ro filc u sisncd {dcmnl rhlr lt or sh. is lkcnscll N^u ,
<br />h lhc tmlisions ol llE Conlraclols Li(cned bw (Chprcr 9. Conmrmirg wilh S.crion ?un o, Divnion I of lhc Businc$ and'
<br />trulc$ions Conc)orthithcorshe Gcxcmpl lhcrcfonlnd lhebasis ror lhc rllqcd cxcnrprn,n An, violdioiorS&rirn70rl5 bt{ny
<br />aptlicsnl arr a IErnrir subjccrs rhd lptlica !o ucivilpc.llrrofnor mnc rltrn tlv. hutrdrcddollam($500)
<br />l. N ownm of rhc EoFny. or my cnDlorcs with w,gcs as rhcr $L cotrrlxos.lion. will do lhc work 0 ltr nru.iuE n tur
<br />i cndcn or oilcrcd lnr $lc (S( ?0,14. BusiDcs atrd ProLsions C(ic: rhc G,nrraclois Licnsc ljw do$ nor arpl, t,,d.widror
<br />rhc pmrcny wh. huild\ or inptuws rhcd)n. ud *ho dm\ \uch sork him\clfor hc*clfor rhnru8h hh or hc..encmpbyccs,
<br />proridcd rhar such improwmnh m nor i cnl.:l or olT.r.n lor sb lt nowcNr, rhc buikliiS or inPmk,Etrr k hld wihrn nnc ,tJr
<br />or.ompLiion, rhc o*ner Buiud { l htrE Ihc budch or lmvint rh,r tr or shc dii mt build or iry'rcvc rhc Imp.ny for rh. lnqrrc ol
<br />I. asoundrlrhcfmp.nt, rnrcx.lusivcly.onticrirAwirh lic.r\d,contrdorrocon(rucrrhc pojccr (S( 7O1.{. Bu(ncss
<br />rid E f6\k,nCodc: TneCotrrmcttr \ Li..ns.l-awdocs m! rpllyk, rnnqi$ ofpn,|[nytho builds or iflnrovcs rh.rcon.
<br />rnd q'ln,.onrnr.hlorruchfrolcch$irhaConlEckrl()liccnscipuFUanrn,rh.(innructr'sl-icrn{Lrs)
<br />-ldflrcxcmpl
<br />undcrSccl
<br />]I!]l]f,IiEsllolltDlsrlllON
<br />DE!:ITIM.IIIIN
<br />I hcrehy ilrtm undcr Fnnlly of lsjury onc oalhc i.llowin8 n(hrrlions:
<br />-lhnvcudvillnminrain0CcnificlrcofCo.scntroScltlnsurcr'orBorteh.l,mp.isdn.dsImvid.dfo.bySdinn3T00olrhct lbr Codc. for rhc pdlornurce oi lhc qori for which thc psmil h Gsucd.
<br />I! hav. ud *ill mrinrlin sorkcR c.nrcnsd ion insurarcc. es rcqut d by Sc! ion 1700 or lhc t$or Codc, for lhc perfom ceof
<br />rhe work lor Bhicn lhh Fdir ia is$.n. My wo.kcs ompcnsrt,n anruon.c cmi.r dll polky numh.r uc
<br />ca.i, . tTqit CAtt?PpS A77oL) lr% Eo^)b
<br />/,
<br />)(i ccnily rhat i'rihc pc n.umcorrhc w.rk lar which rhis p.nnir i\ isnrcd.l sl[llnol cnploy0n, pcnon irany nxnncr
<br />s, as ro hcconE $lijd to lhc wo cn mmpcnsdiotr lows oi Calilorrir. lnd qsrcc rhar il l \huld h.rom \!bj.\r ro rh-
<br />workss conrpc.s0rion [ovisions ofSc(rion]TmoIIhc bnor L-dlc.l shlll- k]nhsirh comply sirh rh.s pn,vi{n,ns
<br />WARNINC Farlurc ro s.urc \rork s conDcnsdrion.ovc.!E ir unloNiul. {nn sholl subJecr an cnll)li,rr ro di.in,l!.mllirr and
<br />.ivil inc\ up ro on. hundrcd thousMd dolllrs ( 100.fi)0). nr addirion lo llE c.sr oI comF.slii.n. dlrugc\ dr providcd fot rht
<br />S..ri()n 1076ofrh. LrhtrCidc. ir crci rtrd dtorncy slics
<br />,"..,- 1/4/4
<br />I lrcEby dfirmundcr pcnillyofpciury thal I !m licensd undcr pmvision ofChllrer 9 (commncins {irh s..rir 7000) ofDivision l
<br />of rhc Busift\r m{ Pmrcdlhns Codc. ord nry lacns. h in tull fore .nd cfiLrt.
<br />)b 5
<br />I hcrhy trfn und.rFn,kyorp.luryrhairhcr.isa$nNru.ri).lcndnrgaScmyforlh.pcrfonunccoflhcsorllo,whi.hrhi\rcmirk
<br />hsued (ss 3097,civ. c )
<br />AfIUCANIDECLAAAIIIJN
<br />I haA,y anim undcr Fnalty of pcrjury .nc or I hc rollowin8 d(larar ionr:
<br />Ocmlition PeflDik.Asbcstos Notificrrion Fcd€ml Rc8ularions (Titlc 40. Pan6)
<br />-RcquiEd
<br />Ldlerof Notilerion
<br />dh,w rmtrriotrcd Imt dy ror i.slEiio" IurlFss.
<br />Applicsnl or Asent Slsnrh'r€ >(.
<br />Pemire mnelprini),rD(tM,4-ll tl ep A/.d5
<br />EJ,TZWAIM
<br />Communications Cable
<br />Sub-Panels
<br />Air Conditioners
<br />il14
<br />L,ndri Addr.ss:
<br />-
<br />-l
<br />ccnili thnl lhc fcdcrol rc8u lario m rcB{din8 asbc(os rcmvrl&c n.t olpltahlc to lhn pnjccr.
<br />-l
<br />.cnify lhal I nlvc read rnh omli.ar ion ond natc thar rh. atBvc informrion n corccr I agft b .rorly wirh rll cny ond Coutrl,
<br />ordiranccs rnd Slntc tiws Ehrins ro huildins consttucrion. lnd hcrchy authoizc rcprc*nrnri!6 o,rhi. Cnyand counlt lo cnt$ urr lhc
<br />I
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