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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />tu @L1Undergrou nd .r)
<br />Pole Bases I U't
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundinq / UFER tel48-4O^+u^)ry
<br />Transformers \)\
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Wqlls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release
<br />Rough h\
<br />FINAL fi-t311 v,wM)
<br />NoteF, Bemarks, Etc
<br />2-
<br />f
<br />OWNER IIU!LDER DELCARATION
<br />I hcrcny .fiinn undcr |).n,lly or lc jury rhal I ad cxcmpr from rhc Ci,nrd.rna l-i..ns. ljw r{, rhc rolbwi.S r..q'n (Scc ?0.11 5
<br />Bu\incss ond l}o,csn'n Codc): Any Ciry or Counly which rcqntcs a ltmn tn construcr. nltc.. improvc. dcmlnh or rcnrn rny
<br />sru.rur.. prdk, ik is\uanc.. uiso equner rhc lpplic,nr fu ch pcrmir ro filc a sisncd sllrctunr rhar hcor rhc n li.cnscd pur\uonr
<br />r(, rhc pmvhiotrs of ihc Conlr{crols Licetrscd t w {Chaprcr 9, Coinmcn.ire wilh Sccrnnr ?UD o, Division I ol lhc Busi,rcsr lnd
<br />Pnnr$n,n\Code)orthllhcorsheiscxempllhcrcnomandrhcbastiorthcollcScdcxeq)lhn.AtryviolatiotrofSdi'n70315h!trny
<br />aptli.rnr Lr d pcnnir suhjrk rh. ryplictrnr r. scivilpcnalryoin.r mrclhln filc hundrc{l dollaF t:951X,)
<br />l. o*ncrofrhc ptr,rEny. or mycmre,rlcs rirh wascs os rh.ir slc compenulion. willdo lhc worl a.d ltf, srrud@ is tror
<br />i cnlln or olIcrcd ror slc (SN 7044, Auri*ss and Prur.s\ion\ Codc: Th. Conta.k, \ Li..n* Uw d€r n t.!ply ro,nowncr ot
<br />rhc pmrrtry wh hxilds or i.lpn)ts rhcE,n. aJ Nho dms Mh mrl hims.ll or hcGclt or rhmurh h is or hcr oen cmpbtdcs,
<br />providcd rhor suc[ imnorcmnr m ml inlcnd.n n oFcEd lor $lc ll h.wcvd. rhc huildin8 or iqnore"Enr is sld wirhin "m ,tu
<br />ol odrk'n,n. rlr Owncr Bualdd {lll h,!. rlf hurd.n oI rmvin8 rhar tE or shc dn ml hoiu or nr0oe ltc poFay ror rh I,u$& o,
<br />I. 0s o!tur .l rl[ psp.dy. r r cr.lu\iv.ly .onkrr inE $irh lice!{d .ontucroE r, c.nntud rlr poiccr (Scc 70.l.l. BunNsl
<br />.nd hnli\\hn Codc: Thc Conh0cln s Liccnsc Llw docs nor.pply b M osncr olpn)ncny uho builds or nnprnvc\ lhcrcon.
<br />r.d who.. tur\l,trru.hEor.rNwirhrContacb(tli.cnscdlrursmnrt'rhcCotulctr'\l.i(nrclrs)
<br />-l
<br />mrcxcrrpl undn s*li,n
<br />,UOAKISI3:AITIEISI]IJI
<br />DICLAAAIIOT
<br />I hcrcbyrllnmunllc. pc rlrt.f frjL4 om of rr ftnl,)*'ngdcclrrrri{,n\:
<br />-,
<br />huv.nlldpill n$intrir d Ccdifi..rc ofcon*trr ro S.lflnsurc fttr soiksJ .onlPcn\rrnrn. I pn,vidcd for hrSccri)n-17u)oflh.
<br />btor Crodc. lor rh. p$aorlM.c ol rh. rvolk ld whi.h rh. p.rn r is i$!cd
<br />rltr\rrknr$hirhr[nNnni'\n\u.dty$orkcAcon,I.n\]rioniNurrDcc.rriqrndE)lic,nun$.rr.
<br />Poli., N!n$cr:_
<br />-lccnifyrhrr
<br />rrhc!$fornmnc.ofrhcqorkturshichrhi\p.nniri\issu.d.IlltrlliorcnlnkJyriypd otr in lny nxnEr
<br />$ t, h(onc suh]cd ro rhc *ortcri conrf.ns,rion l.ws ofcalrrornin. rnd rErcc rhd iIl nnukl trorc Nbjcd lo rlrc
<br />workc roilpcn ionp,rhionsolscdn,n:17(XloilhclntnrCodc.lshall.hnhLvilhcoflDlyEilhlhsclmri\ions.
<br />WAIINING: l'riturc io r.urc workcrs .onlp.trstor .o!.ngc is unl,wtul. .i \hnll suhjc.r 'r.i!roy.r b.riNMl |ttrrliics rnd
<br />civil tucs up ro onc hutrdrcn rhousard dollan i rddin,n ro rhd cor ofc. p.nsrrioh. dr r!c*s F)vidcd lor rhc
<br />S..iiotr lr)76 or rh.l.ahor ( .dc inr.e/4r"
<br />I hcrcbylrfinnDndcr pcnalryorl)crjlry rhal I !n lien{t undcr rmlision otChaprcr t (omBrciry *ith Sccrion TUXI} ofDivnion 3
<br />ol rhc Busims\ lnd P$fcssion\ Codc. !d my lkcnsc is r full r(,a nnd clr(..
<br />J y'zt
<br />I lrNh, nll] n uidd IE ahroftrluryr rhrchacon{rucrbn lc in8 rgc .y fd rh.,.fornu .ofrh. work lnr whi.hrhn!.iinir i\
<br />i($cJ (Scc .l(l)7. Civ ( )
<br />IIzuCANLDE(IABAIION
<br />I llftny rrmn u ndr pcnrlr), orFrjury one orrhe nnh*ins d(lsrlrions:
<br />Dc *,lirion Pcndrs Ashcdor Norificrri(). tcJc.rlRcaullrionl(Tirlc.l0, Prn6l
<br />Rcquncd I.nc' ol Norilirnri,l
<br />rcsuUn,nrEBudl.E rshcno\ rcmul!rc nor inrlic$lcr. rhh prcrc.r
<br />icrri,D a'xl nrrcrLn nr fi,y. irrl.nnxri,,n irconcd lr y wirh nllciry,6d c.unry
<br />, and Counry b cnrd uri)n rtr
<br />?-ts-/s
<br />hcrchyxurhorizc rpr.lrnrrrivcs ol rhi\ Cir
<br />si la.Le D c:
<br />APPROVALS
<br />1)
<br />Under Slab / Floor
<br />Service lvleter
<br />Lcndcls A'tdrus\
<br />U/t/d74
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