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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUI I,DI]R DI'I-CA RATIoN
<br />I h@by lr,irnr und.r l).nrlry ur ocrjury lhrr Ln cxcnrB n.rn rhc Conlr{ror' l-icctr{ l-!* fn rhc t,ll,,winB rc0v{ (Sc..7l)rl 5
<br />BusnNs d ftoa.si,'n cl'dc) Any Ciry or Counr, whi.h rcquircs ! ponir k' Lrnr{nr.r. alrcr, irPolc- dcmolhh or al]lir lny
<br />rtudurc. pri,trn) irr i$latur, nk. rcqun.s rl[ +Ili.n inr su.h Nnnir ro ilco stncd sr.rcnrnr lhnr hcor\h. i( Ii..i\rd ,x^u r
<br />ro thc pmvnnrnr ollhc Conrrdcn, \ l,iccn\c/ lj* (Chaprc! L Com'tuDcins rirh s..rn ruro of Divnion:l ot rh. ,h\incs rnd
<br />Profesio!\ Codc) or rhrr lt or rhc ircx.npr rhcrrionrtul thc ba\i\ r(trrlrdllcBcd.rcnroioa Any!t'hltn,orS..ri,nr7lrll.5hya.y
<br />rmlicanr roralcnnir suhjNr\ lhc aptli.rtrl b r.ivilponrlry.lrx, nrx.rh!n iivc hundrcd dollnr\l$5Ol))
<br />-1.
<br />as oemr olrhe [opcny. or mrcnDbyrcr wirh woscr {s rtct q,L .\,n{f,nsarion. rilldo lhc wo* fln lhe dulr n n
<br />inrcn& or ofcrcd ftr sl. (S( 7014, Bu\in.s ,nd t'mlcrsi.trs Cod.: Th. Conlr.ctors l-iccn* Llw des nor ,p y ro nn osncr or
<br />rhc Impcdy who build! or i,nr]IorB rhc6n. sii who dm\ skh wo* hims.lfoi hct$lfo. rhmuSh his or her osn c'npk,y.cs,
<br />providcd rhdr su.h inrpmlc'rc s m nor i cnded or oficd ror eL lt ho$rvs, rhc huilding .r i,nlrowmN is $rd rilhin onc Fa
<br />orco4rcrior rhc O{ncr Buittr Rill haw thc hurdo orFmvir8 rhar lror shc did nor huild o! imprcw tc I$Fiy for rlt I'ur|.c ol
<br />-1.
<br />a\owturofrhc PmFny, rm.x.tu\ntlyc.trk,.tinB *irh h.cnscrl conrmror lo con(rucl lhe noJecr (sd. 7044. Bunncss
<br />rnd Pr.rcsridr Codc: Thc Conlr.clois l-i.cnsc Law docs nor upi'ly lo !. owncr orPtuFny wh(, buirds or iflprovcs rhcreotr.
<br />and *ho conirach for ruch pn,l..k wirh rConra.t{r)li.cnscd pursnu tolhe(hnlrdois l-iccn{ Lxwl
<br />I mr.\.nU trnd.r Sr.ri,nl
<br />D.le: ()*n.r:
<br />w(tnxFRs.(trltPtit\sATloN
<br />DEcL/tBAllON
<br />I hcrcby 3itum undcr pcnalryorpcrjury ok orrhc r.lbwire dold,rion\l
<br />-l
<br />hrvc !d will m0inrain s C.nifElrc of Co.\c.r ro Scltl.\xE for worrrc onpen\oln,n. as previled for by sdiotr 3700 ol lh.
<br />rrbor Cdq for thc p.rfornEna of lhc wo,k for wnich ltc lmn h hsucd.
<br />_l havc and *ill tuinrain *otlc.a comrens.lio. in*uromc. .r r.quircd 6t Sslion 171,0 oi rhc Lilht Codc, for lhc PcrfonDncc of
<br />rh€ ert aor whkh lhir ttmir i! ilekrl. My workdc .ompcnslion inerlmc cMir od Flicy n!n*,c, @:
<br />c,h, | /ave.tnf
<br />I ..nify rhrr in rlf prnortrwEc ('irhc work lbr whih lhn rcrmir t i\sucd. I \h.ll nor c'npk,y rtry p.rso. in any 'nrnncr$ !ski h.(nm subjc.l r,,lhc workcr\'conl[)cn\ari{,n hws or C,liinnria. rM 4totih il lshould hcconE {h]cd t,rh.
<br />wo*cF .oarFns ion flovti,)nsol Sccin,n.lT(rOollhc lxhtr Cod..l \hrll. tunhwirhconrPlywithlhostrovisi{,is
<br />$ARNIN(; I;iihtrc k, \ccu'c torkcr\ co'nnctlarion..r'rgc i\ tn[(rul. rtd \hrll \uht.r rn cnrPl.y.t b.ri'ni'rl |xtrhi.\ rRl
<br />civil lrtrc! uF lo onc h!ndrcd rho!sal]d dolhs (Sllx).(xx)). in r r' rhc .or<.oinFnv,hn. dunDp.. 3r nmt'd.r rn, rh.'.Lb';:"^*\U't) t',fpplcanl: X
<br />I hcrchylilirn undcr llcnilly oi pcrJury rhnl I am lien{d ondcr Fovirion ofChdP{ct 9 (.lnnrcncitr8 wilh Se.-rbn 7(XI, olDivisk d l
<br />of ihc Bushc$dd Pn)fcssi.ns Codc. rM nry liccnsc is ir hll rhrcc ad ctr.rr,i)t,/a 70Lr'
<br />"^,",
<br />. q/28y't .nn,,,.,.",(r'nr-tZ
<br />CAN BI]CIIANIENIIIILGIGINCI
<br />I hcrchy afinm undcr pcmlry or p.rjury rhd rhm is s.unirudion Lndln8 !8cmy for lne pc,n,ftffc of'hc w.ik lo. ahichrhn tlcrmi n
<br />r\{rcd rs.c l(Dr. Ci! C r
<br />AITUCANIDECI.ASAIION
<br />I h.nby Jtmr undfi pcnahy ol!.rlury orc ollne lbllosin8 dcclaratiorsl
<br />Dcmolirio! Pcrnirs Ash.sbs Notili.rrion F.dcral RcEUIrrions(Titlc 40, Pan6)
<br />-Rcquircn
<br />Lc(cr of Norilicari,n
<br />l.cnilirh rhclcd$ilrc8trhrions r.rfl aing n$.{.\ r cN,v{l m for lLntltnhfu b rhis Pn)ic.t
<br />lccnll.v rIJ I hrrc r.xl(hi\ rplli(ri(r,rRl{rrcrlHrrhcrhnc,tr,nnturi((] i(..rc.r I
<br />ordirrnccs lnd Slltc ljwsrclalinsto
<br />.hovc mtrrnnr.d Dorcny fu insrLTr
<br />.on(tucrk,n. i l hcehy rurlntrrc rrflc{trlil
<br />IpDlirnnl or A!01Silnntrmx /2?
<br />rsre ro conurly *irh all Cnyand Counry" :-'-';it;Zf,
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondino / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)b/,1/c I U/1*-'tz-
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough p l*ltr Ano/A-td)--
<br />Service lvleter
<br />FINAL rt/r/r? i ?4dT -/n
<br />Notes, Remarks, Etc
<br />-t
<br />Under Slab / Floor
<br />l\4eter Release
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