|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondi ng/Grounding/UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)-) ,4 Ca\o
<br />Walls (Rough)\w:.tu
<br />Ceilings (Hard & Solf it Rouoh .,ty'JU \2
<br />Ceilings (T-Bar Rouqh) t l- tL - tg,AtG/>'.*
<br />[/eler Release
<br />Rough
<br />Service [t/eter
<br />FINAL q./d-/V-J)eSaf<t?
<br />Notes, Remarks , Etc.
<br />OWNER EUII-Df R DELCARiTION
<br />I hrrcby afiimr undcr Fn0hy of pcrjury rhlt I m cxenDr tom rhc Cbnr.cbrl Li.cnsc Law lor $c folbwnrS Gson (S$ 7031 5
<br />Busincs\ x Pnfcs\ion Coilc) Atry Cit, or Counly which requircs tr Frnnl h con(ruct, alla. imnn,vc. dcnxrish rr rcnln otry
<br />slrxclurc. rriorto irs i\sudmc, dls rcqutc\ rhc drplicanr for such F,nrir r.lilc ! \igred srlrcft
<br />'har
<br />h.or shd i{ lic.tr{d pu^urir
<br />r(, rhe pn,vnion\ of rl.c Conrlacrn\ t,icenred tiw (Chlprcr 9. (onmEncin8 with Sccrion ?fixj of Divhion I ofrhc lrusincs and
<br />Porcsrnr.sCodc)ortharh.o,shciscxemprrrF..ionandrh.trasisaorrn alkscd.icnflion Any violarion 6fsdio. T0ll Sbrrry
<br />alpli.ant tbr a p.nnil subjds rhc rpFli.o.t ro acivilpcnally6a.ot mnclhsn nvc hunddld.lh^ l$t00).
<br />I. a\ o*tr.r .t rh. ptuFdy. or nt c.9lotr.s wnh w!8cs u\ rhct slc c.'nFnern,n. wil! do rh *od fll ltf, shd@ i\ nor
<br />inlcdcd or oficrcd lor srlc (56.7044. ausincss ond Profcsions cdlc: Thc conlr.dor'r Li..ns. Lrw docs not orp,y to anowncr of
<br />rh. pmFny *h, bnild\ or an{ms rlt@n. aJd who dGs sEh q)rl himrlaor h..elfo, rhmu8h hh or hcr o*n cfrplorrcs.
<br />pR,lidcd rlur such inDovcnEd\ e mr idcnd.d n offcrsl {or sk I( hu*.s. rh. buildin8 or Lnt)mhftnr is tukl wilhin onc ,rtu
<br />ot on{,hrio.. rhc Owmr 8ur[:ts *ill h!rc th. ttrdcn of pft]vnr8 rhd tr or dE dil *n boild ur in{lhvt rh. ptuFny f.i rlr |ltrFr of
<br />-1.
<br />asowncrolrhc tmpcnr, smcrclusivclycofti.lirrB wirh li..ns.d .. trt.. roF ro cotrstru.r rh. pmlcd (SLr. 7(11,1. Busrtrcs
<br />d Pm Lisinr Codc: 'l'he ConrBcrois l-iccn\c li, docs not rpFlylo.! owncr oipropclty wh(, builds o! improves rhcrcon.
<br />and who .oma.k fur ru.h roJc.r *nh n Cu .Jcio(r) li.c.scd ruro r b rhc Conracktr r l-iccn* tjw ).
<br />-l.ncicnrfl
<br />undd S.\ri( .A &PC nr0rirrc rrr
<br />Drre onmr:
<br />&anrc&5:glutlNsa.rloN
<br />DIT].ABAIII.IN
<br />I hcrcbyrr'inmu crp.MltyoiDcrjMyoncoirhciolloqingdc.lar.rions:
<br />-lhlvcuxl{illmoiolairaCenrficllcofConsctrrroSclflnsunntr*olkcsconrp.nsdrion,.stmvidcdforbyScdionlTfi)otlhcLahor Codc, for rh. pdLlnEmc oflhc sork ,or which thc p6mir iq isx.d
<br />and will minuin *orlcn comrEnsarion insurancc. !s rcquircd hy Sccrio! l? )ollhc tibor Code. fo, rht tdroiturcc ot
<br />li1 trhi h rhi. ll('m \ tr\uql M) trorlfl r d{nt$srior rn\urartrc.rnn r pnl() numhq ocEve.rest
<br />\P,'ri.!/-/-/q
<br />-l
<br />ccaifylh nr rhc !..irnurcc olthc work ld qhi.h rhn n nnir is irsucd.I dhlt nor crnploy rny pcrotr h rny mrtrnc.
<br />qr s i, hccom $h]cd lo lh. sortcc' conu.n\alion laws ol Cllitni.. and isre lhll lf I \h'uld hscom \uhj(r ro rhc
<br />workcli &nrp.nsalior p,ovir otrs otSNrn,n 3?uroarhc L{bor Codc.l shall. forlhwitt coflrdy silh rh.e pmvhi)ns
<br />WARNNC fnilur. r. $.urc Forl$s .on[.nsdi(,n ()!cR[c i\ unla{ful. dnd \hdll suba.r M ctrlPbycr ro diDiral trmhas.nd
<br />civil lincs ot lo onc hundrcd lhousrnd dollrs (Slm,uD), in rddit rorhc.o{ ol.onpcns ion, drnrScs 0s !,ovidcd lor lhc
<br />S.cri{n, J076 oirhc Ldrr C(ldc. irlcrc(nnn/*,J-t7'rl x
<br />)d.**.,* Q-rct X,,."..re"He:Lf X^"*". R,..7 3 PLQ
<br />lhcr.byaffi.nrndcr [rnllrrolpcrjuryrhlrrhceis.con\rructbn lcndins ascncy fo, rh€ Frformncc olrh.work ror whkh dis lxinir ic
<br />ksucd (SN.3097, Civ. C.)
<br />A.IIUCAIIDICLAAAIOX
<br />I hcrEt, drm un<lcr pcnahy oI pcrjury orc oI rhc followinr d6l&rl ions
<br />Dcmhion Pcrj !A$.uos Norificalion F.d.r,l R.eul,'ions (Ti'I.40. Pd6)
<br />-Rcquncd
<br />ktr$ ol Notifi carDn
<br />-l
<br />errify rhor thc fcdcnl rcBularions rcsrdin8 ash.sos rcmovalN nor anrlicabh to thh pmjcr.
<br />I.cnitylh l hrvc rcdd ihh aprliclrion rJ sor. lhur rhc ah,vc i l msridn irc.mr.I rg@ Io .omtly with 0ll Cily and Counry
<br />ordinonccs and srat. llws Elring ro building constru.rior Md h.dby.urlkriz. rerc€nlarircs or'his Ciryand Counry ro.nrcr upon rh.
<br />#ffi*:,il:""% ut=6, 1,.^ _ y 7-6-rl
<br />(;-,**.",,n,,,, -fra-V R-le6 '/
<br />Siqns (monument)
<br />Sub-Panels
<br />""*",,1Gbnoo G\7/8 I *.,,".
<br />Ihc'tbyrflinnondcrp.nahyofpcrjrryrharIanrli.Tndu.dcrFrvhn,notChaprcr9(co'ltEncingqirhSc.ri.,.7U )otDirfi)i:r
<br />or rhc Bu\incs and l,rofcsions Cod.. and nrylicctric n in tullfai.c d cfltcr
<br />t E/ezJvtc- 2r <--.
|