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ELECTRICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTSAPPROVALSDATE
<br />Unde round
<br />Pole Bases
<br />Li ht Standards
<br />Pool FountainsSS
<br />Si NS monument
<br />Life Sate /Low Volta
<br />Fire Alarm / Dam rS
<br />Communications Cable
<br />Under Slab / Floor
<br />/ Groundin i UFERBondin
<br />Transformers
<br />To uetn
<br />Sub-Panels
<br />Air Conditioners
<br />ulRoof To entE
<br />Facto Wired Unit
<br />zWallsConduit
<br />Walls Rou h
<br />Ceilin hSHard & Soflit Rou
<br />Ceilin T-Bar RouS h
<br />lvleter Release
<br />Rou h
<br />Service lvleter
<br />L re nNotes, Remarks 1
<br />TlryNFR Iil', -t)titi I)8t-(,\tr'\ l I(rN
<br />I hercby,ffr und€r p€tulry of Frjury lhat I m cxcolpr fmm rh. ConlrrcloF Lic.nrc L.* for rrx folloshg fta$o ls'c 70315
<br />Businers,rrlPtoicsionCodrlAnyCilyorCounlyqhi.hrcqut.salcnnirromnslrucl.slrcr'nnprolcdcmolishorrPrn'n,
<br />stucrur.. prior lo ils h,uaftc. al$ Bqut s rhc llPlicMr ror ru.h lErmir b filc n si8rcd ar'm r rhat hc ot sn' is li"nr'd lunuant
<br />lolh€pmvkhNofltEconkoclolsLi.cns.drjw(chapl.rg.coftrcncin8wilhscclionTfiI)ofDilnion]ofiheBo\in.$.nd
<br />Pmlc$ionrcodc)olthnltf,or\hckcrcm,lthertfrolndthcblsisf.rlhc.ucrcdcrcnprionAnyviol0tionofs..liotrT0]l,5bydny
<br />appli.anr lbr.rrm srbFcrslhc lptlic r ro s.ivilpcnahyornol nnrc rhu fivc hlndrcd dollrB(1500)'
<br />-1.
<br />6 {srcr or rhc pmlrny. (, my cmployes wirh w,gcs ts llrct $tc onll}cnsarn']n wiu do lhc work tnd tE srErm ir mr
<br />inrola m orurca roi ste tie.?044. Bliits tnd Prolcssions Gdc: Thc Contadols Liccne l!* dNs nol dpnrv lo on osnf or
<br />rh. lm|rny *ho builds or in{mw. rhmrn. lnd Bho dds such mrt hi.rrlfor hcrclf'r lhmrgh his or h'r ow'cmllovccs'
<br />p-iia*r rrrur ,u.t' iryrowmnl\ m Nr inrcnd.d or ollcGl loi eh lt bkv.r. th. buinins or in{'lmrcor h $ld wiihin om renr
<br />;f d,mplcri.n, lhc own;r Blild& sill hovc Oc h,rdm of rmvins lhd hd or shc did nor hild or irlPDt thc Pmllcnv ror itr PurIEe or
<br />-1,
<br />a\ owncr ol rhc !mp.ny. an crclusikly .onrdins uil h liccn*d conlrucron ro con(rucl lh. rrcjcd (S( 7044 Busincs
<br />*r n"ro,i,n C.a",ilt" Conreroas Li.cnsc LaN dms not nplly ro an ow $olprolc v wh(' huilds or im!rcvcs lhf"n'
<br />.tr'j *h. ontmcrs fu stch pnrj.cF wilh a Conrr&lrG) Itccnsd puBunr l{i rhc cobrodot s l-ic'nsc L!w}
<br />j!O8IE8S:IOMEDU'AflI!
<br />DruLA.8dIa!
<br />I h.Eby rmrd!.dc. Fnahy oa pcjury one ofthe following dcchrarions:
<br />-l
<br />hnv. uidwill mi.rdin . Ccn ificnl. of Co$.nr h Sclf_lnrlr. r.i wo qr.onP.nerion.6 pmvidci for b, S$rion l7m 'r rhc
<br />L.iDr Codc. f.rrhc pc,{orm@ orth. wort fo! *hkh rhc p. ir t L*u.d.
<br />lafhNc .nd wrU mlioriin *o*c6 comr.nrtr on rnuram.. d rcquircd bv sdrion lToo of rht tibor c'dc lor fic Pt otm'cc of
<br />rk forwhichthn p.m h nsued,1-,fR7F FuLl^
<br />.nr(nr ir{rrrn...rni.r r\lt, 'rl r rh.rrrt
<br />l.cnilyrl i',rh.r.rfoirnaNt,,lrhc{orkli)rshichdrnFnniri\issucJ.I\lulltrorcnPktyrrrv|[noIiI r!ntnncr
<br />$rrt'L.-nc!rhr..ir,rh.s.rtcn'.om!.nsrrn,nhssolC!iilnirrir'rtr(liErccrhnrrflfinrl(ltt'oitsuhic'rhrht
<br />$orkcr\.onro.n\driotrtircvlbsolsNrion.rT(X)ofrh.tihrrCoJ..tnrll.lonh$irh$trll]l)_wirhrlk'{Prov\i{rn\
<br />WARNIN(; Ijrihtrc k, \ccurc sorkeri cotrlt'.d\rriotr co!.r,C.n t hwtul. rnd \hrll suhiccr ntlo)cr h dnnmrllcmllir\ r d
<br />) n, on. lNndrcd th.trsintldo!['\ l\11)l).lxxr] in .n. darBscs rs lrovitcd for thu"iry-:
<br />t,t,tct,,\R,\1 r()N
<br />lhcrchyaffirnundc'Fnull,ofp.durylhatlanlien*rjUnderNvti.nolChlPlcr9(s,u'EncingsilhselhnT{)(x)).fDivi\it,n]]
<br />or $. ausincsand Pbfcssions Cod.,,rx1mr liccnse i\ in tullforaddcftccl. r
<br />c
<br />COIIIEUCIIQN.LENPING.&CEI|CI
<br />lh.6hyarfirmundcrFnnlryolpsj,.yrhrlhmisftonntudiunhndinsac.evforlhcpcltomnccolrhc{'rkforrhichrhip'rmith
<br />hsu.n l Se. 1097. Ci!. C )
<br />ATIT.TCAIITDECIABAIION
<br />I hotty aIIm trnd.r Fnalty of l*rjury orc of lhe folLwinS dxlarorion!:
<br />D.rmlirion Pcrmns Arb.stos Noriilclrion Fcderol ReBul,tions (Titlc 4'(). Pd6)
<br />-Rcquircd
<br />lrncr ol Nolifsrion
<br />-l
<br />&dir, lh,l rhc {cdqal n$hrions Esatding ,stEslos tcmlal d. nol lpnli.,bb nr lhh pmF t
<br />I ccnify ltur I hrrc rctldlhis alnli.ariona l rhlr rhc sh.rr inforndnr iscoru1 I nlre to or{ly *ilh rll Ciry and Counl y
<br />odmn c\and srrrc trss tl ir Drcscnrrt\c\ ollhi ( iry ind Coutrr! ro
<br />abovd nr.ron.d ropcny for
<br />Anplictrnl o.,1Atnl Si!nnl"
<br />rcrcb'yt,ncrc
<br />@
<br />lrr.x.n,|l uftLcr Sr.rtrrr .ll .\ l'( l(r llLi\ rr{)'
<br />O*Nr
<br />Site-Work
<br />Buildinq
<br />/-) tll
<br />8/34r/.ffi
<br />FTNAL /t y'z.e/:ll 4.Ml
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