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ELECTRICAL.INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Flough)
<br />[/eter Release
<br />Rough
<br />Service Meter l /-r4
<br />Notes Remarks Etc
<br />FINAL
<br />u -'\
<br />OWNE[ BUN,DER DELCANATION
<br />I hcrchy olnm u.dcr ranalr, {,t pcrjury thd I m .x.n/ rn,m rh. Cotrtrrcl('F l-iccn* ljw ror rh. rollowinS rcasn (Scc.7oll 5
<br />Busincs rd Pn,fcsion Codc): Any Cty or Counly whi.h rcquncs o Frnir x, ..ndruci. ulr.r, impft,vc. .hmlth .r rcnJt zn)
<br />rtu.rnrc. ! trt' irs issunrrc. also,cquircs lhc 4plicflnl lhr suchFrmii t,lilcasigncd si0rcmnl thl( ncorsh. i\ lic.nscd NrsuMr
<br />ro rhc Dmvhnns of rh. Co atr.ror's Liccnscd l-0q (Chortcr 9, Conrmercirg wirh S..rn,n 70OO of Divhiotr I ot rhc Businc$ rid
<br />PmfcssirnB C{)dcl orth.r hcorshc hcxempr rhercliomund rhc b!\k fdIh. rllcecd cxcnrdion. AnyviohrnJnofSccli.nT0ll 5 hy rn}
<br />rmli.anr for r lcmir suhjah rh. lptli.rnr ro a.ivilr.n,hyolnor moc tho. tivc hundrc dolltrrs($5(x))
<br />l. xs osn r ot rh. pofEny. o! my cmployccs with wlBcs $ lhcir $Ic .\,mJtnsar ion, sill do lhc wolk nnd lhc smdm is n.r
<br />inrc cd or ofcrcd for $h (Sa 7044, Bosituss and Erna*i.ns Cdlc: Thc (tnrrocr.is l-iccns uw ddr nor a!/y ro 3n o*icr or
<br />rh.0tupcny vho hoilds or impEs rhc@r a shodm\skhk hi.$clforhccelforrhmughhhorhcro-ncmployccs
<br />n,ovidcd rhlr such impmv.nrnk m nol imudd oltu fu *lc Il ln,$c6. rhc building or inu.rcmnl h sld vithinoe )td
<br />oico'nplcrion. lhc osncr Buildcr *illhat lhc blrdcn of povins lnar lt or qh. dkl Dot huild ot in{'mre lh. tmPory nn $c r rpo{ ol
<br />-1.0\o*ncr
<br />otrhc Dmpcnr. uardr.lusiv.ly.onr,.rine wirh li..n*d conrachF lo con(tucr rhe pn&cr (sc. 1H4 lrusims
<br />and l)ft,rN\irtrcodc: rhcCo.krclolsLiccn\cLrwdcsnolq'rlykrrnow.dollrrop.ny{hohlildsorinprovcsrhcicon-
<br />ond who conrrack for r!.h rftjccB wilh r conln.k{, licctr*d purulnl ro rhc Conka.'ois l-i.cnrc tjw).
<br />I inicxcmDl undcrScdion-, a & PC rdrhl( r..{trr
<br />Dote Orn.r wonxrt$ c(r,trr prt t.slttolt
<br />DEC!A.EAUj.}N
<br />I hcEhy ifilirnutrdcr JrcncllyolIcrjuryond of lhc following dolaralions
<br />-l
<br />hovc and sill nui aiidCcnitl.arcolConsc to srlf-lmurc ln *o!kcr\' co lFnsurtu., dr ImvidcdlorbySccrn,n:lTurorrh.
<br />t$or O)dc, for thc ncrlonumc of lhc wort tu which rhc p$nrir i\ issuci
<br />_l hlvc rnd*illnsinrain *.rkcn cotrpns.tion insuruncc..s rcluircd hy Sccr ion l7O0 of rhc bbln (bde, l'o, rh. Pcrfomktrc or
<br />rhc sr* trwhi.hrht ptrnir is iss&n Mywortcn .onqEnsarion inslrler cmhr !d tElk, nuil$cr ac
<br />t1.,.J \, trhl
<br />l.cnil!rhlr in rhc lcrlormrceof rhc work for shichrhn pcrn ir irsucd. ! shlll nor cn9n,rsny Pcrson in.ny monncr
<br />$ dro li<onE slbjcd ro lh. lork.n compctrr bn hws of Crliior.io. $d ngrcc rhlr irl should trconE sunj.tr rorhc
<br />oorkc.s.an.p.osarnrnpii,visionsolScclioolT0OolthcLontrCodc.l\holl,bnhwirh.omtly*iihthospmvisions
<br />WARNING Failu,c ro scure sorkcr'conp.nsrrnnr (r.rxsc i( lnlnsrul rnd n'rll{,lrjccl rn cnrll,,)tr ro rinrinrl PcBlrts lnd
<br />.nil lnr\ uri b oflc hundr.d rhou\atrd dollr'\ (Sl([).(rl)), in rddirtr,cosr of ron\anqriotr. dIMScs 0r provi{lcd lnr rhc*'"'"ry/*ry'q,'"*
<br />llr1ld![IlQ!
<br />I hcrchy arfirn undc. nenahrorp.rjutyrhal I m licnst und$ Diovishn olCfilplcr 9 (('nrftfting wnh SNlion ?mO) olDilnion l
<br />of thr Busircss and Pmlcssions Code. od ny ltcns. h in tull ade Nd .ittcl
<br />Qq zg'l
<br />CONSIBUCIIQNIINDIXC.&GINCI
<br />I hcrcby trflinn undcr lEnalry of pc.jury rh,l rher iraconsr cr i{,n kndnr8 ,8cncy for lhc pcrlonMrc or rh work lot which rhh ram n
<br />irsucd (ss 1097, civ. c.).
<br />AffUCIINLDECI.AXA:TION
<br />I hcrc{,y arm uodcr pcn.xy or r.rjury onc of lhc followin8 dcchrat ions:
<br />Dcnhlition Pcrmirs-Asbed* Noiific,rion Fcdcnl RcBuhrions lTillc 4tr. Pan6)
<br />-Rcquned
<br />Lens of Norifi cdrbn
<br />l.cni!rhd rhctcdcdlrcSulalions rcE ding ashcstos rcmovrl !rc Nrrlplic l. rorhi poJ.l_r
<br />rhd l hlvc rcl(] rhis lllpli.rrior'{l(rrrrhir rhcrh,ro i',lon, i( 'rcorr..r I r!rL!
<br />ordnrimc\ rtrd Sl.rc I-rssrchlirg t.' hnildirE
<br />ahii? nrnri,nnllmrlxn! tur iN
<br />ippli. trl or \[rnl Sirn8h,r.
<br />+,,1a62-
<br />ro c.mnlv wrh all Ci!v.nd Countr
<br />trrr,. iirvmJouru{o ors ur"'n rrr
<br />*," ,/r./rr
<br />E,inZ,
<br />Pole Bases
<br />-."** )(
<br />I
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