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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARNIION
<br />I hcrchy ,lfirm undcr p.nrlly of pcrjury rhrr I am cicmo from thc A,ntaclrs l-ic.ns. tjw tor rhc rolloshS rctbn (Sa 7031 5
<br />th\in6s 'd Prclcsion C.Jc)r A.y Ciry oi Connly which (qxn.s a ldnrir r. .on(ruc1. alts. improvc, dceriah or rcprn My
<br />srru.iure. Eir ro its issuoncc, als rcqun s rhe arpliclnl lbr suci Frmi n) fik r siaftd (dcmfl (h,( rE or shc k liccnsd pursuanl
<br />b rhc l(,viriom ordf, Conra.bas Liccnsd lzw (Chatrs 9. Commcrcitrc with S.c'io! TOOO of Oirhiod I of rlE Blsirrc$ and
<br />Prclcssions co{c ) or lhd ncorsh. n cxcmpl thcrelrom and th. bash thr rh. trlbs.d .rctp'i.n. Any violrlion ofScclion 7031.5|,y any
<br />lplliclnr for !pcn r subjds rhc !mli.an! h rcililpenalrrornot nk,rcrhannv. hundeddollrs ($sool.
<br />L ds .w.cr ofrhc tm|Eny. or nryctnployes wilh wagc( ar rhcir slc cotrrp.trlart,n, will &, tl* woik dd rhc iMrurc i\ un
<br />inrcrlcJ oroficrcJ for ql. (Sc ?Ol.,r. Bxsincsand P fcsion\ Cldc rh. Co m.rolsLiccnseL{sdocsnolapplyh!noakrof
<br />rhcpdlEny who builds or lq,oves rh.rof. ad who dms such w)r( tnnsc lf or hcr€lf.r rhmngh hk or hcr own enuloy.cs.
<br />F,vidc rhrrsuch nn,rc\crrnh aEmr intcndcdoroflcE\lfors!L.lt ho*cvcr rhc hildinB.r impov.ntbr is sld wilhnroN )txr
<br />oicoq,hrio,, rhc Owncr Builld sill hrvc rhj burdcn of lln,virig rtuf h. or shc di].ol tlild or imotrN thc ptr,Fiy fitrtlr nuqncoi
<br />-1.!so*Tcr.trhcpopcny.amer.lusivcly.ontnri'rgwirhli.ciscd.onracksrocotrsln.tth.proFcl(SecTOt4Bu\i'FsrM Pn,fssi,n Codcr'IlE Cotrlraclors Liccnsc Low docs norolDlrn) unowrroflrorc ywho huildsor irPruvcslhcrcon-
<br />!n who..nrmcrforsu.hpmrccBwirhaGnrtuclr(rli.cn*dptrnu{nrtorhc$nrracroiil,iccnscliw)
<br />-l
<br />umcrcnrfl utrdcr Sccrion
<br />]IABf,III5I;AMIENSAIIANt[cLaaarlQx
<br />I hcrchy afnm unilq r.nal'y of pcriury onc ofrhc rolk'wnlg dcclnrurion\:
<br />Ihrv.undwillminhinaCcnifEarcofConcnll.Sclllnrurclorworkoi.onllxnsarion,as,,ovidcdlorblSccrion:17{Dotrh.
<br />tjh, q)dc, far rhc r.rfonmc of lnc wo ior which rhc pcrnrir ir hsucd.
<br />-lhavc
<br />rd will mrinhi. *orkcrr c."ln.ns(nu insuru Nc. ns ruqrn&l by sNt tr!1 1700 oi rhc Llhor Codc- fo, rhc |xrli)nun( or
<br />/tldwqt- Luth
<br />r.omF-n\rri{,n in\urni.ccrfti$ d lx)li.y trunthcr ttrlrs,,^ 5fl{wcntfitrl^.L4.1,,
<br />I.cnilyrhd in rhcr.rforn mcoflhcworklirRhnhriispcnniishsuc.lshrllnoredlloysotrrr$nin ynMncr
<br />e, s to h..otrE srbn{lo rhe wolicr' onrpcnsllion hws ol Cllil(,rni!. od rBrcc rhar ir I should bc.onr subjcct lo rhc
<br />sorkc^.ompcns,riorpmvhn,nsofSelionlT00ofthchhrr(odc.lshall.tonh*irh.onDly*nhrho{pa,v$ions
<br />W RNINC: Ililur. t, {cur workerj..n{.nsrrion covcBlc i\ utrh*tuL ind shrll subjd !n cmpk'ycr h dn ,hllIn rra\ rnd
<br />civil finc\ up ro om hundrcd rhot{nd dollrn (SIO0.0U)). ii ,'ddiri.n tJ lhc cnst ol conrcnsdn'n. d:nrg.\ r! pr.vidcd lor rhc
<br />Srcri,,n.11)76nlrho lf,hrC,xlc. crc
<br />18,,,.,.,AUG 08 20
<br />Ihcrcbynlrrflundcrpcnaltyofpcljurythalt!nlien*n!n!crpmltionofChlrrd9i.otmn.ingwnhS.clion7{{)O)ofDivtion.l
<br />oa rhc Blsircs and Profcsrions Codc. iid my li.cnsc ir in hll r.m ud cff(r.
<br />s,Io o 'tcl Prtl
<br />"'"ftUG 03I01L .,""*"*- r<'+t..r"'-'-
<br />SANflB!,!]trQNUND]AC{i.ENCI
<br />I hcrchy nflim undcr lenulty ol pcrju.y lhal rhcrc h a ondrudhn bndh8 ag.my fo.lhc 0crfonuncc oflie erk for whkh rhi1 Jtt.i( (
<br />i\\u.d (S.c 11097, Civ C )
<br />A.tTLIIAXLDICLA.8AII!.}N
<br />I lBiry alim und$ !.naxy orFrjury om ofrhc followinB dNlnrdionsl
<br />Ocmlition PcnDic-Asbcsros Norific ion Fedcrol Rcsul ion\ ('lirlc,{), Prn6)
<br />-Rcqutcd
<br />L.llcr of Norifi c.rio!
<br />l(nifyrhnr rhrfcd.r lrquhrnin\ rc8dtliry NhGlos r cnrivrl $. forrpnLicrhlo t,rhn llrojeiffi ul r; r:"1"'lr,"u'rr ;l
<br />ovc rnrircd fropcny lbr inspccrion
<br />i,,nr(l(rr. rhrrih.rhtr. i"lor i,nr '\.o'fu.r I df,rero.onrplywirhrll( iryrtrd (i nr_
<br />irivcsofrhh (iryand Connryt, r r$Wo0llt
<br />ApDli.nnl or A$nt SiInnkrrc
<br />e1/\\h'-v ,! I rr: A "q 1+i0
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Bouoh)
<br />lvleter Release
<br />Rough 1/4/'tt s{'b
<br />FINAL /n tvtb
<br />Notes, Remarks, Etc
<br />Sub-Panels
<br />Service l\,{eter
<br />LJndfl . AdLIcs
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