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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceillnqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />I
<br />Rou gh /&,)
<br />Service Meter R
<br />FINAL t0-.-/1
<br />Notes Remarks Etc.
<br />OWNER BUILDER I'ELCARATION
<br />I hcrcby lr,lid oidcr pennliy of pcrju.y rh{r I @ cicmpr liom rhc Conrrekrn l,teNe t{w fo, rhc lollowi.g r.$n (s(.70r1.5
<br />Ausircs rnd Ptufcsion Cod.)r A.y Cily or counry shich Eqrirc\ , Frmn r. ..nsrucr, alr.r. improvc. dcmo,nh or rcprt any
<br />\rtucrurc. priorlo its issu6Nc. ol$ rcquiEs thc ilpli.er for su.h lErnn( b filc a si8rcd (alcnEnl thlt hcor she h liccnscd purunl
<br />ro lhc lmvisbns oi thc Cotrhcrols Liccn*d bw (Chaflcr 9. Connrncing wirh scction ?flD or Divt6tr :1 ofrhc Busi.cs ond
<br />Pn,r.$i(raG e,orrhlrheorshciscxcmptrhcrcfmmandrhctusistorrhc!lle8.nexcry)ri,n. AnyviohrionofS&ri,n70r1.5bydny
<br />amlica for. pcr.rir subjcch thc 0ptlicrntbaciviltcn,rryotnorm,rrhrnfivchundmddoll s($too).
<br />-1.
<br />as own.r of lhc IroF y. or ry cmrlolEs wnh wagcs rs rhcn $h o p.rqrion, wil! do rhr wor* oJt rlr (MruE is not
<br />intcndcd or oficrcd ior sk 1Sa.7044. Busircs ind Pr.a.ssions ('odc I'hc Conhdois Li.cn* lj* dms nol apply to !n osncr ot
<br />rhc Pn,pcdy qtF l,uilG or iqrorcs rhcmn- ud $ho d€s sh wo* himsclfor hc$elfo, rhml8h hh or bc, o*..mploycc\.
<br />providcd rhu! su.h idpmvcm sm rcl i0tndcd ffoflcEn tors.b.ll howw. rhc I'uiklins or itrIl,m$ft isv,usnhir',,nr)tr
<br />ol comptrion.lhc owrcr Buildcr will h!rc llE hunlcnorlmvinS rh tr o. rhc did d htritl or i,rpow 0x pmFny for tlE purns ol
<br />-1.3\o*nerolrhc
<br />nmncny. rncrclusiulyconrru.rinB $irh liccnscd conra.ron r,,.oNrucrrhc pfl,icr rse 7lEr, Bu\ir($
<br />Md Pli)li\sbn Codc: Thc Cont&r.ar l-i.cnsc l,aw d.cs n.r rntly ro an.(ncr oiprcFny who build\ or nnfrolcs rhcrcon.
<br />and who co mcls for such tmjsls qirh ! Conr..torls) liccnscd pursuanl ro rh. Con .lols Li.cnrc ltrw)
<br />-t
<br />lnrexcufl unds Sccr 4,6-u,,. ?t(-tV u*"..
<br />DDCI.ABAIIo!
<br />I hcrcby alfirmundc. pcnahy oi pcrJury orc oirhc li'lhwnrS dccl,rdrioflsl
<br />-lhnvcardwillmrinrdinaccnificltcorCons.nrros.lrlnrurcrorw.r*ns.omtlcns0tiuraspmvidcdforbySalionlT(rOoIIhcL$or C1d.. for rhc Frfitrtu.. of rh. eof* t.r *hich rhc ncdir is (\ucd
<br />lhrvcrid*ill'minrinr*ulcr\.c.'npcn\rrionin\u!rn.c.rsreqtrtdhySmrion:17(I)ofrhclnhorCodc.f rhc P.rfornrtuc ol
<br />rh. *ork fq*hi.hrhi\ pcnnir i\ is\kd My*orkcrr conrpcnqriotr in\urrtuc.rnicr rkl policy i!n,h.r arc:
<br />WARNIN(; Frilurd kr surc work n .omt nsdrion c.v.dg. i{ lnhwful. $d shrll rub,cd .tr cmfhicr ro crininrl lcorlrics and
<br />civil fitrcs u,) to.nc hundr.d rh.usand d.ll0* (ll0t),U)'0). in sd nk,n Io r of.omtl.n$io., drnuScs rs
<br />Sccr,on.r0,n ofrhc ht$. andc. rnrcrci tr 0rhrmy'sre!
<br />o^.. 7'/c- tg
<br />I hcrcby aflnm undc, Enohyo,pcrpry rhnr I am lienrn !ndc! pmvhion olChlprct 9(connftncitrs *nh serion 7fllo) ofDivision l
<br />of lhc Busincss and Pofc$ions Codc. and my liccns is in tull fore {d cilNt.
<br />LicNe Nudhq:
<br />-
<br />C(INSTRT]C'TIoN t I'NDIN(; AGrNCY
<br />I hcr.by !fln undcrlrn"lryofpcrjrryrhdIhcrchoon{ruclionlcndinga8cmtlorrhepcrfonrnccofrhc$orkf(,qhichrhi(Frnrilis
<br />is{rnls.d :ll)S7 ( iv C l
<br />AIIITANIIECLABAID!
<br />I lmb, slfmr undcr pcDall! ofpcrjury om orthc aollowinS deld.thns:
<br />D.rmlilion P.rmii$Asbcs.s Norific ion Fcdcml RcStrldrions (Tirlc40. Pn.t6)
<br />-Rcquncd
<br />bncr of Notifi cltion
<br />Iccn'fyrhrrrtulod.rrlrrgrlrionsrrB di'rgr\h(d.srr x,vxl rrc nor rrplir lc t) rlri!,r,lc.r
<br />-l
<br />ccnifyrhtrt I hrvc rcodrhi\ rydicnriotrrnd stdcrh rhc.tnvc inlnrMrion tcotrccr I a8re ro conpl, wirh ,ll Cir y ud Counry
<br />ordimnccs and Shrc hws Elarins ro buildin8 consrru.ri.n. lnd oultxtrizc Enrcsnl3rivcs ollhi\ Ciry Dnd Co0.ly b.nrcr olhn trt
<br />ahort mnhoncd F otcdy ror inslEhotr 72,3*,?'tt- tF,\Dt)li.n t or A,tdt Six.rlr'tu
<br />y'4 (ttla olnTt "
<br />anl4luill
<br />lvleter Belease
<br />I ccdiryihar inrficr.rfurnBnccofrh. sork for which rhis pcrmn i\ k\u.d.l shril n.r cnlr.yanypcr$i in rnyrlnncr
<br />s s to lE o'ft nrbrd lo lh. woder omp.nelnrn hws ofc{liioflrir. and rArcc rhir ifl should t(conrc sutjc.i h ',i*ortc6 q'mpcnslion p.ovnionsofScclioD 37(x) ot lhc ktrr (xlc.I shrll. fonhqirh comply silh rlE{ pmlnn,nr
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