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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFEFI llr I 4r\tuheVt >b)
<br />Translormers I U I
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)vr)lvleler Release ry
<br />I ,^lrt)Rough tr I I q4ufi
<br />"rffi)Service lvleter Ir
<br />FINAL I /:#tr
<br />Notes, Remarks, Etc.,r\
<br />OWNER AUILDER DELCARATION
<br />I hcrcbt af6nn utrdcr pcnllry of lcrJury rhar I ut €renfl fon rh. conkr.k,^ Ltctrr bw lo,lhc lououine rcnsn lsec.7o.ll.5
<br />Businc$ and Profcsion Co.l.): Any cny or Counry whkh r.qutcs a Pcirnil to .on{tucr. dr.r, imrorc, dc."l"h ". .1,"" ";yddcrurc. orb ir{ irsx n.c..l$ rcquircs thc spllica nlr sucn [Ennil io liLa si8trcd sarcmnl th hcot shc h li&n\cd ruAU,
<br />k,lhe pmvkions of llrc Conlmcror\ Licc.sd tiw (Ch!p(tr 9. ConrmNins wirt Secrion ?fix) or Divirion ] ollhc Businc\s aid
<br />ProrcssbnsC.d.)orrharlrorshciscxcmptlhcEfrnmandlhcboshforlneullescdcrcnprion.AtrrvnnntionofS<rirn70:llshyrni
<br />trppli.n tur , Nrnrn suhj.ch thc rrllicontloocivilFnolryofnolhorerhr.,lvchuMrendolhrslS5U))
<br />-l-
<br />a\ ownerolrhc pnp.ny, {, my.mplorcs qnh waScs.s lhcir wlc co'npcnurn,n. will do rh. work ond lhc slnxruE n tun
<br />i.tcndcd or ofcr.d i{tr elc (Sc.?o44. Busirc$ and Pretcsions Codc:-rhc Cuntadols Liccnsc Ls{ doer oor uPply to rtr o*rcrof
<br />rhc Dmpcny wh, buikls or inlpn*.srh.en,a i uho dos such sd( himsclf or hcrcla.r rhmngh his or hcr own cmploFcs.
<br />,n,vidcd rhd su.h i'nfmw$ e dn iolend or otrcEi tar sk I ll h.*e\rr. rh. boildin8 or in{mvcmnl is n,ki wirhin uic tor
<br />otcompbrbn, rhd Owtur Buildd sill h.vc rtE hunlcn olprcvir8 rhor hc o, shc did mr huild d iqmvc rh. nm!.nr lor ih. Putbs.f
<br />l. r\o*ncrofrhc rmp.dy, nDcxclu\rvcl, contnctins sirh licctred conrr.ttrsro cotr{nrcr rtE Proiccr (sN.701.,1, 3unrc$
<br />rd PniL\sion Coitcr ThcConlrrcktr s t-i.tn* l-rw do$ norrt plyi.0nowncrofpropc ysh(, huildsot nnntolcs thcrcor
<br />rnd slb co h.F ror such poic.G sirh r Conrmcbn 9 liccnsd puhurnr k, r ht (in rlcrois l.i.cnsc lf,w)
<br />I rmcxcmfl u cr Scdn
<br />Gvq.ie\a i-e:z_
<br />ll!!t"!!,1! !!D
<br />I hcleby rfljrDund.. ri.nnhy .t pcrjfiy
<br />-lhtrvca
<br />will nBinrrin s Ccnifcdr of Conscrr lo Scli lNurc lor $ortcn $hpcis nrn. as Frvidcd lbr by S(rion :17{X) of th.
<br />tilior C.dc. for Inc pcrfortuncc orrh. *$* foi *hich
<br />'hd
<br />Fimir is knrcd.
<br />-lhuvc,trd
<br />will frrinrah w.rkcB comrnsrlion insuroncc. rs rcquircd byscctdrlTmol th. Lshot Codc. f.rrhc t'c.fonn0ncc of
<br />rhc sort ir which rhisp.rn r i\ issucd. My workcr' comt'cnsation insu.Mcc c,nid,.d r.licy nu.rbcr rc:
<br />l.cnilyrh,r inrh. ncnbflmncc ('irhc sork fitr which rhnrennir is i$u.d.Ish.ll nolcmploy !nylc oninrtrymrtrncr
<br />h .s ro hccom subjd ro rhc woik ri.dmp.nsrtnnt hws ol Caliloarid. ond r3re rh3r if I shonld t!.otm sublccr lo llE
<br />*ol(cm coarpcnr ion pm!i\n,n\ of S*rion lT0O of rhc tntrtr Codc. l shsll. thdh*irh .o'nply *irh rhos fovGions
<br />W,\XNINC Frilurc r' {cur. rorkcrJ c.nvLrs,lion orcrrlc is unlxstul. rnd \hrll \!bic! dr cnrl,loycr lo di'nir'd p.r'lric\ ttrd
<br />civil incs up l,) onc htndrM rhous0nd dolla^ (X)). in i(ldirion b rhc co! of.otrfcn\dridr. drnuacs r( p(,vidcrl l(n rhc
<br />Scctiu.llrT6 ofrhc I-ntrrCodc. inrcrcs rnd ull ro,.re\"r lpf e,Z-
<br />I hcrcby dllrnr undcr pcmlryorFrjury ihai I am li.cn{d undcr pmvhion ol(hrprcr9(mnnxi.n€sirhSc.rionTlxx))otDni\n .l
<br />CONSTRIICTION I FNDIN(I A(iENCY
<br />I hcrchy ainm undcr rEnahyorp€iuryrhar rh.rc r..onsrd.rion hndinaascnc, for Ihc FrrornDmc ofrh. work tr *hich rhi\ Fmir il
<br />i\sucd (sft. 1097. civ. c.).
<br />AIILICANLIIESTTBAID!
<br />I hltr,y rfim undcr pcn.hyofpcd!ryonc oalhe roU.*ing dc.ldarions:
<br />ftmlirnr Pcrnrirs AsrEsos Nolificalion Fcdeml R.8u lat ions (Tirlc ,10. Pdn6)
<br />_Rc+irtd btrcr of Ndiff,dion
<br />! ccnilyrrlr !hc lcdeul'csul,rrnlreardrnS,.bc{.,.r.'tu\aldrc n.r,nnli$hr. r' rhr I,mKl
<br />-r.*\rl
<br />r u* *,a,r^ JDnl'c,rnn 0,r1$n,c thd rh. liovc inromrion ir.olmr. I r8e ro.omply wlth alr (iry0nd loutrr,
<br />ordinJnccsA\SErcb*.Eld'ngroburldrnScon{rucriotr.ndncrcbylurhdrizcrdpidc.nrariv.sollhisCilyandColnryt,cnlrunonlh.
<br />ah^. nEi{iurctrnNny rnr in\Fcrinn DurD.e{;;:;#;;;c^""*-Oq fae-' - ,.,.,rlrchY -Grt..ie\a Lonez
<br />Site-Work
<br />I
<br />I
<br />7
<br />c mifl
<br />-
<br />Policy NumlEr:-ElpiE*r
<br />-
<br />of rh. Bx\incs,nd Prolt$ioN Codc- ffilmr licctrk i\ in llrll loN nnd cfitd.
<br />trnd.ii Aildrsr'
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<br />I
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