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ELECTRICAL-INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.OWNER B('ILDER DELCARATIoN
<br />I hcrchy afinm hdcr !.ntrlly oi pcrjury thd I am cxcnru ri. lh. Grfta.ro^ l-i.cnsc ljw r.r rhe f{rlowi.g rcaq,n (Sc.70ll5
<br />Busnrsr dlrr Pn,rcssn,n Codc), Aiy Cir, or Counry whict ,equircs r l{ilnit ro con(rud. !xn. imtmvc. dcmnhh .r rcFn rtry
<br />druclurc. pri.r ro ns hsuancc. ,le rcquics
<br />'hc
<br />lmli.anr tur {ch Frnir ro tild a sig*d sr ctunr rhd h. or shr i\ li.cn{d f,uruad
<br />ro lhc pftrlisions.rrh. Coft.dDr's l-i.cnsc Llw (Chlprcr 9. ComnrcNin8 sirh Sccrion ?fiD ol Divhion 3 olrhc Burinc\s ond
<br />Pmlcsions C.dc ) .. rhri h.orshc is.rcnllr rh.r.fron Md th.tush ntr rhc ullc-lcd cxcmprn,n. Any riol ion.lSccrionT0ll5 hy any
<br />0mlicrnr lor r lc mir rubrc.h rhc .mli.anr fu a civil I,enllry ol nol mrc lhan firc hun.lrcd dollus ($500)
<br />-1.i\owncrolrhcpn,Dc
<br />y. rn.tulusivcly c.nk&ring $ ir h ticc.*d .onkarroF t' .on(tucr rh. !!+cr rS( 7OJ4. Bu\i"cs\
<br />otrd ttfLssioiCodc:Th.Conk.cror'sLi.ctrscLlwdocstrollpplybatrowncrolnrop.ny!h,)truildsoriflnnrvc\rhcrcon.
<br />,nd who conrrach tb. \uch rmjc enh r Coor,acron, li.cnsd pusu.nr hrh.Conirac'ors t-kctr€ lrw)
<br />-l
<br />amcxem/ lndcr Sedion-. B &PC forlhnmson
<br />Dole: ORner:
<br />w(lRKFka, (:olrPFNi/rToN
<br />DES'AAIIOT
<br />I hcrcby trmrnrnDdc. r,cnally oiD.riury otrc ollhc &nbwiff ddcl,rdi(,nsl
<br />-lhavcalxlwillnrn
<br />dniCc ili.rlcolconscrllos.lflnstrrcrorsorlc^.onl)Insdi.tr,as pn,vid.d r(r by serion 37{D ol lhc
<br />Lih, C.dc. ror rhc lcrrorfrMc. ol rh. worl ro.whichrh€ pcrmit is isslcd.
<br />_.1hlrc rnd will,nrilhin qorkcrs coDlrcnslh nxufuncc. as rqunL{ byscclninlT00orrhc tlhor cbdc.ld thc poli'flr ccol
<br />rhc *nk lnr*hichihi\ nc nl NI coq).nsdn n,snr.mc .rricr dd policy trun$.r m
<br />1o /t//P
<br />-l
<br />ccnify th.r o lhc p.rform .c.trhc sork f{tr shich rhis F..ari i\ i\\u.d- I \hall nor .nDloy 3ny pcrotr in rny nBnRr
<br />v, s lo bccom subj.ri lo I hc workcs' comrcNal ion hws or calnbali( r aSEc rhnrifI should hccorc rbjcd tolhc
<br />lorkcB qnnpcnsrlion prcvki.ns ofSerion 3?fii oflh. rjtb. C.dc.I sh,ll. fonhwnh $mplypirh rhoc provisions..
<br />civil incs u, to otrc hxndrcd rhousdnd d.llr^ (S100,(rD), in addirion n, rl[ cosr .f
<br />Sclr,otr lon',irh. tihor Codc nLrc{ rd ro.i\fHu\ ,1 ,1V/X//& ^"",,-1, \oo, _ (6/t
<br />' '_,/ Lrt.prsro tott.ucrtrt
<br />/t "ff;h
<br />,DECIJSAIION
<br />, h€rhy atfirmundcr !c.{lry of pcrjury rhd l0h licnr.d und.r rtuviri.nofChupt.r 9 (.omnrMnrg *irh S(ri.n 7UJ0) olDivhi.n l
<br />(2o ? P3E>
<br />VEZ6
<br />l:ONiInlJlJI()NLEXl)lT$rIGEILI
<br />I hcrhf nflir uMor Fnrhyofp.rjuryrlrr rh.rc n r .onitucri'n bDdi',8rgctrry fdrhc Frtunrr'.. ofrhcx.rk r,, whrhrhl\ Fnrir i\
<br />i\\ur rscc :ll)97 Civ C )
<br />Lrndcrr Add,cs:
<br />-
<br />i( r ifil {drcrhnr rhcrhrc n,lnrnltutr ncorc.r lrgNn)co DlywirhillCiryrtrdCounly
<br />srrucrio[ rit h.rhy aulhori?. r!!:.€.r.riv.r ofrhk Ciryand Counryr. ctrrtr u[nn
<br />I'rrn'ilce mnr.lDri Y e-q /4 0tt
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />L!!9 Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceili ngs (T-Bar Bough)
<br />I\,4eter Release
<br />Rou gh
<br />Service Meter
<br />FINAL tleln /llt4t\
<br />INotesRemarks, Etc.I
<br />COMMENTS
<br />l. !\ owncr of thc lrmFny. or my cmnlo)es wilh waScs I rh.n k c .ompctrrddn, w l do rh. w.rl oftt rlE {du. h n.r
<br />intetrdcd or oflaEd h, elc ISL! 7IX4, Busitusr and Pmt'cs\ions Code: 'tuc Co.racror's l-i.enc Law dms ml aaply ro an oNncr ol '
<br />rhc pmFdy who builG or inrpro$s rhcE,n. and pho dcs ru.h eo* hinN.lfor hftsclfor rhmueh his or hcr otrn.frplotccs,
<br />lnvidcd rh.r su.h inlPmkf,rnk m r, inrcndcd or offcrn tu sdh ll h.wcq. rlE hoilding or iDpmRmnr is sld wirhr I .nc nr
<br />oi.on{,hriod. rhe Osmr B iUr*illhrvcrh.hnrdcnolpovin8lhlrhco.rhcdildnhoi .r nn0mr rhc pR,Fny for rhcl)utTx'r of
<br />ol lhc Brsnr$dnd Pmr.ssi.rsCodr. rxl my lic.n{ i\ in tullfucc rid
<br />AIIUCAILDECLAf,AII!'N
<br />I her.+y anim undcr Enalty ol pcrjury orc ofrhc followin8 delarulions:
<br />DcnDl btr Pci,trirsAsbcsros Notiicltion ldcr.l R.gu!.!io.s (Tnl.40. Pd6)
<br />-Rcquircd
<br />Lctro olNolili$tion
<br />lccrr,ryrh rlrf.dcfulrclrl niis rc!ndi',8 \k{os r.m,vrlrrc mrrpfllcJhlc h rhi\ nRll.cr
<br />-lccnily
<br />lhir I havc rcrd lhh
<br />onlinanccs and srrrc lrws
<br />rhovc nEatnnrd pmFny ror
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