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EI.ECT ICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.coifivrEirrs
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si gns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondi ng/Grounding/UFEB
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soff it Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Itleter Release
<br />Rough
<br />ll ?
<br />FINAL ./L
<br />Notes Remarks, Etc I-
<br />OWNER BUILDET DELCARATION
<br />I rxr.by rfirn xnd( Fodhy of pdjnry thar I en crcq)r tmm rhr ConrloN Lians Law for rhc follo{ins ,c,q,n lsd.roll 5
<br />Businc$ and Prolcsion Codc) Any Cily or Counly phich rcquircs o pcmii lo consrdcr, alrcl inrProle. dcftnkh r'q\tr my
<br />{dcrurr, rrtur ro irs issumc. als. rcqutcs rn +Ili.ad lor su.h Fmir ro ,lk u si8tr.n solc'rcn! lhar hc or sfic is lice.scd Irlrrunr
<br />to thc pmvlqi.nr ofrhc Cont.cror's Li.cns.d Liw (Chaprcr 9. C.nrnrncing whh Sccrirn 70tD of Divkion I of lhc Ausinc$ rnd
<br />Pr.fe$ions Crdc) or lhor hcorshc is excmpr lhcrclionr0ndlhc b.sis fo.lhe !llcscd crcnurrion. Any!iolurionorSeri.nTo:rl.5br.ny
<br />rmli.am tor r p.mir \rhjdrs rh. applicrnrroa.ivilptnahyofnorm)rcrhlnfivchu.droddolhB(S5Ol))
<br />l. rs owncr or rhc pn,Fny. im cr.lusntly ..trkrtr i'rC *i'h lic. {d ..tua.rr\ ro .on(rud r}. p.oicl lS(. ?(B{- Bu.ircs
<br />.nd thrrLsbn Codc: l hc contacrofs Li.cnsc Lrw dms not rpply ro owtrcrofprolEny*hohuildsorimpmlcslhcrcon,
<br />rnd sh. rotrtrcr\ lnr \uch |I,]c.rs \irI r o(s) liccnscJ Nr\urd n,rl,cCotrtrcktr x l-icctr\.l.rs)
<br />aJ L5 I-IIr'\J-,
<br />I hcrchy nlIirfl undd Fndlry.fNrrur o . ol rlr l()lk ri'u d(.lxrrri(n}
<br />I hrvc rtrd will mnduh work.rl .om,'cnsdnnr insutuD.c. ds rdqurcd by sNr ion l7([ of lhc tihor Codc. tu lhc p nnn!!r.'c ol
<br />rhc *ork liI{hichrhis !.rmil is issucd MyworkcF omp.ieriotr rn{mEc.,nicr ond,'olicy nunrbc,nrc:
<br />Cmicr:-
<br />Poli.yNrmbcr: Ertircs:
<br />-l
<br />ccnilyrhrr in rheFllornranc.oflnc sork n)r $'hich lhis pcirnil n is$'cd.I sn,llnoi cnrploynnyl*r$n inany unkr
<br />s' ,sr0 hdotrr subjc.r r, rltr trorlcK co'np.isdi)n lnw\ otCrlifonris. re! a8rc. rhd ill should t{.onE snbjd n, rlE
<br />w.&ci(..rthsIiotr!r.visiotrsofSc.rion.lT{X)ofrhel;'hrCodc.lstnll.fonhailh.orntlywirhrhosrrovhions
<br />'W^RNING: Fniluic ra *curc w.lkcr mNpci n,n .ov.a8c is unl,wtul, d shall subicr an cnr,]lolc. ro aiminal Fnalrhr and
<br />lm.Ulo). in.ddirion ro thc cost ol'compcnsalion. darroEcs a\ pr.vidcd{or rhccivil lnrs up lo onc hundrcd llr
<br />I hcithynfltnrndrrp.mlrr.l t{rjttryrhnr I rdlircMd undcr pfl,ri\i,n,.l Ch crq(.oinkn.iirg
<br />CONSIf,UqUONIENIECIGENq
<br />I h.nb, rrtrm undd Ixml'y of pcrjury rhd lrm i\ a s.sd.rbn lcnding ag.n.y fo. lhc l.rfonruna of lhc wort for whth rhh F"hi n
<br />isrued (scc. :r097. civ. c.).
<br />AIILICANLIIES.AAAIIIIN
<br />I ltrcr'y rmnn uMc, l..llry or!.rjury o.c orrh. ti,lk,wing del,.ait,nl
<br />Dcmlirion Pc.mic- Asbeslos Nor ificar ion Fc<leral Rcruhrbtrs (Tirlcl0. Pan6)
<br />-Rcquncd
<br />bllcrof Notifi calion
<br />.orr.d I a[(r h co,nply sirh allCiry xnJ (innny
<br />crrcsctrfutivcs of rhis City 6nd Ci,unry ro cnrer u,xnr rhc
<br />0 7<Irervv1=r\EZ
<br />/za-
<br />Site-Work
<br />Sub-Panels
<br />Service lvleter
<br />/0h1fi{
<br />l. ,s ow cr of rhc pmpcny, or my cmplo}tcs airh w.Bcs as lhcn sk conrFDsalion- Bill do rhc sork und llE ntud@ b nor
<br />inrcNl.d oro,jar.d for $lc(SN?()l4, Busircs md Pmlcsions Calc l h€ Conr.acroi\ Licens ljw d{B nor aptly t, {n owncr ol
<br />rhc rmrEny qno huilds o. iqmrcs lhcmn. and who des suchNo hnnsclfor hcr{lfor rhn,ush his orh.r.qn.nploy.cs.
<br />nn,virlcd rh.r such nnDhwnf,nk rrc nor ir .lrlci or o,Icr.d f(, srk. ll hr'cwr. rtE huildiq or i prurcrEnl is $tl wirhin .,m yrs'
<br />ofcon{,lcrbn. rhc Owrcr Buildcr will hlw rrE idden ol pmviry rhd h. or shc did d t uild o. inlprow rhc prDFny tu rlE puqls o,
<br />laTL
<br />I lRvc dxlwill nrdi.rlin rcc ill.rrcofco.scnrbs.llllNxrcr(rqorkcn.onDcns idr.rs ovntd li,r h) Ssrnn, :l7lx) o I Ihc
<br />t-'htr Codc. f{r rhc pcrf.rnDn.. or rh. $uk r(n which rhc!.nnir ( i\\ucd
<br />S(ri.,n lr176.f rhc lilnrCalc inr.r.(
<br />,.,",oq lZs J e,
<br />ol rhc Busima! and Profcssions Codc. e'd m, licensc is in lnll fore and efec'
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