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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS oWNER BT'II,DER DtrLCARATION
<br />I hcrcby af,tn unrlcr l).nolr, of pcrjlry lh0t I m crcin,rr rhnr (hc c.fta.k,N l-iccflr tjw lnr rh. rollowin8 r.rsn (scc 70rl 5
<br />Businc\\ aBl &orc$ion Code) Any Ciry or Counry which r.quircs . nsnrit ro con(ruct. rhcr. nnlmvc. d.mlhh or rclair trny
<br />slru.rurc. prh. ro i'\ isruN., lls r.qtrn.r rhc applk r aor such !,cmir ro filc a sisncd (arcm rnar hc or n'c ir lic.n*d pnrunr
<br />r. rhc Foviiions oflhc Conlrucu\ Licen\ed Lnu (Chrlrfi 9. Com'ncNin8 uith Secrion 70Oo of Divisn,.I of lhc Burircss lnd
<br />Pmlc$ionsCodc)orrhar hcorsh. is crdmrr rh.r.fon and rhc t'!si\ Ior rhc alL8cd crcmprion. Anyliolatio.ofS..rion?0ll5bysny
<br />rptlicanr toru pcrnit sutjechlhc apnlicanl to tr.iviltctrlhy.rnor nmrcrhan 6vc hundrcddollari (Ss00).
<br />L ns o*if or rhc l](,rt y. or ny cmt loyt.\ sirh tr rgcs rs rhcn $h .omn.nqrion. till do rh. {,rt :ud lhc {tururu i\ ft
<br />inicndL\l or olltrcd lor $lc (5(.7041. Ausincs and Pror.si(,x Codc: Th. C(, tu tr'\ t.i.cnsc ljw docs mr apfly b rtr u$ $ or
<br />rhc lR)t(d! wh. htild\ or inrn&s drmn. n sbdB$rchsl) hinNll or hcncll or lltr ush hi\ .r hcr owo cmpl,)yccs.
<br />Fovid.d rhal $ch inDmrcDEtrrs urc nn idctrdcd or ontrcd lirr sk ll how.vr': rhc hiklin8 or inrrmvcnrnr i\ eld *irhi', otrc $r
<br />ol conlpLti[ rhc Osncr Buildd *iU hr]t rli btrrdcn of!rcvin8 rhd h..r shc did mr hoild or i'lnrovc rhc pnrtdy,brrl.c purlnr of
<br />_1.asowncrofrltpn,ncny.,rcx.lu\iurlyco.r rins wirh licctr{d co krc()^ h .on{dd rh. ntuj.{r (sc. 7(11,1. 8n\ims
<br />rDd t\!ll\si Codr: Thc (bntrkr'\ t.i.cn\c lrwdoc! nol ipDlylo 0nowncr ol,tropcrty*ho huild\ or irnrhvcs rhcrcon-
<br />rnd who.ontrachfornEnlnjccNsirhrGi.rd.k,ns)licctr*dpor\mnrt,rrf,c.itr.trsLi.cnftjs)
<br />-lrnr
<br />crcnu und$ seriO I & I'C turrhn r.r\n,
<br />Drler Osncr:
<br />wltRxFas- (:()trtpFNs TtoN
<br />DECI,TNAIION
<br />I hcrcby uflnm undcr pcnalty ol pcrjury om oalhc fouowin! dftld,rk,ns]
<br />-,hnvcandwillnridrinrCcnificrrcofConsc(nJS.lllnstrrcf.rworl.^.ompcisarion.u\
<br />providcd fd hy S*rotr :17(X) .f rh
<br />ljh, Codc, for rhd p.rbrmak.orthr sorlt for shichrncpsnrn n isucd
<br />rhc$orklirshichthi\lcnn[1s1$ucdNiyqorkr^ro'npcn\rrionin\urrncror'.r N]ict.!nrh.rrc:
<br />Poli.! Nurhcr Erpn.\
<br />I ccniry rhar n, rhc !.rio"uDccolrhc tr1nt nn s{ichr[h ncflnir r irsd. ! shr]ln.r c'nnloyrnypc6on in ooynunncr
<br />qrNrol..onf,sul]]C.rk,rh.qo&c.onlFNdn)nhNsolcrlifornir.rnJr8rucrh ifl \lruld h.conr \ohjc.r k,rh
<br />rorkcis'.umJlcns n ptuvi\iotr\oiS&tnr.lT0O.rrhrlntrC(xlc.lshrl!.fonh\rnh.o'nfly\!irhrho{pruvisnnr\
<br />W RNINC liailurc ro su,c sorkc$' co.rrcnsrrbn .o\rmtc ( utrlNful. md shrll suhFcl on cmplo,$ h aiminrl pcnrllic. and
<br />*:*'** *'i, ""."*::;',,ffi - -
<br />DICI.AMIIQN
<br />I turcby trLtrr utrdci FnJlyoip.rjury lh l am li..nsd ul\.lcr tmvi\io! .f Chnpr.r 9 (.omrMing wirh s&rirn rfiD) of Dilisk,n l
<br />.r rhc Brsi c$ ard Pofc$ions Codc. atrd myliccnsc is in lull lorcc $d cffccl.
<br />(rf ,lttI
<br />is!'r,lrS.. \l)t)r (i\ ( r
<br />AII:LISANTSCLIB6I()X
<br />Itrd)yMn und.rpcnalry.f pcriortomof rhcaollowingdc.hmtnm
<br />o.'tuliinrn Pcrhic Asbcdo\ Norificarnrn Fcdcrxl Rqnllti.ns ( Iillcl0_ P.lno
<br />Rrqtrncd l.rr.r nf Mnificrrhn
<br />l.olLl,vrhxr rlr liJrrrlrr!ulxrr)f\ rL!rdi',g r\ltno\ rrnn)vrl xr. ror xl,0lrxhl. r, rhn t'()..r
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq i UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Flough)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilin s (T-Bar Rough)(,ffbt1,J\16
<br />Ivleter Release
<br />Rough
<br />Service lt/eter
<br />FINAL bl/_b/t<(bDif!
<br />APPROVALS
<br />Gndcis Ad&css:
<br />-
<br />-l.Lnifylh
<br />lhrwt0dthGaptlicolio.dd{ir.rldlhe0tovcinr.inDri.nis.orccr.Ir8rer.coqnysnhrUCilyo.dCounry
<br />ordituncc( and Sratc L3ws Ekrins ro blildinB con(ruction, ald h.rchy lu'rFrir kEc\cn'div.s,'lrhn ciry inl ?u yloc.r6u|[nrlE
<br />:TJ,-;.-ilL''XK\xf- fl. ,"," 7f , fr I
<br />Air Conditioners
<br />Notes, Remarks, Etc.
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