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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rough
<br />Service It4eter
<br />fqrf.,tpr./,autu tN 1',"D
<br />Notes, Remarks, Etc
<br />OWNER BUILDDR DELCARATTON
<br />I hdrcby lmrd uidcr pcnaxy ol r.rjury lh,l I n cre"fl tmmlhc C.nlEcxni t-i(n{ h* for thc lollowinB rcas. (Scc 70.115
<br />Businc\s rnd Prorcssn,n Codc): Any Cily or Counry shich rcqoircr t Fnnir ro on(ruct. .ltcr iry'n,{c. dcd.lhh or epair my
<br />nructurc. priorr{' iG issusnc.. trho i.quids lh. npplicanl lor suchFnnir lo filcasisncd {at rent rhnrh.o.shc t licenscd ,lunulnr
<br />ro ihc ,mvisions of rh. Conrrrlols Licenscd ljw (Cbaprc,9. Comm.kine wirh Sc.lion 7(llo of Divist,i :l ofrhc Businc$ .nd
<br />PmicssionsCodc)orrtnrhcorshcilexcnprrhcrcrromddthcb,lisrorltuallcacdcicmrlion.Anyli{,lariotrorsdionT0ll5bynn,
<br />applictr lqoFrdir.uhF.krhc.ppli.rtrrro0civilpc.0hyofnorfl$arhlnaiechxndrcddolltm(SsuD
<br />I. as ownn of thc ,)R,ncny. or my cnDl.rcci wnh w,gcq N rh.ir qih .oNFns.lion. will do lh. worl rrd tl'd {tum n nol
<br />inrcndcr.l or olitEd ,o, sle (SE 7(x4. Bu\incs rtrJ PmLssions Codc: thc Conrrrk, s Liens tiw docs mr ot'ply ro an owncr ol
<br />rhc pnlcny who hlikls or i.trpmrs rh.Nn. sJi sht dds sh Mrk himscllor hc'\clfo' thmuBh hk or h.r o,nc$pl.yccs.
<br />prolidcd rhnr such im!$rmnh m mr inlcndcd or oflcred .,tr salc ll howctr. rhc buildirg or inrpmlcrunt is nnd wirhin , {r $ar
<br />oa onDhri.,n. rhc Owncr Builld will hrw !h. bunlcn of Frcvin8 rtul tr or shc dil Bn buill Dr inlxrec lh. PmFy for rlt lx$)* or
<br />-1.!s.sncrolrhcropcny.,mcxclusilclyc.nr,crir8*irhric.nscdco
<br />aclo^ ro cod{ru.r rlt ptujccl (Ss 7or4. Bu inc$
<br />rri Pn'rssbn codcr Thc Cotrractols Li.cnsc Li* docs nol lprly k, M ownf oII'ropcn, qho huilds nr in'ri(,ccs rhcrcon.
<br />and who co.hcr\ for such proj..k wnh d contrln( s) liLctr*d NBUlnl lo ihc Conkd.'oi\ Lrc.$c t,r* ).
<br />-l
<br />umcremlr lnds sccrio
<br />toani&):roNfEN$.IlaN
<br />lliCLISdIlAN
<br />I hcrcny ll.itnr h cr F-nrlr! or Frjory onc ol thc l(nhwir8 lcelml io]s
<br />-l
<br />h.vc ml will Ninriin a Ccnificrrc of Con{ tu sclr l'rsurc ({ E rkcrr co'n|xn\rinnr. r\ jrtuvid.d nn h, s(ri,,n :l7lD of rhr
<br />L0t(r Codc. Lrrhc |{rformonccolrhc $ork tr*hi.h rhr p$n,ir is is$td
<br />-l
<br />hnrc !.d s'ill mninrrin s.rkcB'..mf'-nsarn nNnnrcc. d\ rcrtuircdhlSccrbn.l?(x)orrhct-nh.r(bdc-iorlhcPcrronmkcol
<br />lhc $or[ lor shichlhi\ Fnnir ir i\\md M y work.rj .onrNtr\dion iiNtrrunccodcr md policy itr $$ d.
<br />crri.r-
<br />R,licyNumh.r-Erpnc(:
<br />-I
<br />c.nifyrhrr ihrhc pcrlorntrn.c ofdcwort n, qhbh lhi pcrnri, i\ hsucd,I dDllno' cnr oy rny Irron in lnt mMmr
<br />w N k, bcconr subj.\t k' lhe work.rr cotoptnsri{nr l,ws orC,lironrin. Md i8rcc rhar iil sholld trc.@ suhiN' b$c
<br />workc^.otrrpctrs0rnrnpmvnion\oiSccrtrnlT00olrhcl2t$rCod.,lsttrll.lonhwirhcomdywilhrhotrii)visions
<br />W RNIN(;: Frilurc r) surc w(Ikcm (nnpcn$rion covcE8c is tnl"wful, sid sh.ll s,hjcct otr emPlorr rd ainnnat p.trr[is nnd
<br />civil fincr nI) t' on. hrndrcd ihousond dollln (Sl0O-(xD), h ddnion ro rh..osl ofcoflrPcnsrion. drtuC.{,( rrovidL{ lor rhc
<br />sc.rnrn :1076 ol rhc tibr codc. ir crcn rlld lrorrcy\ lccs
<br />Dal.:- AppliEnll
<br />, rcursnn conrrilcron
<br />DICI,ABAII!]N
<br />I hcrcby lrtr$ undq pcMlry or p.rtury rh.r I am li.rnsd ufrh! tmvisio. o( Ctupld 9 (com.cing wnh Setion ?UJO) of Diririon l
<br />or rh. ausincss ond Profc$ions Codc. ud ny liccn{ k in IUU rom tun cficcl
<br />Liccnsc Nu$cr.
<br />$NEIAI&UONITNDIIIiAAENS
<br />I hcrcby afftrn ud€r pc.rhy.r r.rjury lh, thcrc n ! onsldctio. lendina asenc, ror rh.l,rrolfucc of lhc srk fitr shkh rhis ltrmn is
<br />ksunl rscc.3097. Civ. C.)
<br />APILICANI.OEEITMITO!IMy.lfr under pcnalry oipcrjury o.c oithc lollopirg dc.ld,rions:
<br />Dcmoliridn Pcn[E-Asbc os Nori6carion F.dcEl R.3xhrhns (TirL ]l{). Prn6)
<br />R.quir.d t rt.r of Nodicdbn
<br />l.cnilyrh l[cli(l.ral'cguhriotrsr.!rdtrr!r\b.do\tu n)vr] c D.r rftll.Jhlc ni th'\ Pn'JC.r
<br />-l.cnifyrtu
<br />I hrvc Esd rhn rrllk.ri(,n alt nalc lh,l rhc,hrvc inrb,nElion iscotur I lgrc ro.onDly vnh ull Cit, and Counrt
<br />ordinrkcs and Srarc La*s rcbrinE rn buildnrS con(rucrion.ord hcrch, luthoiTr rcprescnrrriv.s ofrhh Cirynnd Counry r. cnrcr upon rh.
<br />$oR nrtrliotrcd pror.n, rbr inspccrio. ruqrxca
<br />ADDIi(lnl or AA.trl Si8n{krre
<br />III
<br />DATE
<br />Communications Cable
<br />FINAL
<br />t-nJfl \ NJnc _
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