|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Life Safet y /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />lrl>*qoBqnding / Grounding / UFER /o-1-r3 J )
<br />Transformers r:-Y
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Sollit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rou gh
<br />Service Meter
<br />FINAL to-?-rg J/n,frr{frt:
<br />Remarks
<br />OWNER BUILDER DELCARATION
<br />I hcrcby rifiirn uft.r pcnrlry ar lf,rlurt rhrr I m crcnui h,nr rhc Contaclon l,ic.nsc trw lbr rhc folloNii! rca$n (S..r0ll5
<br />aurin.ss rd Prolt*ion Codc) Aiy Cil, or County which rcquircs { I)cnnit lo coosrrud. rlrcr. inl|/ovc. dcirnlish nr mF r .'ny
<br />idclurc- I,liulo ils issuaRc. aho r.qrircs rhc appli.nm fu sr.hpcrnir b lllc a stncd ,rcdnr rhar hrorshc i\ li..rs.d prruant
<br />ro lh. Frvnnrns orrhe Conrrrcktr \ l-i.cnscd ljw (Ch!!rer 9. Com'Rn.nr8 *ith Sc.lion 70( of Divkioo 3 of rhc tsusiNss lnd
<br />Prolcssionr Codc) or Ih.r h.orrhc kcnq, rhcrcrr,ma.d rlchtrh forrhc 0llcsed crcmplion AnyvidutiooofSccri,n?Oll5byony
<br />,rtli.a.r for!pcmn subjslslhc applic.nlrorciviltctrrhyortrol rorc rh,tr livc huMred dollrs (S5m)
<br />_1. as osrcr or (hr rop.ny. rr n'y d.'rl.rte\ wirh wrscs us rhcn Db .onrFnsllion. will do rhc work ond lh. (urur n nol
<br />idc lsl orollcrcd lnr slc (Sc 7044. liurimss and P(nissions Cod.: ThcCin a.kr'\I-i.cn\c LaNdod\nor arflybr owicr.f
<br />rhcpolcny who huilds or inlrovs rlrBfl, and uk) drf,\ chsn hinr.ll or hcNla.r rhmugh nis o. hcr own.'nphyccs.
<br />pn)ridcd rhar ruch i'npmkmnc m nor inrcftl.d o oficEd for srL ll. howctu. rh. huiklir8 or nnpnrcmn! is \nd *irhh . . Jrrr
<br />oldnnlkli('n.lhcOwncrBuiklcrwilhrvc rlrburdc..fpr,vi'r! rhrr h.o!sfic dkl n tniu or imrrolr rhc propcnt fffrhtllrln{ol
<br />-1.
<br />asowtrcr olrl[ Fmpcny.0m.r.lusivcly.onta.rins wirh liccnscd conrracroN ro c.n(tucl rhc I'n,rcct rS(. 7044- Bosinc$
<br />rtol Pirft.sb. Codc: 'l hc Conracroar l-iccnsc La* docs mr nftly k' M owncr olpr.Fny who builds or inprovu( rfurcon.,nd who conrRch ror such pmjccrs w'lh r G, 0d.n n lkns.yl pu^u nr rh. G,nrrcroa\ l-iccn* l!s)
<br />-l
<br />rncrcorF undcr Sdifl . B & I( |,tr r[n rrrnn,
<br />Dtrlc: ()qne.
<br />ITO.BtrE&::IjOMITNSA]]ON
<br />I2EUdAAII'N
<br />I hcrcby rmflnxnd.r p.nalry orFrjuryucofttu ti,llosios dcci{rlrioN:
<br />I ha{ aftl u ill rtuinrain ! Ccaiff,lrc of Conscnr ro Sclf.lnsurc fo, $orkcrr ompcnsnrion, rs ,svidcd tu 6y s.crbn lTur or lhc
<br />Itrtxn C.dc, l'or rtr lcrftrmncc oI thc qo* lor which
<br />'h.
<br />ponir i\ issncd
<br />-lh.vc
<br />nd willDannain qnrkc. cohpcn\rrn'n insur!rcr. as rquncd hySccrion lrotrol rh. t]bor o)dc.t:(,r lhc pcrloflnrncc uf
<br />rhc [ork lor whth rhis p.inir is nsu&1. My *orkcn conrFnssr ion insur@e crrk. r'xl policy nu nrher ec:
<br />I.cnirrh!l inIhc pcriormncc of rl"a sork Iir whi.hrhtr$,nir i\ h\uc . I\hrlln.r.npk,y rnyprr$. ina , trrr.i.r
<br />v, skJtxoft s!bF1-r lo lhc $orkc$ c.mlcns[ion hws ofcrhlirarir, ,trd +Nrhar ill *ould hc.o * sub]cd brhc
<br />work.r\'co'npcn\rrionpovisionsofSccrionl?00ofthcht rCod..lshrll.lodhNirh.onrplywirhrh.*rrovisids
<br />W RNIN(|: l;{ilurc to ccurc *orkcrs mmtci\ on.o!.'rtc i\ trnlnwful. rtrd shxI\uha.r rn cillhy.r k' dnnitullttrrlri\ kl
<br />civil finc\ up i. otrc hun rcd rhousond dollan 1 cosl ol .. lt*hsdn . danu!.s rs flovid.d for rhc
<br />s..ri6n :1076 of rhc L,tnr Codc. hrcE
<br />116tc:
<br />z_-
<br />Dr.( I \R \ l t{)\
<br />I hrtuby inn und.r nrfuhyor|rtrjrrt
<br />or rhc Busircs und Pmic$ions Codc. ord my liccnse t h rull ior.. and cficcl
<br />I hcrchyalln rundcr JrMIiyott)crjuryn r rhc'ci\acon(
<br />n\trcd rscc 109? Civ C)
<br />r lc insrBcncy rbrrlrNrli,nnucc ollhc work rnrshichlhn pcrnrir t
<br />t8rLl! Nfuirlj$anaN
<br />I lrrbyrflinnundcr prnalry.f p.rjrry om of rh. n,llowin3dcchrarnnrs:
<br />D{- dinun Prnrirr A\tf,no\ N.ri{icrii{,n Ic crrl R.Buhriqrs (Tirl..l0. Por6)
<br />Rcqui'rJ l-crirrolNr.,i.rriotr
<br />d rhir nfplicatbn .trd {Jrc rhxi rh.llr,vc i',fon,uri{,r i\romcr lr!a{kicompltsirhrllCiryrndCouiry
<br />rclaringroIrurldirEcoNru.n.i.tridhcrchtrdlktrircr.prcsd rrivDrofrhisCir,MdCounryt). tTuA rhr
<br />Lq L<-
<br />Ou,,,,,",,,'{",",".,*rh-\,frr(rnc rr".
<br />dFl,vu trErlxt|nN t
<br />^o!li""eh, ^py;ism
<br />Pe-i'rr{,m#rinr)l
<br />N&ILft
<br />Siqns (monument)
<br />Notes,EtC.
<br />I r liccnsc trn{lcr rx)ri\1fl.r (-hrDrcr q(connncNins $irh S.clion 71[[))oll)ivi\i.n.]
<br />l-ctrd.r's Addi.si
<br />-l
<br />ccniiylharrhc ltdcnrl rc.lul0rions rcgeding rsbcros rcntr'ral rrc nor arpli.filcn, rhisri(rccr
|