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ELECTRICAL.INSPECTOH RECORD
<br />APPROVALS OATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground thfl rQ t h."*t /l/, t "DtcuD
<br />Pole Bases I Dt
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouqh
<br />Service IVleter
<br />ltr?riEr'<:FINAL $lls-lrc -:*l )
<br />Notes, Remarks, Etc IT u1 v
<br />OWNER BUILDEII DELCAR TION
<br />I hcrcby donm undcr penahy of perjury thll I rm cxcnrfl fmnr lhc Conrreron Li..n\. Law ror rh. rolrowing rclbn (S.c.7031.5
<br />Busircs ond Prcfc$ion Codc): Any Cily or Cotrnry lhicn rcqun s r Irrnir ro .o.sinct. ahs. imPmvc. dcmlish or rcPrn any
<br />ru.urc, f,rid ro irs L$nifte, ,k. ,.qutcs $. apllktrnr ttr such Fmir ro flle , shned stltcmnl lhal h. or slE ! liccnred ll6x r
<br />to rhc pmvisions ot tlE Conr.Bcrd s Lianscd L.s lchaflc. 9. Codrcncins wiih sccrion 70oo of Dilkm. I nt lh. Busincs and
<br />Pnfcsrionr Codc) orriat h. or slE h crerl,r ihrcrron od rh. bNis for rh. alh8cd cxcmption. Any riololion oISec'bn 70:11 5 hy dhy
<br />,mli..nr ror r Fmn subF.t rhc .pplicanr ro , civil pcn0lry of nor mrc lh,tr fi\ e hunnrcd dollaF ( S5O0 )
<br />_1. !s .wncr oI rhc !.oFny- or my cmpk',rrr wirh waE.\ !\ rhct \.lc .omr.nsar ion. Rill do rhc wort mn th. srrr!rc is mr
<br />inrcndcd.iofidrcdf.reL(S(T04.4.BusircsNndPn,r.sri.nsCodclhcConl.a.loisLiccnscljsdesnor'pplyi.anowncror
<br />thc pmpcny who hilds or iqmr$ rtrmn. ui who des srh *oi( hifrsclf or hd$lf or rhNUAh hn or icr .str cnlloyccs,
<br />rovidcd lhar su.h impmwnrnh uc nol inrcftlcd or olTerd n, qb lf, ho*.hi, rL hxiui.g or inqrowmnt is sll rthin .m ]ttr
<br />or.ompkrbn. lh. own . Buildcr will harc tnc t tcnofpmvinSrtd h{ orshc did mr bliu o. ir{s,( rh. r,DFny ror llE tlurlns ol
<br />L Nowncrorthc pmpcdy. an.xchsnclyconrdirg wirh llccnscd conrract,s ro condtuci rrr pmjcct lscc. TLVt. auenusl
<br />otrd trofc$hn Codc:'l he Contrucroi\ l-iccnsc La* docs nor apply ro mownd orptupcrty wh() buids or nnp,ovG rhcrcotr,
<br />,nd pho..nfudcBlorsu.bf6rc.swirh!C.trrtr.rtr{s)li.cnrdpusuarrbrhcC{nructn\l-iLtn$tjw)
<br />lrdrrc rtr u c' Sc.li(ni .lJ & l'( r,tr lhi rx{r'
<br />l)dr (rnnu.:
<br />W(TRKrJRS' C(IMPENS T(}N
<br />DS]I,ABAIIO!
<br />I hcr.by afinm undci pcnaltyorpcrjuryotrcollhc lorlowing dlcl ,lions:
<br />I hr!.nnd*illmintain,CcnLfi.atcolConscnt kJ S.lali\trm lar q.rkcr' c.mpctrsirion. !s ptr,lilcd f{{6ySdron:r7lx).1rhc
<br />lih.rCode. tnrlhepcrfornurccofrhc {orl ror$hth rhc pcrni n n\ucd
<br />I hrv. and will nuimiin *ork.rs' c.mtr.srl ion insuhrc. N equrrcd hy Ssi ion :lIlO of rhc ljtx, Codc, f.r rhc |Erformncc of
<br />rhc *ork lor whi.h rhhFrnrit is hsucn. My *o!kcr'comnctrsotion in{rarce cricr ard plic, nrnb.r dc:
<br />l.cdilyrlrr inrhcpcrfo.tun.c()frhcwoJk tu whrhrhr\$rtrrir i!,r{'.d.Isl lltror.'nnk,! r',y pcrto nranl minncr
<br />q) ir r) h..orE \,6jd h rh. workc'\ conlncnsrri,r lxss rl Crlilan,ir. r d a8to. rh[ if I $onld hccoN $b].cr k'rtu
<br />worlcF.nnU.n\rriorpnxision\olScrri,nr.lT(X)ofrh.lihtrCodc.lrhrll,li,nh!'irhconrtly$irhrhoscpmvi\ion\
<br />lVARNINC, lirilurc ro {curc *orkcrr
<br />civil llnrs up r. on. hundrcd rhorsatul
<br />I sulrtccl nn cflrploycr t) .ri'ninrl Nfuht\ x ,l
<br />..nrNn\{n!r. tlxf !.\ \ t,o\ d(d ],tr rlt
<br />lf/1
<br />t)t1t,\R\tlr)\
<br />I hcrcby.rfirn und.r p.nalrt of pcrjury lhal l0m licrtrEn u.dcr rsvision ofChaprcr 9 (cofrftftin8 wnh selion ?0oO)otDivhion 3
<br />of rh. Busin.$ and Pmfeiiions C.dr, ,il nry lh.n* is in tull for.c nd cffel
<br />C- ro c\f
<br />(
<br />I hcrchy anrm undcr Fnalty ol,)crjury r
<br />isucd (Scc :109?. Ci! C )
<br />rhcrc is o c.nnrudiu hndiis rsch_y Lrrhc p.rromncc olrhc Eoik ior *hi.h rhl nrrmi n
<br />fcd$,j reellrlions Eg.rding asbcaros nmvnl N nol lpplicoblc ro thh proirr.
<br />r.ad rhn appliclrion.rn slatc rhor thc ltlow i.fomrion k.orel I ngc ro.omply *ilh rll Cilyond Coutrl,I
<br />tzssnhriryio buildinScon ri(nr rfrl l[rcbylurhori.c rcprr{nrrrivc\.rrhh
<br />AD|,li(nnl oi A*€nt SisnaluE
<br />{nLr.r,*\c
<br />:'w;:*
<br />Translormers
<br />trtrJr,'. ,lJ,rn
<br />AITLICANLDECIABAIIIJN
<br />I hcnsy aflinn undcr pcnalry.rrcrluryonc olrhl lollowin8 dcclor0lios:
<br />Dcnrolirion Pernirs AsbcnosNorifi.lrio. rcdcrl Rcsuhr ionr (lirlc 4), Pd6)
<br />-Requtcd
<br />Lctrcr of Norifi carion
<br />I
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