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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.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 />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service l\Ieter
<br />7n,r,rar<FINAL tl"ilq 7'D-)
<br />Notes, Remarks, Etc tt ur
<br />OWNER BUILI'ER DELCARATION
<br />I hcrchy trifinn uMcr pcnrny of lcrjur.v rhlr I d crcnrpr tio'n rhc Gfli,.knl Liccns ljw for rh. lollowiig d.ioD (s(.71).r15
<br />B!\incs Md Pmfc$ion Codc): Any cny or Counly *hich Nqun.s ! Fanit lo mnsltucr- alrcr- n4tovc. d..mhh or rcPlt on,
<br />dru.rur.. prior ro ns isr,tr....ls rcquncs thc lFplicant lor su.h p.rmi h nh r \ilncd {arcmnl rhdr h.ot fic h liccned punuur
<br />ro rhc lmlisions or rlE Conr@tois l,icen*d tis lchapt., 9- Co'nnrftinB wnh Scction ?000 of Division .l orrh. ausntss.nn
<br />t tutcsnrs Codcr or rhlr h( or th. h cr.mpr lh.rcfmm rnd rhc basllltr rhc allcscd cxcmption Any riohrn,n of serir 70:l L5 hy ntry
<br />Jnr'l.trtrrrNrrc'nrir.dhr(r\rh.0m110ntror.rvilNn0lr'orTrnirc lJn lac hundrd J',1'r'. r'[rUJ,
<br />Sffi ',tr;*"tr,fl ,a;el: ;rl,H;xH",:::":il,;]r|il'iil;*',rl;'li*iT.Ixl'*:r;ffi ffi :T:. ",rhepmFny who tdilds or improus ih.rmn, and wll) dcs such k)rk hinxclfor hcr$lfot thouAh hn or ncr ownc"tployccs.
<br />ptuvidcd rhrr such irn0mvemnls m ft,1 inrendcd or ollcrcd tu salc lt no*crci rh. hoil ir8 or impmrcnEnr i\ sold *irhi'r onc ,tar
<br />or.onpkti('n. rh. ow.ci auikld vill lrvc rtE burncn olpruvirS that hc.! she did nor rdu or i4trorc !h. trcpcny for thc Puqns of
<br />*,**,:lr*rr,;::il:tirn.*r:i':]rh";:i#i]'::,,rr;:::ffii:fi"iirffi*,ly,l',fift;'fi:
<br />rnd who.onrnrNrorsu.hpmittsvilhrConifro(s)licctrrcdpuruMrrorhc(ronkacror'sLi.cn*tjw).
<br />7;;
<br />I}ECIAEAITQN
<br />I hcrchyalfi nundcrn.allyof p.rjuryoN.frhcfolk,wi',sdcclaari,,ns
<br />Ihlvcdrdpill'minlainaCcnificlrcolConscnrroSclllnsurctrtrworkc^ c.nt.sarion.!s pmvidcdforbySc.ri.n:lT0Oorrhc
<br />lrtx, cldc, ror rhc FrrbnnM.c of rhc work forwhich rhctcrmil is hsucd.
<br />lhrrc rnd sillnDintrin *orkcrr compcnsrrion insurrnc.- as rcqnncJ hySdri(,nlrurofrhc tit, Co.lc. lor rl$ F nnmn.col
<br />rhc *olk io whichlhis pcnnit is issuc,l Mysorkcrr co rr.nuriinr nNrr!ft..nnr.M P.licy Nn$cr uc
<br />,r{d:
<br />u.rb.r-
<br />ify rhar i. rh. pcrfortun . olrhc work lnr qhi.h rhis ptrnrir is isucd. I shlll nor cnlPk,y rnr tcBon in lny nunncr
<br />$ ishr bc.uN suhjc.r nr lhcw.rk..o'npcnEri h*\i,fcrlinnir. od +to.rh ifl rh.uld hcconr {ubjccr hih.
<br />workcs conp.ns,rnr !tuvhions.l Sccli()n -lrl)0oIrhc khor c{ c.I slull. ronhwilh.omfly\ilhrhoscI'rovnk,n\.
<br />civil linc\ up tr, onc hutrLlrcd rhor\r d dollrt (SlU).fiDr. i 'ddirtr$ r) nrc c.{ .f conp.n\nri{n,
<br />S..rtr,n 11076 urrhc LJhn Gulc. ir crc{ r
<br />".,".7/ze/4
<br />DECLAMIIO!
<br />I herby arnflnunder pcn(lly of pcriury rhar I snr lion$d under fdJviiion ofChaplc!9 (Nflrftncins *ilh sccrion 70(x)) ofDivnion l
<br />or Ih. Busin.s and PmacssiorNCodr. and my liccn\c is in full r'olcc and crecr.
<br />l-iccn\c Cla$:-Li.cnsc Nun$.r:
<br />-
<br />Dslr: Contro.lor:
<br />caxslf,i,lcuaN.L[NluNglcl,Nlr
<br />I icrciy rllim utrdcr p.nllry orFrjury thd rhd. k r con$fl.rbi Lndir8 rScncy lorrnc I,crro.nrncc orrh. *.rk ior $hich lhis Pcflni i\
<br />ssNllsc.. l(rq7. (-iv ( )
<br />AfIIIIANfDECIASAIT9N
<br />I hcrcly aoim under pcnulry olpdury oft of$c lolloeing dcclmlions:
<br />Dc.rlirion Pcrmils.AsiE{os Norificarbn F€d&al Rqxldrirns (Tirlr 41). Pan6)
<br />-Rcqutcd
<br />Lllcr ol Nolificalion
<br />b@*nn, ,nn ,* *o*^,csurnions RsarditrE 0sb.sros rcmoval !rc mr olplicabk r. rhn pojccr
<br />I ccniry rhd I hrv. rad rhis appltotiotr and (alc llnt lhc otrie inrbnulion t cor&r I lere ro smplt Pnh &ll Cn, dd c(,rnr,
<br />ordinrmc\ Md s6rc ttr*s ruLr ine ro l,uild in8 consrrucr i,[. rd hcEby"urhori2c scnrrrivcs ofrhi\ ciry afd (irnry b cnrd ulx rlr
<br />rtr)ve rtrri,rncJ Imncny r(r nr\f,.rnI t)ur
<br />,1|,plic!nl rAgetrlSiEnalua z/2"
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<br />Communications Cable
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