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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<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 />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />lvleter Release
<br />Rouoh
<br />Service Ir/eter
<br />FINAL q-V"ts.Jikl*z (u)
<br />Notes, Bemarks, Etc.
<br />OWNER BUII,DER DIiLCARA'I'ION
<br />I rErdJy trfii, uM& |rnolrt ('r trrjury lhar I m cxc'nrr tmn ihc C.nlncroF l,iccn{ ljw to. rh. loll(sing rclsn (scc.7(r.11.5
<br />Ausinc$ ml Prolcssion (itel Any Cily or Counly wiich rcqutci a pcmir k, .onifl.(. !tcr. nnnrovc- dcrmlish nr rcnJnr y
<br />{rucrrc- prirb ir\ isroaicc. dko rcqxncs $c.pplianr lor suchrf,nnirn) Iilc r si-lncd ( crEnr rharhcor shc ic I'.ciscd N(uinr
<br />ro rhc prolnnns of lhc Conrrrcntr i l-ic.n\cd liw (Chaprcr 9. C. rnrn rS wirh Scdiotr 7lxrc of Divisiot:l orrhc Br\inc$ r d
<br />Prof.\innr\Cod.lorrhrh.orshci\crcmptrhcrclionandrhcbrsklorlhc.llcscdcrcmprt'n Any!n,Lrt,nolSccrionT0ll.5hyany
<br />.rpli.a.( t)r a Fnnr suhjNa rhc apllicanl ro r civ il l)cMlry ol'nol rmrc rhan lfu htndrd doll 6 ( $500)
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<br />rs owmr oi rhc nmpcny. nr m, cmpbyecs *iur taEcs a\ rhcn {,h conrr.n\rr nr will do Ihc 'o* anl thc srrr@ is n
<br />inrcnd.d or oficrcd lnr elc I Sc. 7U4, Bu\irrs nnd Prclcssions Codc Th. ContNl(ri l,Ectr{ ltrw dds ior ,prly k' r. owncr ol
<br />thc pmpcny who hilds .r in{n*B rhco . dd wh. des s*h qor* hnnsclf .r hcrrclt or rh'nugh his or her o*n .mpby..s.
<br />prcvidcJ rhrr snch iDlmlc'mn8 m nor i, crkil u oflcrcn fr qlc Ia hoft\ cr, rtt htrit]iq or inDmrcnrcnr is sld wirhin otu )u
<br />of.otrllblnr.lh. Ovncr Buildcr qillh{rc thc tur&n olpovi.g lhd h. or \hc did ior huiu.r nnF,w rhc rmFny for rhc puqn$ o,
<br />_l-rlowncrolrhcpn,r!ny,rn,ex.luxiv.ly..nrr.ti',asirhli.cns.d..itn.hslo.onnru.ilh!proicr(Sec?044.Busncs
<br />,trd Pfufcs\ir Codc: Thc Co.krcror's l-iccnsc Lnw dms.nt rnnly lo in.wncr oino|*ny *ho build\ or nnprovcs rhcrcotr.
<br />and *h. c.trlrrclslnr\u.hrn+cr\ wirh r orltliccns.d pusutrr brhcCofirn tols l-iccnsc l-lw)
<br />;:rPiT,4
<br />I hcr.hy ,lnm trnn.' |itrrlryol frhc rolk)qid! dr(l r ri(n\
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<br />hllc ad sill mirrain a Cenificarc of Co €nr ro SElllnsxe n, knk.N ..trrp.trs.tn,n. as pmvidcd fot
<br />Lalior CDd., ior rhc pcrformne of lhc work for lhich ltc tslni n &ucd
<br />-lirtcandwillmainlainsorkc6cohFnsrriooinslrarc..!srqundbls..rionr?0Oolthckbo.Codc.lorlhcFrrormr.corrnc work fnr whicn rhh!.nnir i1irx.d. Myworkds ompctr\rrnnr in{tuflc.ffiicr 0d Arlicy numbs uc:
<br />-l.cnilylh
<br />irthc Dcrloiruricc oflhc work firwnich rhis l,crn,ir i\ is\ucd. I sllll tror cnr oyinyFnoninunynEnncr
<br />v) as x, hc.r,m \ubjrcr t, rhc work$J .. rfcrs.rion ldws .f Crlilnr trin. rnd l3rcc rhar ii I shoul,l tEom srhJl-rr k, rltc
<br />wor[s1 con,pcn\trrnnrpn)vhb\olSNriotr:]70OofrhctjhrCod..lshill.lorlhwilhronrplywirhrho*fn,vkiols.
<br />'--l b
<br />I
<br />hundrcd rlnnrrnd doll{!s 100.ftx)). ir lddirion nr rft co\r or..nrt.n\rr.
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<br />I heEby u,nrnr und.r pcnahy nI pcrFry I
<br />.f rl[ Bn(ims d P6f.sion{Codc
<br />Irovisi(n oi Chanrcr 9 (innrmnc inB wilh Sario!
<br />nryliccn\c i\ in tullnlr.c a,klclrccr
<br />icen{c Nunrhr _
<br />C!}dSIAIJIIION.LINDINJ iIINCI
<br />I hcrcby ufinm undcr Fidlry ur pcrjury th,t rhd. is . comrrudi.n LMinS r8cmy |or l hc pc{orrote or rhc sork ro. rhich lhi\ Ilc nit h
<br />hsucd (Scc .109?. Civ C.).
<br />APILICANLDEII.AAA.IIAN
<br />I h,r'by ,f6m undcr p.n,lty of Fqury onc of lhe lollowin8 dslarutions:
<br />D.nolirion P.rnirr ArtEqros No'i6c{'ion ftdcrrl Rcgulrtionsflnt 40. P0n6)
<br />Rcquirod trllur of No icalbn
<br />8c .or ,ppltrbk ro lhh Fmj.rl.
<br />formrion is corK-r. I uFrc ro 6nlJ)ly wnh rll Cny and
<br />riTc rrp'.\. nnr\ ofrhis Ciry dnd
<br />\'{,rn ,r \rr y. n
<br />WAltNlN(;r F lxr kJ {.urc sorkcr\ compctrs.rion covcrrtc rs unlnslul. rtrrl shrll \uhrcr a'r cnr .ycr ro ni inal pcnihic\ mn
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