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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)I f4ru,*Meter Release tl tllli ln---
<br />I
<br />Rough t(,YILY €yuon t6>-fu,VDService lvleter llr 17r lts.'lc,-
<br />FINAL tl h flv ?n/erL l&.---
<br />Notes, Remarks, Etc " lI "
<br />OWNER BUILDEN DELCARATION
<br />I hcrchy umrn lnder Fnahy of pcrjory rhai I m eicmpr liom rhc Gnnracrdf Lit.h\c tiq for lhc followins rc!$n (Scc 7O3l5
<br />Business a.d Pn,ter\ion Codc)r Any Cily or Cdunry which requn s r nciinil lo conslru.t. rllcr, impmrc, dc nirh .r tlan any
<br />(tu.rurc. pr& k ns h$,tr.r, ds rcquncs tu 0mli.,nr [u su.h p.r,nil ro nlc . siBrcd st cmnt rhar tE or shc i\ licdtrrd puruatrr
<br />lo rhc pmvnions ofrhc Contrucrols Lienscd Lnw (Chaprcr 9. Connncncilra sirh Sc.rbn 7fix) of olvision I ol lhc nusincss rnd
<br />Pmlc$nrn\ Codc) o! thar hco.sh. h ckdnrrr rhcrc[r.nDnd rhc ha\is lorrh.allcgcdcxctrrprion AnyviohlionofSdioi?0]l5byany
<br />aptli.,nrr.rap.nnircublcccrhl.pplicamloi.nilt'.nalryofno'nFErhonfivchundrcddoll.r(S5{x))
<br />-l.isownqofrhcpn,pcrly-ornycmpbrt$wirh,asesa\rhctn,lc.onrpcnsaitr.wrlldtthc*o,k.narhcslnEluruis'rninrcnl3l orofie'cdf{n$lc(sc.7u-1.Bu\hrss dPi.fcs\ir)nicodcThcConr.ctoisLiccnscL!*docsnorllPplyturtr.wE.f
<br />rhcpmFny who buikk or iqmvcs ihcR)n. rlwh,.locssuchqnkhnnscllorhursclf.rrhrouShhtrorh.rowncmtloyccs.
<br />p'ovidcd rhlr such inllo(mnk m nor inrctrdcd o.otltnd lbr salc ll] l.i,qcvci rhc buiLli4 o! inqnorcnf,nt is s,kl sirhi', otrc $r
<br />olco'ryhrhtr. thL ow.cr Builds will harc thc brrdctr .r prori,B th hc or shc di{l nor hild or i'nnr.r rh. pmFny tbr lhc purlt)s of
<br />,.rsuwtrc.orrhcptup.ny.!mexclusivclyco"lr.ctnrsrithli.cns.t.oorra.n6hdn,id.rrttPmjd(sc.70'l-l.Bulmrs(n hr!\sbn Codc TIE Conrrsckr's Li.dn\c l-aw d.c\ n r ll,ply b dn osncr or [op.ny sho huilds or iml)rols rhcron.
<br />rid wh.onrn.!{f(,su.hpmj.crwirh.cotrrDctonolmnscJtunmnrrorhec)nrrocroisl-iccnscL2w).
<br />I ncr. pr uid.r Sc.riotr
<br />"r+-
<br />t hcr.by xllirtr,und.r D.nrlrv ofDcriury
<br />_l cdifyrhar in rhc lr..foiflrmc of rh. w.rk lnr *hich rhi\ pcflnir n isucd.l shollnot cnrployu, pcnon in any nmmr
<br />{' asro tr.o,B subjc.r t, rhc wor*cr conrpcn\(ion h*s otCrliiornia. lnd asEe rh3r ifl \hould l$dnr subi\l h Ilr
<br />sorkdr comr.nsarn,n ,mviions of Scclio" 17(x) of rnc Lahor Codc. I shrl. fonh* irh conDlt s nh r}x,t ptuGnrns
<br />WARNIN(;: Failurc lo sctrrc sorkcrs con
<br />.ivil hrcs up to onc hu rcd lhouslnd dol
<br />S$ion 1076 oI lhc Llhn Oxlc- inrcrcd md
<br />..r.tug. N trnh$hrl. x nrlL \uhE.r rr .ordo}ar l(i .' n)
<br />xxr)- ir !lni,,n r, iltr c.{ ol.onrltNrrnnr. drmiscs x\4-At
<br />lL
<br />Ir1 t, \R \ l r()N
<br />I h*cbt rllnh urlci [frh!oiNrjuy r 0r.\i!i, r.l ( hrI.r 9 r.on, nrnring qnh Scrri(nt 7(X
<br />!ANSIBIJCIIQtr.LDIDING.&GIII.I
<br />I turchy amirn unds ltnoll, olncrjury lhar rhcrc n !.onsrtuclion lcnding tgcncy aor th. p.rrbnntrcc oflhc tork nn *hich rht IEmil h
<br />is$cd ls.c.10S7. Civ C.)
<br />AIELICANLDEIAAATA!
<br />I h.rhy dllrm undn p.nrlry olpcrjuryotrc olrhc lollowinE dcclararions:
<br />Dcmolirioo Pcrdib AsrE os Norincdiod F.d.rtrl Rcguhrbn\ (Tirlc {0. Pd6l
<br />-Rcquned
<br />L!rrcr of Ndiffu rhn
<br />-l
<br />ccnilyrhat lhc icrlcralrcruldi,rn\ rg&lin8 r\h{o\rcnrx x'r ior lpplicrhlc r) rhis Pni.,ccr
<br />.bvc iinnnn i,,n i\ corcd I
<br />)hL
<br />agre lo comply*irh allCiryrtrd Counry
<br />ivcs ofrhn Cir, tud Cou.ry ro cnln ntbn rtr
<br />-rl*," t/zz/zoj(
<br />Communications Cable
<br />Ihnk.ndwillmJir0inaCcnificntcofConscnrloSclalnsurclitrworkcfi ompcnsdn,n, sr PmvidddrorbyScctionlT00olrhc
<br />l-abor Codc. f.r the p.rfomnc. ufrhc r$k ror *hi.h thc pciinn i h{ucJ
<br />I hovc and sill moior0in wortcrs'coDDcnslrion insurancc. !s rcqliri by Sccrio.lTan orrhc tjhor Codc, foi lhe ltrlom&mc oI
<br />thc work for*hichlhh pcrnril is iss!€d Myworkcis mnFnurion i.\xrak cmht {d Flt} numhcr{e
<br />Licc trs. C hss:-Liccnr Nunb.r
<br />Drl€ Contncto.
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