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ELECTRICAL.INSPECTOR RECORD <br />IDiSIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq i 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 (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service [/]eter <br />FINAL t0*t-t , <br />Notes, Remarks, Etc <br />OWNER BUILDDR DELCARATION <br />I hcr.hy sll]'h und( Fndhy or lcrjuiy rhrt I m .xcdpr nnnr rhj cbnlrncroB Liccnsc t w for lhc folloNi.s rca$n (scc 7031 5 <br />Bu<inc$ md Pmlcss n Code) Any City or County which rcquirg a pcr.rir ro con(ocl. alrd. irgiovc. .kmiish or E,'d, any <br />slrudurc. I,rhrro ils issunce, als rcqones lhe q,plicanl nr such 0cmir lo filc a shtud {domnr rhal tror shc h licctrrd pursunnl <br />b th. tmvi\idns or rh. Cortra.ror's Liccnscd tlw (chrrr$ 9. c(nnnEnci.s with Se.lion 7000 of Dilhn'n -r orrhc Busirr\(md <br />PoltssiotrsCodc)orrh{lEorshencrcmrrth.rcfiomandthctashforrhcsllcscdcrcmprion.Anyviol.iioiofSationT0Sl56ylny <br />anpli.snr for a pcmir \lhjsh lhc atplica.r ro rcivilp.n.lrynfnor mrcrhdn fiv. hundrcd dollds (!500). <br />l. as osrci or r hc pmpny. or my c,nplorcs {irh w08cs ,s rhcn sb o,ncnsarnnr. *ill do rlE $o* ud rhc srdm h n <br />inrcndcd or oficrcd for slc (Sr.'.70.14. Busircs lnd Profc$ions Corlcr Itu Contuctn\ Liccn* tiw dhs nol appl, lo .n osmr oi <br />rh. ttup.d, who blilds.r in0n)B thmn. rxl wh, dm s.h *\)* hnnscllor hcrcllor rhrouAh hG or hcr own cmployccs. <br />p'ovidcd rh{r slch imEoktrrnrs m ftn inrcndcd doficGl for {ft ll howcv.i rh.buikinS.r itrI)losEnr Ge0*irhinonc ru <br />of coqrldion. rhc Ovflcr Buildr qill horc lhc hoftlcn oa rovin8 thal hc o! shc did nor t ild or inpt,vc thc lmFdy lor lh. puqns of <br />_1. isowrcrolrhc l,o!cny. rmcxclu\ivclyconrrkciins wirh liccnscd contrtrs k, con{nkr rhc DoFcr (scc. ?u14. &hioc\! <br />rnd lbtu*i)iCodc lhc Conln ktr s Licc sc Lrwdocs Dolifplyto rtrawncr.llripcnyr1r hlild\.r i'tl,R)vc\ rh.rcotr. <br />rtrd who co r \ l'or \uch projccr\ wirh a a)nrroctr( o liccn*d I[^uirhrhcco h.t's Li.cnsc kw). <br />_l <br />I <br />lrElL]-tsl|Q! <br />I h.tuhrrllnn,un cr tf,rlrloltuFr) <br />I hav. nnl will @inrrin r C.niftar. orcon$nr ro sclf ln\urc tor \orlcn cnn{'cnsarion. as Droridcd for byS.crionlT(x}orrhc <br />Lal'or Codc. lor lhc l,crformmc ol rhe worL tor which rhc pcrmil !\ G\ucd <br />I hrvca d *ill nEimnin work$r'.o'np.nsarion inrur.n.r, rs rcqun d bySrdionl?mol rhc lrhorCodc. f$ rhc ldfoflnaftc ol <br />lhcworkfor*iichlhilFrmirisksucdMywortc6conrEns.rioninsurance.lBicrlndF,licynufrb.rre' <br />I..nili rhil ir rh. lr.r.nnrN. orthc work lor *hi.h rhi\ lEirnlr i: iss,cd. I \lnll i.r cnvl.y a y rr$r nr rtry mrtrrc. <br />$ 0s lo hcoN $hjcd r' rhc workrr conpcn\drnnr h*\ or Calitu.nir. rid .Frc hit il I sh.uld hccom luhjcc' ro rhc <br />workc!\ c.nrr.i\Iionpn,vi\n,ilofSmti.n.lTm.rrhclrtrtrCodc.l\hrll.ibtrhwirhcomplysirhrho{pmvnios. <br />WARNIN(; Failurc r, *curc workes'conrlcnsilior vcnxc n utrllenn- ann \hall rxbjccr ,n .'npL]s ro aiminal r'.Mni$ a <br />civil litrcs up ro om huftrcd lhousand {xx)l in dlirion k, rh. ro n ol cofif, \xrion. drnrpcs 0r 0r.vid(l l.r rhc <br />o^"b,a <br />ln(r\I\llr)\ <br />I hcrcbyrllnfl unds F.tr.lly oI n .juy rhor nrovi{ion oi Chrtrcr 9 lc.mmn inB wirh S..ri 7(Xx))olDi\i\i,r:l <br />Conlo.lor: <br />rcNEIAISUONIEIDING.{GEIII <br />I h.eby firm undcr lrn|lly o f |EiJUry lh rndc k a.otrslrucln,n bndins uBc y for rhc rdromm.. or ihc sort lot which lhh rdmil is <br />hsucd (S.. lo97.Civ C) <br />AIIUCANfDEII.ABAIIIJN <br />I hcicby dtinn utrds Dc.all y oI Pcrjury onc of ine follorinp d(lmr t,.\: <br />o.nxrnnrn P.inir+Ash.sto! Noriicllio. ardcrol Rc8uldln,rr lTnt 41). P0n6) <br />Rcqutcd Lxrrd of N.tifi carion <br />sr8rdir8rslcslosrcnmv{l{rcnor3prlicrhlct,rhi\pr.Fr <br />ion od narc rharrhc rtnvc nrntrnrri{)n i\.oftc.i. I nAiN tu conr/y wnh 0llCiryand (i'uly <br />r\Llnch) r lr, /o 'rt,'c$ <br />APPROVALS DATE <br />ts_-prdl <br />Sc{-& <br />fuhzoat <br />ol rh. hr\i'rc$ rtrrl Protc\si{'n\ Codc. rnJ 'n! liccn\c n i'i fLll nnr Jxl r,f.rr <br />I e*lc' . AdJrs <br />( <br />2ClB <br />I <br />I <br />=