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ELECTRICAL-INSPECTOR RECORD
<br />COMMENTSDATEID/SIG.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondinq / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service It/eter
<br />FINAL 2lrtll9 -//44h,
<br />Notes, Remarks, Etc -,
<br />OWNER BUTLDER DELCARATION
<br />I hcrchy artrm under I).nslry ol Frjury Ihal I sm cxcmpt {mm rhc ContrioN Liccnrc Llw for rhc rolhwing rcasn (Sec 70.11 5
<br />Busjnc$ ad Poftqsi,rn Codc): Any Cily or C.hry which rcqutcs . pcnnil ro ornrrtucr. dr.r. imprclc. dcmolish or rPun m,
<br />sldcrlrc. lrior ro irs issuarcc. also rcqlircs rhe 0prlkanr Ir su.h |Ern l.likariSncd satmnt thnr ,E ot sh. h lic.nrcd Pumu0flr
<br />ro rhc pmvnions of rh. Cont,.ror's Liccn*d La* lchaPrcr 9. Conncmin8 wiln Sccrion 7o0o olDivision 3 orrh' Bn!i"( rnd
<br />Prolcsrionscodc)ordrrhcor\hcircx.mprrh.rcrrom,ndrhct{sntorlhcallcstdcxcmPlion.Anyvi.llri.norsctbn?0.1,tb,lnv
<br />,pplicrnlforaFrmirsuhjccrsrhc,rplicsntloacivilrcnallyofnormtr.rhanfivchundrcddoues(55m)
<br />-1.
<br />!s os.erorrhc otxriy. or nry cnphyes wnh $ns.\ as rhdn sh .omrnsari{,i, will d. thc *ork and rhc $Brm is mi
<br />icdcrr orofrcdd ror slc (Sa ?O14. B!\i!c dnd Pmr.sions Codc rhc Cont|ror's Lic.nt Lrw docs nor rpply ro m owm! or
<br />rh.pmFny wtn hild\ or nrq,mkr rlrNn.ond who &f,s ikh mlt hirsclrDr hcr*ll or lhrou3h his or hd o*n cnvrlovcc(
<br />prolided rhar\uch imlroKtrEors m oo! inrcndcJ o.olTcftJ lor sL.Il ho*crcr rhc hiHin8.i in{otfnrnt i\ $Ll *irhnroft }ur
<br />afonulcrioo, rhc Owncr Builds will havc rh€ hr.dcn oa pnrline rhd h. or shc di:l rn hriki or inDmt thc !$p!ny lor rhc purl'Jc of
<br />-1.!rosicrofrhcnni!.
<br />y. rncElusiv.lyconrEcri.! virh licc.scd co rncx,nro..nnrucr rhc pmjecl(sd 7(x1. Bu\i"cs
<br />..d Pol$siotr Codc:1he Conh.rofs Li.cnsc Law d.cs nol lnplyro r osnci.lPtopctrywhohnildsorinpmlcilhcrcon.
<br />rnd wh. .ontrN lor such nnjccr wirhrconrado(s) liccoscd pu,surnr h rh. c.nr.dor's Liccn* trw)
<br />I afl cxcmpt unds Sd io.
<br />wotxrRs' (lt)NIPFNSa'rloN
<br />DSCI"ABAIAN
<br />I hcrcb, amrm undcr l]..ahrorpcduryom ollhc folloqins dctkalions:
<br />-l
<br />have and will roinllin a Ccnincalc ol Conscnr lo Scli lnslrc ror *.rkns oarpcnerion. as lmvidcd for l,v Sdion l7m of thc
<br />codc. for lhc Irrformrftc or rhc wor[ f.r whichlhc !sn]i n nsu.d
<br />vc and will hainrrin workcs conrtcnsrlion inst.stuc. rr r.quied by Ssl ion l7t)0 or rhc bbor Code. ntr rhc pdiormnce ol
<br />,.rmir i! n{cn. Myworkc( comprnsDrtun insuraNccrricrr li,li.ynunnf,r rc:
<br />gtrolaD I
<br />-l
<br />ccnify lhar in rhc lcrlorrrEmc ol rhc sork lor uhich ihis p.irnil is is\trcd. I sh ll..l cnrlloy nrr lc6.n in.nv.rmmr
<br />$ N to h.conE subjccl l{, rhc wo&cn' .ompcnqlion lnss of Califqnia, and dSrcc rh ift shotH h.con[ su$jsl lorh.
<br />qorkc6'qnnpcnsalionpioli\iotrsorSelion3?lDolrhcl,tnrc(xlc.lshall.fonh*irh.omplysnhihotpD!isn'nr..
<br />WARNING Failurc ro $curc *ork ^ .onrDcNarn covcruSc is uhwful, rtrd {hnll suhlccr trn c lhJrer b.in nrl lfnrlrics artd
<br />b onc hundrcd rhou{trd dollars ($100.000)- ir addirion b rhc cosl ol.omI.n{rriotr. drrugcs r\ pfuvidM lor rhc
<br />sfrrio. 1076of rh.lrhrC(xld.i, .rcnand
<br />,;. q[l,{rY a
<br />D!tLJ!!-l!9ll
<br />I hcrcbyumrm undcr F..,lry of r.Uury rhd I am lictn*J un&r Pi.visiM o{Chxpro 9(.onnFNins uirh scctxrn T(xlol olDivisn'n I
<br />oi rhc Busine$ ond hotesn,.s codc. ad myliccns i\ in lirll rdN drd cfiitt
<br />i0 4-
<br />\tr t
<br />CIJIEIBUCITONIINDI!!.iACDNCI
<br />I hcrby rmnnutrdcr lEnollyotDtrjtryrhm rhcrc naconsrruclion lcndi',g Ec .y lor lhc PcrlormNt .r rhc wotk iu rhich rhi\ Frnrir i(
<br />ksucd {S.!. 31D7, Civ C.)
<br />AIPIIIANLIICLdX{IIAN
<br />I hcft$yailnmundc! !.n,lry otrcrjury om orrhc r(rlowrnS dccl lItnrs
<br />Derrelilion Pcflni(s Astrst,s Noriircolion Fcdcral Rcsxhrn s (Tnb40. Ptrn6)
<br />Rcquir.d l,cncrof No1ificartrn,
<br />lrrhd Ih. icdcrnl rcguhtn,nr (g$dire \lxnos rc'mvrl are nor rPplicrbl. h rhis n(,j(l
<br />ily rhd I turvc rcad rhh appli.,r ion ,Jxl { c thar th. ltolc intfltur ion ir coFd I lrxd b .onply *nh oll Cirv 3nd Coutrr,
<br />rnd simc L,wr rcl0l iry to huildi S.on(tuclior and hcrchy rurhtri2t rcPrcsctrl irc\oflhilCiryrndCounrvrocnrcruFonrh'
<br />Fr
<br />,,," til I tY
<br />I
<br />APPROVALS
<br />Under Slab / Floor
<br />Sub-Panels
<br />Air Conditioners
<br />l.trJc.! A'lL.{
<br />-
<br />81\
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