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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, Founlains
<br />Signs (monument)
<br />L ile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor
<br />Bonding / Groundino / UFER
<br />Translormers
<br />To rqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rou gh
<br />Service ltrleter
<br />FINAL \\r\r\t.[,(]"h(r\
<br />N otes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />I hcrcby rtfin! uidc, p.ndry (,f n rjury rh t dn cxcmpt lrom rhc G,nrrocroB Liccnr Luw tu rhc f.ll.wiog rcNon (Sc.?I):ll.l '
<br />Eusin.ss n*l Pofcsio. Codc)r Any Cny oi Cou ry {hich rcqrnc pci,nir r. ..ndru.r, alM. inDrovc. dcnDlkh or rcn0n nny ,
<br />slrucrurc. lior io irs issuoNe, lho rcquncs rhc iptlicanr lor su.h tErnfi ro fih! si8ncd narcm.l rhlt heor shc n liccnscd pu(uani .
<br />ro lh. pbvsions ol dE C.ntdofs Li.cn*d laa (Chrprer 9. Conmcki.! wirh S..rnrn 7(X)0 ot Divhn,n I oflhc Businc$ ind
<br />Profc$io.sCodc)orrhartEorshchexcmptrhcrcfm'nandrhctJriqr(,$c,llcScdcxc.Uriotr.Anyvnnlriotrol'Ssti,n?0ll5byany
<br />Upliclnlforapcnnilsubjalslhcapllicanlloocivilrcn,hyofnorrmrcth0nlivchundrcddoll.ri($5U,)
<br />l. ,r dwnd ol rh. pmlrny. .. my .mpk,rds wirh waScs as r hcn sb .o'np.n\ar i{,n, sill do rh. r(rk ,l1 ilr nuturc is nor
<br />inrcndcd or ofcrM for elc (Se.7{}1,1. Busirrcss and Pn,Lssions Cdl. Thc C.nrrttr s l-icctrs liw der nol al'l,ly lo oaow"s ot
<br />rhc lmFny *ho hildsor inqmks rheBrn. arx! who dcs \Eh $ort himsclror hcrslfor rhmugh hii or h.r .wn .mployecs,
<br />p.oviddlhlr such nn}rorcmnls m mr inlcndcd or ollcr.'d tor sL. ll hoRrq. rhc huiuing or inlaNrrr h sU *irhin.m Fr
<br />ofcoirlLrir.. rhc Ownfi Buildcr will haw rh. h{ilci orpmving rhr h. or \hc diJ R, buiH o. nPmvc rhc ,}mFny fo, rnc ,Nqrc ol
<br />-,.asowncrolrhclr,o,'cny.ancx.luriiclyconn'mswirhl,.cn*dconra.rtrsr...nsrrucr'hcpN]c.rrsrc70l,l.Busnc$nfrlPbfssirCodcTh.ConrEtor'sLi.cn\.Lrwdocsnorapplyhmo*nc'ofp(,r.ywhohuitdsornnprorrslhcrc.n.
<br />nftl who .orrrlcrslor such pmFk$irnr C.nrmchn\r li.cnsd I(r!u!N brhc (i'nt,cktr \ l-iccnsc lrw)
<br />-l
<br />om crcnpr udcr $dion-. B. & P.C lor thh rean)n
<br />]lQ&il]Blll0ttf,l5rllllll
<br />DEel^.B]llt(})i
<br />I hcrcbr rnnD undcr rn0llyofpcrjuryonc oflhc rblloNirg dNi^ririds
<br />-lhovcad
<br />wiil nuinhin a Cenificarc of Consn[o Sclf lnsurc io. *orkqc con]l}cnslrt,n,6 polidcd rorhysc.rk lT0oorlhc
<br />Llbor c(dc, id lhc ldfonroftc ollhc wolk ior whi.h lhc pcrmir i* issucd
<br />_l harc rnd {illnui iinworkcncoarpcnsrlnDinsur.ncc.r(rcqnnclhySccliqr.l?urollhcl-lhorG'dc.t)!rh.pcrrunriccor
<br />lhc }rrk hr which this pcrmil ir i$ucd. Mysor*cN conr!.ns i({r irsurnncc cnn'icr ! Fnicy N'nbcr m'
<br />l.cnify rld in rhc p.rfontun.. ufrhc woik frtr which rhh !.rnrir is i\su.d, I \hnll nor unpk)y nny 0cnotr irt rtry nmnnc.
<br />v) 6 ro bccotrr subtcllolhc aolkcs' conDcn$lion laws of calituiiritr, rnd urcc lhllil I nn,uld h(com suhicct t,lhc
<br />woficrs conra,cNnti,,n pmvnionsofS(tion 3700.1ft Labor corlc. r shrll. t)nllwirn conrply *ilh lhoc !n,vi\i.ns
<br />W,\RNIN(; Frihrc b \mur. {rtrkc^ o'nprn$rior co\rrrgc i\ trnL$llrl. rnd \hrll \lhiccr n'r ci\nor_.r h dimirrl,r.trrl,ic\ rtrd
<br />civil linc\ !p (, otrc hondrcd rhousaid dolh^ rSlU).UXr. ld rd ii(nr ro rhc ..i of.o'np.i\rrn r. dr rgcs rs frcv cd tur rhc
<br />:2,-(fo,r", 8 - 2
<br />l.lt!L!-8rr.!a!
<br />I h.rcby ofirm undcr lc.allyofpcrJury rhat I !m liens'd undcr r{,vhion ofChrplcr 9 (conrmmins *irh S(rtn 7u)0, orDivtion.l
<br />ol th. Busimssdd PmrcssionsCodr, ard my lic.sc h in tullfoi.c dxl cflacr
<br />Licctrscclasr l-,.ctr\. Nun$cr
<br />o*" Q q:-- tB
<br />I hcrchy!filrmun'lcrFnihyoipcrjurylhrr rhcrcka conshcrhn lcndin8 rEcncy for rhc p.riorroncc oiih.*o r{r *hich rhi\ f.nnir $
<br />is{rl (Sc. 1097.Ciu C )
<br />ASJ.ICINIDI;II,I.BAII!}N
<br />I ltrcby unim undcr Il.nal,, of p.rj!ry otu ollhc folk,*ins dccltrftlionr
<br />Dcflrolition Pcirnik.Ashc(os Nolificdion lcdcral Rcgul.rions ('rirb40. Pd6)
<br />-Rcqunc<l
<br />t llcrof Notificdion
<br />l(dilyrhJr rhclaJcrrlregul ri.ns rcB3rding r\lf,nos rcnn,vrl r.c norr||r icrhtu n) rhn fRlccr
<br />lcrnili rlrr I hrt rcrdrhi\ rltl
<br />odinrnrc\ rnd Srnrc Lrwsrhine k)
<br />rh'vc nrtrri,nrn nn)lrny fin insp.cr
<br />nrM {rrurhrrrlEnhvc irlhnuri,u i\.orc.r I rlrudr,.otridywihrllCi'y{trd Q)unly
<br />n! con{tucrii)n. rnd hctu6)- rurl,o'i/c 'r|rrr\otrrrr \c\ otrhN ( rry r rlCrtriryt,.trrcr uJr{r thc
<br />9->z-t8
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