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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountarns
<br />Si gns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service Meter
<br />.^rl ertJ(FINAL q tq,tK'ia ,9)
<br />Notes, Remarks, Etc.U\I
<br />OWNER BUILDER DELCARAIION
<br />I hcrchy aafirm undcr pcnrlry of f*.ju!y rh l m cichpr lnm rhc ConlEck a Lic.nre Las f(tr fi. following r.rson (Se ?031.5
<br />Busii.* and Profcsion Codc): Any Ciry or Ciunr, which rcqlircs a l,.mir l. <onslru.r. alr.r, improw. {r.nDlish or Entrn !try
<br />{tu rm, prid r. irs hruu... ,lqr requn s rh. ,ptlka.{ ror s!.h Frmir ro lilc a sitkd sntm thd nc or shc is liccnsd purslnl
<br />ro rhe lrovirions ol tlE Conrncrols Lkcnsd h{ (Chlprcr 9. Conurcn.in8 *irh Sccrion ?OOO ol Divnion I6f rhc 3u\n'crs rnd
<br />Prorcssion\Co!c)orrhlr hcor\h. is cicnDr rh.relmmand rhchrsis a{r rhc ilLgcd dxc!ryd,r. Atry violnti.trofSccrionT03l.5 hyony
<br />opplicrnr for 0 pc.nir subrcc$ lhc iFpliconl lo ocivilpc.,ltrofnor morclh.n livc hundcddolnus (5500).
<br />l. as o*er of rhc pn!.ny, ui my cmrk)yc.\ wnh wuscs as rhct {rk .\,mp.nsarn r, will do rh. wo* ,ld lh. (ulm is ml
<br />inrcklcd o. orcrcd rr eh (Sd.7O&, Ausircss and Proa.sions Gxlc: Thc Co,rr.dois Li.cnsc Ln* docs nol amlr ro an owncr of
<br />rhc p'.pcny wln l,uilds or im|nolcs rhcftoi.,trd who d{Es such wnl hinNcllor hc clforrhn,uAhhhorhctosncnDloyccs.
<br />orovidcd rhrr such i$prormnk m nor inhqlcd or offcred ior s.lc ll ,rNo.r, rhc huilding or in{rokmm k v,ld *ithir onc )ur
<br />.lconphti.tr, rh. owRr auiLlc. wil huvc lhc hul&n ol tovinS rnd tu or shc dn d, hoitl or iryr('vc rh. pR,p.ny ror th. pu4srol
<br />-l.rsowrcrofrhc|n)r^-ny.anrcrclusntlrcorrrucrinswilhliccnscdcotrkrcr{'Nk'.o(tu.rrh.pftic.r(ss7lq-1,susrnc$r h)fssi'n Codc: lhc Conkactr: l-i..i\c t-asd.c\ noi flntlyb rn.wnrrol pnrp.nywh(, huilds or nnprovcs rherco0.
<br />rnd who codmck f{tr such lmtcd\ wirh 0 Conki.kn( s) liccnscd purmnr ro rhc Conln.r.i{ l,icctrk ljw)
<br />-l
<br />!n cxcnrpr undq Sr-^li0
<br />Dalc: O"ncr-wonriqsiaoMPrNali6-
<br />DECI.Af,AIION
<br />I hereby !firmunds pcmlry ot pcrjury oe oalne fouowinr dNldalions:
<br />l3l h:"c lrd e ill minhm ! Ccn ificotc of Conscd ro Sclr.lnsurc for ertcN ompcBarion, a! ttuvrlcd lor by Selion l70O of lhc
<br />l)60r Codc. lor rhc Fn.rmR orrhc wrk fm qhkh thc psmt n Fsuct.
<br />_l har and will mainrain sort*l conFnsadoo inslrnke. as rcqutcd by Srrion 3700 oflhc tjbor Codc, for lhc p€rtortun.c of
<br />sdrkcn unlnotr\i otr nrd'rn.c c ricr d Fl'.yiunrhcrarc
<br />q 73L15Y €1q
<br />I ccnily ihlr in rhc p.rloiiumc ofrhc work r(, which rhi\ pcnnir n is\urd. I \hnll tror cmfl(!y rny pcnon in 0ny nrMncr
<br />$ sk, tt..m \uhj..r bthc*orkcn onlftrs on hws .r C,linmi!. .nd a8rc hln iiI shoul(l bcconf, suhic(rrorhc
<br />wurk.ri .un!c \ar n f()vnt,ns .f S.rrion l70O of thc bhn Gxlc, I slkll, lo hN irh contly s ilh lhnE pmlhnnr
<br />ll \ubtc.r r. cnrb)$ lo .rnnirml pcniltii and
<br />or.omr.nsdtun. da,mgcs !s provided tur lhc
<br />I h.toby rlliro rodcr p.Mlryorp.rjury rhri I an li.cn{rl xidrr phli\n ofChdrrs 9 (co,nnrNin8 wilh Scclion 70(x)) ofDivkion l
<br />or lhe Busioc$rnd Pror'cssiqr Codc, rBl nry liccn\c h in ri,lllnrcmdcffccr
<br />c
<br />'1,(t
<br />I tcrch, 3lfirnr u.dcr pcmlryolpcrjury
<br />hsu.d (Scc lr)97. Civ C )
<br />rhrto isacondtocri,n kndin8agcncy fn rh. ,rrfornukc of rh( work tu shth lhi! Frmir k
<br />AIIUIANfI]ECI.AEAII!]N
<br />I lr['by ollin undcr pctrolty oi rcrP.y onc ofrhc fouowirE d(ladtuns:
<br />Dcmlil,on P.rnireAsb.{os Norificalion Fcd€r.l R.Bulal ions ITnl. &, P.n6)
<br />Rcquircd l.rtcr of Noifetbn
<br />nrJ,ly *irh ill Clrt rnd C Lnrv
<br />( irr- ind (i)utrry ro.n0 trtrn, rlf,
<br />,","4",,,
<br />*Jr,"
<br />Pole Bases
<br />V:
<br />/ nDv^c 2
<br />t nd.as Addr..r
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