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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilin gs (T-Bar Rough)
<br />lVleter Release
<br />Rough 1-t o -r7 lZc zlt*4s
<br />FINAL Lll?.lt T /-/ztr/t4 )
<br />Notes, Remarks, Etc
<br />OWNER BUILDER DEI-CAI'ATION
<br />I hcrcby ,ifum undcr p.nnlly {,f pcrjury lhll I m cxcmpt fmm rh. conhacrou' Ltcnsc L.R for thc followins .caq'n (S< 70.11.5
<br />Brsincs and Pofc$io. Codc)r Any Ciry or Counry whth rcqutcs u ,c,.rir ro .on\rrucr. llrcr. ifrrmrc. d.mli$ ur rctDir {ny
<br />strucrm. Frio,b its isquan.c, al$,.qun srh. alpli.mr r.r such p.iini o fil. r siBncd sr.rcmnr thll hcor shc h liccnsd pu^uanr
<br />tu Uc l,{,lnions of dr Coirra.ktr\ Li.cnkd L* (Chaprcr '1, Conm.cina wirh Sc.tion 7fllo ol Dirision 3.f lnc Busirrcss nnd
<br />Pmfc$n,rs Cod.) or rhd hcorsh. is cxcnDl lh.rcaroMnd OE barir r.r rlr .lLBcd cxcmptiotr. Any liohlion ofSalion T0.ll 5 by uny
<br />applicanl for a pcrmil suhtccls Ihc appliconl lo acitilpcmltyoinor mrclhan fivc hundrc{j dolh6 ($50)
<br />_1, ,\ .wncr or rhc ttuFny. .r my cnrd.yes wilh wrgcs ,r rh.ir vrlc o Dcnsdidr. will do rhc srk atrd Esurure h mr
<br />i.rcndcd or ollcrcd aor ik {Se 7044. ausimss and Pml.srn,ns (ixic:ltu Conta.t, s t-i.cn{ bw dms nor amly lo an ownc.of
<br />ric ptr,pcry qh. builds or imDrolcs rlNn. a *lrdessu.h"orkhnn,clforhc^cliorrhmushhisorhcrowo.mpk'yccs.
<br />!ruvidcd rhar such ifrpovcn.ms d tur inrcnd,n or oafcrc{i for sale ll ho$cvri rhc hnikling or inprowmnr i\ $kl {ithin on. )td
<br />ofconplcriotr.rtEOqNrBuildssillh.v.lhchurdcnofphvinSrlxnh.or$cd n.r hild .r nr!r()h thc fop.ny for rhc purlx)s.f
<br />-1.
<br />os owrcr of lhc pmpcny. rnrexclusivciycont0crir8 wilI li.cn{d conlmclos to construcl lh€ pmrc<r (S$ 7044, Bu\iE\1
<br />rxl Po{F\ion Codc: Thc Coorra.rois Lkcn\c liw docs nor aptly ro an osncr orpn,pcn, *h() brild\ or anptulcs lhcrcon.
<br />and who.ontr&lsntrsuchr4cctssilh0Conra.to(rlic€.i.dpunMmk'lhcconkcror'sLic.nsctjs)
<br />-la
<br />cxcnflundcrsdion ,B.&PC forlhh,cuson.
<br />D.lc Ownerl
<br />wonxgis_ ( r tMPF,\SATIt)N
<br />DECIAf,AIIA!
<br />I hcrcby orfi rfl undcr p.Mhyolp.rjuryom.lrhc lollownrg delmrio.sl
<br />-l
<br />havc od will mi.(ain r CcdiaEarc of Co.snr ro scll.l'NuB r.r wortoi .omp€trsolion. !s providcd for by SNr io. l?(x) or rhc
<br />bi.r C, .. for th. pctt.rmmc ot rhc $('ll for which the pdnir i\ isru.d.
<br />rnd lvill n rin *orkcrs'compc t,\SccrionlT0oo! rhc Llhor Codc- for rh.rdroiin,mc.r
<br />coricr lnd policy numh.r m:My
<br />ODDOD .L5Y \2
<br />-l
<br />ccnilrrhar in rhcllLrntrmEc ofrh.sork ftn whichrni\ pcnnir is GrcJ. I\h!llnor. Dh,tr y p.is.n i.rny m,nncr
<br />n' asro lh... r. suhjc.r ro rh. workcn co'nFtrsarn,n lrwr otcrlirr.iJ. and 4N rh rrl shruld hccom subia o lhc
<br />woikeri LlnlP.n\di,n Fovnidns of Sc.r ion l?m of rhr trhtr Cdlc, I rhall, n,nhwilh onllrly s kh rkrr provhions
<br />WAltNlN(; hilurc k, {ctrr. s.rk.h conr|{r\dnr (o\r g. i\ r r!,ul. rtril
<br />I lr'ch!xllnmu dcrpoulryof |trpryihrr Ixmlr.ci{alundorInorL\i,{fl i 9lconmncirB wilh SGlion 7([x)) of Oivi.n,n:]
<br />oi rhe Blsincs and Pmfesions Codc- and my liccn* is in lul fi)re and cfts!
<br />N t )
<br />ho
<br />I hctuhy rnlnnrtolcr pcMlryofpctury rhrt rhdc is a r.n!rtudion kidi'ig,gcn.y ld rhc lcrfoinDNc
<br />n$rcd (Scc.309?. Civ C.)
<br />qork lor whch rhh pllnir h
<br />AIII.ICANLDECI"AaAID!
<br />lH'ydflirmundcr pcnahy o, t'.rjury orc oflie lolhwin3 d(laratioDs:
<br />DcnElirio. P$nirlAsbcsos Noli6calion Fcdc6l R.Bul,rions arirlc 40. Pd6)
<br />Rcquircd trxcr ol Norifrark n
<br />z. dlr.scnrarivcs ofrhis Cn
<br />COMMENTS
<br />Communications Cable
<br />Under Slab / Floor
<br />Air Conditioners
<br />Service IVIeter
<br />.Y
<br />-l
<br />ccnifyrtlr rhc lcdcnl rcellar ioni EssdnrE a{Enos rcm,val arc nor applt,}'lc lo rhis pdjc.r
<br />1
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