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ELECTRICAL.INSPECTOR RECORD
<br />ID/SIG.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 />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / 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 />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service Meter
<br />FINAL to ll lty -{-{/ 7 (/'y
<br />Notes, Remarks, Etc
<br />OWNER AUILDER DELCNRATION
<br />I hcicby aftirr u d.r ncn,lry or !.rjury Ihal Ln .x.npr ro'n rhc conttrctoF Liccn$ Ljw lbr rhc followin8 rca$t (Scc 7011.5.
<br />Itusincss and Prolcsion Codc): Any Cily or County wfith rcquncs ! pcrnril lo conntud. ahcr, inlrolc, dcnnich or tlah Mt
<br />nocn,c- ,rin r{, irs issunce. rho ,equircs rhc lpplica tor slch I.ml t, fi|. a \i8ncd sd!.,mnr rhd h. or snc i( liccnsln puN,nr
<br />to thc pmvnions of riE Conlrsclors Liccnsd lj* (Chaptcr 9, Connmrcins wilh Scction 7000 of Divhbn I or rh. Busincs rnd
<br />PrclcssionsCldc) orrhal h.orshc iscxcarfl lncrcfromnndtu bash for lhc sllcscd cxcnDlion. Anr!t ari.n of Sdion T0l l 5 br&t
<br />!mlic..l lor r rcrmil subjals rhc lprrliclnr to u civil pemlryofnol nrxc rhan filc hu.drcd dolhs ($500)
<br />-l-
<br />os osn , oi rhe pmpcny. .r my cnDlolcc\ wirh wr8es .{ rhct nn. coDt^-osu' ion. Bill do rh. worli ri rh. iturm i. frn
<br />n cr cd oroiTcrcd f{r elc (Sm 7O1:l. Bu\inc$ rnd Profcssions C{xlc 'Ihe G)nh.n, s Licdi* La* des nor nly ro a.ouNr ol
<br />rhcI[Fny wlt) hlild\ or ituravc! rhcRr rri who d,xs \kh work hnnscllor hcr*lf.r rhnu8h hh or hcr o$tr cmployccs.
<br />provnldl rh \rch im|,ownEnls orc nor inrcndcn or oflarrd fn slc. ll ho$crcr. rh. tuiilin3 or irym(..nr h btl wirhin om )rr
<br />olcon crion- rhc Owncr DuikLr will hlr rhc hr ci oi I,rolins rhlr hc or shc dil nor build o! imptuvc ihc ldFiy f.r $c NqxM ol
<br />-1.
<br />asosncrofrhc prorcny, !ndch\iklyconrecrins wirh licenscd connackx ro c.n{tu.t rh. pnrlc.r {sd. 101.4. Busmcs
<br />ond &nfssbn Codc: Thc C.nk t*t Li.cnsr Law docs nor stply b n. .wncr ol prct^..ny qno builds or i.rprorcs lncrcon.
<br />ind *ho conuocB for slch pmirls *irh a Co m.to(,liccnscd ruBuonr to rhc Contrsr(tr's Li.Tn\e ljN)
<br />-l
<br />amcrc,n/ undcr Scctiotr- B. & P C for this rceso.
<br />0rner:
<br />!IaB$;B sUt[X$LION
<br />IIECLAIAIII}!
<br />I hcrcny if,tnrunder pcnnlryof pcrjurrnnc.f rhc iolbsn'E dcclamlion\
<br />l ha\r dil will mrinrJn d Ccnntui(c ol Consctrr tu Sclf.lNrrc rrtrB.rkcrs coDEnsnriotr. as rruvidcd lorhyS.crn,n:17ff)ofrhc
<br />ljtxtr Codc. ror rhe pcrforronccofrhc trork for*hichrhc pcrmir n n\!cd
<br />I h,vcrnd will mridrin wortc.i comp€nsatio insurrncc. as rcquted hySccrion3?Orroflhc l,'bor Codc. rd rhc ncrronnnmc of
<br />rhc uork forsnichlhn pcnnir is tso.i Mysorkcc .ompcnslrb. iosumrccc@., d polky nxnib.r *.:
<br />-Errt
<br />r
<br />I c.rifyrhrr nr rhc r.rf.nn.n coflh. sork li,r qhi.hihis p.rnn is isucd.l shull nor cmtloyrnyp.6on in anynrntur
<br />$ d lo lEonr subjcd ro rhe wortcr empens ion luws.fclliaorni!. aod rarr rhd irI \lk td hc.oft rubj.\t lo ltr
<br />workcn clmlcnsation [ori\ions of Sccrion 37mof rhc l-anor Ane I ihall. fonhwirhdnnply wirh rtxr* n$visbns..
<br />WARNIN(;: f ilu.: t, *-ti. *o&crl.o rtr snri()n ovctugc i\ unlxwlul. d {hrll \uhi..r rr cmfk)ycr lo.ri'nnallr.nrlri.\ a
<br />cnil [nc\ uf k,otu hundrcd rhou\lnd dollr\ (Slu)(xl)r. i'i rddir nt, rhL co{ ol compcr\rrion. dr.u'8.s rs prt,lidcd n th.
<br />Sdti.n loTaolrh.l rt ra.dc inr.rcnanda.rmv\
<br />,.,", 1--\A-l% ^,,,*,,@+ek-st
<br />DECI4BAII(A
<br />I hcrcby!fimuods pcnalry of r.rjury rhat I aor li€cn*d lnder ftuvhio, otch{pro 9(.om@ncing wilh Scction 7Ol)0) olDilision l
<br />oa lh. Bnsims md Pmfc$ion! Codc. ard my lkcns ir in tull foe s,n dld.
<br />,-"**."*,c_\o .""",".,.*,q[otqb b{.SI8...*-,So\a-f^
<br />I herchy rl.lnm undcr $n.llyolpcrjulyrhJl rhcr i\ a consrr.rt,n lcnlios xcdi.y tr rhc Nn.xrun c olrhc worl li,r which rhis rannir h
<br />is{rcd (Scc 1097. Civ C ).
<br />AIIU!:!-NI:!EUI-ts\[A!
<br />Irxarl,y li'nr rld l,rfr rI.r nrr]lry.n. !lr[d n,][r\ i"g d..ltrri(n,\
<br />I).rtr.hr(r |r'nrir\ A\lr(o\ Nor'1'rdii, ' lc .rrj l{c!ulri|tr\ Il 1..11).l'( ar
<br />Rrqunc lrr.' rlNor'li.l nr
<br />l(.,r'1)rl'rrrh.1r,Lrn".gtrrrtrtrNk!rnltr,gr\h(r\nrr\rr.nolrf!ltrrh.!)1lr\Dnj(rr
<br />ordirtrn..\ Md Srrr. lnwr rclrrirA nr co.(rucrn,n. Md hcrcby rurho.Tc {nr ivcs oirht Ciry rnd Cornry t(). icrutx rhc
<br />rhrc nrnri.ncJ pmptn, for
<br />Arllicrnt o. AB.nl Signolur'
<br />S cw-(\^ ?(A
<br />APPROVALS DATE
<br />Meter Release
<br />I rtul.''. \ lJ'rs
<br />\8
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