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APPROVALS DATE ID/SIG.COMMENTS
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />Spas, Pool, Founlains
<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 />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service lVleter
<br />@trurtAFINALL//4///-/tD -
<br />Notes, Remarks, Etc
<br />-v
<br />OWNER BUILDER DELCARATION
<br />I hcrcb] .innr undcr Nmlty oI Frlury rhar I m .xcmpl frcm rh. Conlr0clos t,icense Li* lor rhc lolbwiog t r$tr (s.. 70.11.5
<br />Blsircss und Pft'fcsion Codcl: An, Ciry or Colnry *hich rcqtircr r lrcdrir t, con\lrucr. alrcr, imptuvc. dc'nolkh or rcn0n uly
<br />{fl.rurc, Irior tu irs hsurn.o. rko rcqutcs lhc rprlicMt ro. lu.h pcrnln b fih n si8rcd lltmnt lhol hc .r shc h licci*d pu^uh
<br />io rhc polisions ot rhc Conrrs.tr's l-lc.nsd Ij$ lchnprcr 9, Commctuin! wirh sccrion ?fi)o ol Divhion 3 of lhc Inrines a.d
<br />PmicssionsCod.)orrh.ih.orshciscxcnqrhcenosaftlrh.tusiforrhc.llc3cdcxcnprion.Anyvi.htionofScclionT0ll5hyany
<br />applic.nl f.r r ,.rnril rubFch rh. rypliconr lo ! civil pc.dry of nor mrc rhu fivc hu nd'aal doue\ (S5m)
<br />I. as owncr or rh. ,mr.ny. or nry lnrlloyccs wilh wa8cs !s rhcn bb cornpctrsrn r. will (kr tht sort ud rhc dMruc n ton
<br />irtcnncd ororcrcd lo! slc 1Sa.7044, ltlsiEs flnd Pmfcsions Codc: Thc Co riclff s t,ic.n\c I-,w rcsnoramlrroatroRncrof
<br />rhd pftDcn, *tx, hikls or inprovc* lh.d r.dd whodods\!ch*orkhimsclr.r hcrscllorlhmuahhh or tu, or'! cdplolecs.
<br />lrovi.lcd rhor such inrpmwrEnrs N tror inrcndcd or onircd aor \!l€ ll. no*cEr, rhc boildinS or impmkrm is sold within .N FJr
<br />ofcomplcrion. riE owrcr Buikcr will harc ll.c burdcn of povirr8 d,r tE or shc dil ml llliu or u.aevc rhc pmFi, ror 'h lUrF,* or
<br />-1.
<br />!sowncroirhc prcpcny- amqclu\ilcl,coDrracrins sirh liccnsd conti.bn tJ .on{tu.r rh. rnicr (scc 701-1.8unnc$
<br />rM PnrrssirnCodcrlhcConl!rcro.sl-iccnsctiwdosmlnptlyroatrowncroltmpcnywhobuild\orinrpn,vcsrl'.rco.
<br />ond who co mcls tor such lmjccrs qirh r Conlmcro(, liccnscd puruanr r{' rhc Codrlclois l,i.ci* Ldu).
<br />-l
<br />anrcxcmpl u.dn Sclion
<br />u!}tstr[&s:l;o]lfjNsAJ]Q!
<br />DECIAAA.IIO!
<br />Ihdrchydfnn uidcr pdidryofp.ruryoN ofrhc foll{,wi',8 dc.l[ iotrs
<br />I htrlr hlwill nbinr4in aC.nir-rc,rc.lconrcn' r, scltln{.. for uork.( conr.$,rion.0s lrcvidcdlbrbySalinnl?(x)orrne
<br />L,l,or Codc. for rhc pertornunc€ of rhc work for wnkh rhe pcflnir h k cd
<br />_l ha\tanlvillnri iir *orkcs' .onrFtr\or ion iNumn.c- r! rcquitcd hySccrion.lT(X)olrhc lrhrCodc. f.rrhcr.rf,rnDmcuf
<br />Fnnil n isrucd. My workcr'.(nnrcn iur ir\urincc. tricr d.d rnicytutr'hcr ra.
<br />lo't -.1 1*-
<br />I ccniry rhit in rh. f[iform,tuc df rh. $ ork for *hi.h rhr l. trir is nsucd. l null nol cmploy rny pcFon in an! manrcr
<br />$ !s lo bcLrm uhjccr ro rhc soi(cn'conD(n\alion l.w\ or Colilornil snd lgN rhn' ill should ttolE nrblctt ro rhc
<br />sorkcN.onrF.snlionpmvhionsolSccri,rnlT(roolrhcL,atnrCodc,l\h,ll.lonhwirhc.nrtlywirhrho*Inovhiom
<br />C<),-17 555
<br />,2-3_t^tt€Grz,aS*er-
<br />!:ANEIBIJqIIIIIIENDINCTAEICI
<br />I hcnby nfitf, under pc,ahy ol lcrjury lhlt lhft n ! onslrudion kndiB oscrcy lnr lhc psaornDtc .f rhc work for which lht Frmil is
<br />h\!cd (Sc. :ll)97. Civ. C.)
<br />AIELUANLIIES,TBAIIO!
<br />I Mrt affid unlcr p.nrhyorp.rjnry orc ol'hc aolto*ing d..lfi,ri.ns:
<br />t).mlirion Pcnnirs AslEsros Notifi.arn,n Fcdcr.l Rqulartuns (lirlc 40. Pd6)
<br />-Req!ncd
<br />llus olNoritr.drion
<br />I.enirl_rhrr Ihc fcdcr lrclrlnrion\ (g tnin! r\hrno\..trxrrlrrr mrxmli. lch,rhnnr,Ir.r
<br />-l
<br />ccdiiyrh[ lhn\c rc!d rIi{apnli.riion rnJ (rrcrhrr rhd itx'\. i',n]rmarion i\.otrccr lrgftcr o.omplywitnlll Cilyaftl Counl,
<br />lhn Cily and Counly ro enrs uF. fic
<br />^,",=?-al-t Z
<br />okiinrnccs! Srirc lrx rclaringt, huildinC.oi{D.ri{
<br />rbrc mnlioncd propcny io. inspcc
<br />l\Dpliotrlor /lg.trlsi8$l
<br />Sll E,-l€b
<br />ELECTRICAL-INSPECTOR RECORD
<br />Site-Work
<br />WARNING: Fuihic k k.ue workcB orll[ns{n,n covcE!. is unlaufnl. $d shlll subict on cnplort, !o mdi'll |rtuhi* trnd
<br />.ivil 6n.s xp ro onc huflircd rhousand dollaN {S10o.000), h addition ro rhc cnsr ofconvEnsar o. d,oa8.r s rmvid.n lor rh.
<br />S€lio, 10?6 of lnc hbor Codc. inlcrcst and arlonry r fccs
<br />",,,, 1-3i-tk npp,*,,E l4D 3l-,84\zl.\ -.
<br />UIENSEILCINIAASI]A
<br />DECi ARATI(TN
<br />I h€reby affirm u cr rcnshy oi pcrjury rhnr Lh licn{n undcr ltr.liri.n .t Chdpr$ 9 (.om,rcn.inB with Sdion 7000) ot Divi\io. 3
<br />of lhc BusiNssa PmfcssionsCodc. od my liccns h in iull force dcfltcr
<br />I T-----
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