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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNEN BUIT,DER DELCARATION
<br />I hdrchy ifilri trndcr pcndry ('r FrJnry rhar Ln.rcmfl rbn rhc C.nr,.h^ Lic.n* bw tur thc ,olloeirs rc!$n {Scc.7oll 5
<br />ausincss trft1 Prolcsion Codc): Any Ciry or County shi.h rcquncs a pcnnh ro onsrtucr. ahs, iopolc. &mlhh N rcNn ony
<br />{ructurc. prntr to irs GsuMcc, aho requircs rhc aprlicrnt lorsuch D(rmit ro fiLs !i! cd i0r.nrnr rh h.ordr k liccnscd ,)uNinr
<br />Io rhc provisions of rh. (1) mctois Liccnrcd Lar (Ch.rtcr 9. Connmrcin8 rirh Sccrion ?(&) ofl)ivision:l ofrh. Busims rkl
<br />Pron$ions Codc ) or lhal hcorshe neicmDl lhcrclronandlhc basn for lhc allcsdcrcmprn,n Any vn,hrionorsccrionT0ll.s bya.y
<br />rmli. r fo. a pcrdn \rhjen rh. drplicanr b d.ivil ,.nalry ot nor nkrc rhM fiv. hu.drM dollrs (SsuJ)
<br />-l.
<br />rs owncr oi lhc prolf,ny. or nry cmpk,yc$ wirh euscs rs rhcn {,b onrll.nsd ion. will du th. work rl lh. srf,rIurc ir ml
<br />nncndcn or oltcrcd nr sb ( S( 7044- Burinc\r lid Prolcsshi\ Codc Th. Conr,.hr's Licctrrc I-l* des not 0p!ly lo !n owmr of
<br />th. popcny *ho huilds ur i'iq,orcs rhcrcon. and who dds skh wor* hnnsclr or hcrslf or rhrcush his or h( osn cnPl.yccs,
<br />providcd rhal such imrmrmnls N ml idcnd.n o, or.r.n nr et ll howcw, trt huildi.e or h{'oEnrnr ir s! qnhin oe ,tr
<br />of.ompldion. rh. osner Buihcr *ill haE thc burdcn or pmving lhd hc or sh. dil mr buiu or inDmw rt. I)mF 1y ror rhc tuqr$ oi
<br />_1, usowNrofrhc prol].ny. rncrcld\i*lycontrc(ins wirh liccnscd conta.t,s k' otrsflcr rlE rojcd (Scc. ?014. Bu$ne$
<br />rM t')lotc$bn Codc: Thc Conk ui Liccnse tjw docs not apply lo m owncr oa prolErry *ho hoild\ or impr.rts rhcrcon.
<br />und *ho conlmcls aor slch p!)jccB $irh r Coirack,(s) li.co\cd pu udn' r.rh.cbftadors Liccns L!w)
<br />uoatrrxti:glMtBraua!
<br />DECLARAIlON
<br />I hcreby olfiirn undcr pcmlty ot pdjury orc oalhc aollowing d(luarion!:
<br />-l
<br />nrvc n will mihtdn ! CcniaEarc of Consot ro Sclf lnsrE lm worts .oftpereraon, s Fo,id.rl for by Sdion 1700 ol thc
<br />kbor Codc. ror rhc p.raormne of rfic wort ld rhich th. I,6mit h issucd.
<br />_l hovc and r ill mainlaifl worlcs .odpc.s.rion insudtue, $ Equied by Sdrion ! 70o of rh. kbo. Codc, for lhc pdfomrcc of
<br />ir n i\\ucd Mrwo crr con,Fnslin,n nNrrntu.Mi.r dnd Bnicynuft.rm
<br />I
<br />vlCo t.r.\4
<br />I ccnify rh,r in rhc pdfornam. oirhc work for *hi.h rhh p.rnri n Gsurd. I shollnor cnulot lny pcnoi in any nMnncr
<br />$ N lo b.com suhjccl to th. worlcs'o'nDcnsarn'n liws ol CuliLmi!. 4d lsm rhlr ir I should h..omc sulrjst ro thc
<br />Borkm c.nFnsurion lmvisions olSccrt,n:ITIDolrhe ljh, Ordc,I \h,ll. fodhsirh.onrly wirh rhoe Fmlninns
<br />WARNIN(; F,ilurc ro r.urc sorkcr omDcnsriotr covcrisc is unlNtul. and shill \ubicr 3n chplo)$ b dinnnll IENlti\ lnd
<br />i:.I,li)fr ii{r,![iqd:r[$l dollaF ($lm.Ooo). in addition lo rhe.osr ol compcrelion. drmges ns providcd fo! lhc
<br />I hcr.hy anrarunds,'.nrlryolFrjuryrhar I m lic.n{n u r pn)ri\n,n olChnprd qr.o ncNirS Nirh Sccri(nl T0UrrolUlri!on.l
<br />of rlr Burincss aM PNlcssiors Codc. ond nry lkcnsc is ir full rbrc !M clle.'l
<br />q)NIIAIJEIIONI.ENDINC.{CDNII
<br />I hcrch, afinm undc, Fnrhyoircrjuryrhlrrhcrc isaconddcrirn lcndin!rs.ky rorrh.l( oarNce ofrhc work rbr which
<br />'hi\ Fnir i\
<br />issucd(sc 1097.civ c.)
<br />A}ILICANLDECLINAUA!
<br />I hntJt altm u nd.i pcnrhyorpcrjuryonc of'tu rolowinB dc.hmrions:
<br />Dcnx,lirk,n Prrnirs Arhros Norilicaliotr Fcdcml Rcguldions (Tirlc40, P#6)
<br />R.gu,rcd trtrfi of N.lili.alion
<br />I .cniry rhrl rh. fcdf l rcgul.rions rcSrdin8 Ntrslo\ rcnnv0l orc .ol rnplicahlc r. rnir trujftr
<br />F,*::*:0r I hdr rcadrhnaDplicarion a' (rrr rhirrhcahrc innnfBri,,n i\..m.r lrlroro..nrtlr*irhrllCiryrtrdCounry
<br />sfulc l]qsrcldin8 ro huiliinE rho't.r.ltr.\rnrrr,vr\ otrhn Ciryxtrd C.trnryii rtrrrr trJx llf,
<br />|tt,vc mtun,md poFny r0 i,rsPicr
<br />,\Dplir l or,\sr l Six ilu
<br />65"
<br />tuil 1 f 7n18
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor
<br />Bondino / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Ivleter Release
<br />Rough Clt-o (g )tWtl
<br />Service lvleter
<br />FINAL 4Z 9\c s
<br />Notes, Remarks, Etc
<br />ID/SIG,
<br />I un.rrnr|r tr .r Sc.rnn . B & l'j( l(nrhnr.rvn,
<br />l)arc (rRn..:
<br />Irretn^b.t*'JtlNatlslo '-'^*.(tu h//rtr.
<br />Lcndcl.. Ndm
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