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ELE RICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.boMMtNrs <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Si gns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bonding / Grounding i UFER <br />Transformers <br />Torqueino <br />Air Conditioners <br />Rool Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouqh) <br />lvleter Release <br />Rough <br />I <br />FINAL L rytlllx a,trill- t n <br />Notes, Remarks, Etc <br />OWNER AUlI,DOII DELCARATIoN <br />I hurcby rrinn utulor pcnnlry or poju.y rh.r I m crc8fl riom rhc Conr,cur Lncnsc L!* ior rhc rirlkJ*ing tcrsn (Sccr0ll5 <br />Busincs ond Pmn$ion Codc)r Any Cily or Counry *hi.h rcquiEs a pcflnir t, .oindd. r&, nnpiovc. d.mlish nr rcldn ony <br />{dcrurc, nritr t' ir\ nsuur.c.,ls, rcquir* rh. {tlictur f.rsuch Frmi r) nh i siBr.d latcnf,nr rhrl hcor shc h licensd ou^uanr <br />r. lhc pmvkiotrs of rlE C.nrracrols Liccn*d Llw (Chlprcr 9. ComnrncinE wirh sc.ri.n 7000 or oivnion I ol'lhc Busnrc$ and <br />PFn$ionsCodc)orrhlrtorshctcr.dprrhcrcrmnandrh.hasi\rorrhcalh!.d.xcmpti,rn.AnyriolilionolSa'i,n7O.ll5byLny <br />amlicnnr tu a tErnrir suhjc.rs rh. ,ttli.ant tu,.ivilpcn ryornor ftnc rhan nvc hutrdrcn dolltrs (S5m) <br />-1. <br />as owRr ol rh. I'()I)cny. or my emnlorcs wilh sascs ar rhct wlc confrtr{ra(nr, *ill do rrc uork md rhc nmruE h mr <br />nn.Mcil orofi.rcd frtr{tc(Sd.70t{, BusiRs* aM Pmfci\ions (-odc Thc Conto.rols Li.cnsc t w docs ml !ppl} ro an oen& of <br />lhcrmpeny phot ilds or improts rheNtr ud uho dcs such m hinrEllorhc^claorrh&lBhhi{oihciowncnDhyccs. <br />providcd rh slch impmve'rnrsm tror idcdlcd oroflcrcd lorslc.lt hd*e!.i rh€ brildin8 or impmlrm h$H*ithinorcycu <br />of conplclion- tlrc Owncr Buiklc *ill hls llE hurncn ol pmvin8 rlu hc o hc did mr tiuitl or itrqrer lhc pmrEny ritr <br />'h. <br />puts$ ur <br />L os owrcr or r hc Frpcny. oar erclusivcly .onlrooins wnh liccnrcd conrrNk,F b onddd rhc pK,jcr (sc. 7044. Busircrs <br />anl h'fLx\in Codc: 'l hc Conrrlcrois Liccnsc Law docs nor lprly ro an owncr.rprop.ri), sho builds.r imlroves rhcrcon- <br />dnd sho co m.B fo! sucn rojcds sith r Co.lE rons) lion{d N^u$r rorhcColxlacrffi l,rcc0sc ljw) <br />-l <br />.n excmpl under S(l ion-. B & P.C. for lhis Eav,n <br />]TOAtrIBS.:CIJMIENIAIION <br />DEUANAIO <br />I hdrchy Dinrh utrdcr pdnahyof tdjuryon of rh. followi"g d6_lrrdliotrs <br />-l <br />h!!c md sill minrain ! Ccn ificdc or c.n€nr b selr l nsu.c rr *ork r\' .onwns{ io., .\ nrcvidcd for h, Srcri,n ]70(r .f rh. <br />L3bor Codc. tor rnc pcr{olmrcc ot rhc *ork tu ehicn I h. pcnnil k issud <br />I h.rr.nd will mai .ir *orkcF .onlPctrsor ion insurr..c. {s rcquircd hyScclion 3?o0ol'rhc IrhorCodc. for rhc BYlornuncc ol <br />lhc aork lhr whi.h rhh rcmrir is ksuct. M, wortc comlcns0lion insurorcc ca cr dF,li.ymfrb.rft <br />_lccnily rhBr in rhc pcrfortutud oftlE work for *hi.h rhis lrrnrir is issDcd- I shill mr cmpLy ony pc6on in any mnn r <br />s as ro b..onr subir ro rhc workcc comrcnslrion l.*s ofcalibrnir. and asrc rhar irl shodd b..om subjctr ro thc <br />worlcrr conrpcnsllion nrcvhions olSdion lT0Ooflhc ljtr. Codc.l slDll. fonhwirh.omply wirh rk,! Pmvkiotrs <br />WARNINGT Fi,lxrc k, rcurc qorkeN' coDp.trsaiion .!vcD8c n unh'ful. a dEll $ihj.cr :n c'npk,yd tu dimin0lttMlla$ rnd <br />.ivil 6ncs up t, onc hundr.d rhons0nJ dollns (SI00.00O), nr nddiion ro cod ol co'npcneri,fl. da Dgcs as providcd for rh. <br />Sc.rir{:ll)76orrhc Lrli/ Cod(. i ercnNddkrNyr <br />I hcEhy llnrundcr t^-.n!hyof Ptrjurrrhar I D I undd Im)irjorrrfhrfld o r commL rtrg wnh Scclhn 70.ro) ol D* hbn J <br />.r rh. Bn$,rs.nd Protis'.'NCod. anl mvlid.nsc h <br />COISIBISUONIENIIN(iIIi.ENSI <br />I hcrcby lffinn ln<lcr pcralry.l tr.rjurr rh, rhdc is a.onitu.tir lcnding rS.my for rhc lolorro.cc ofltc wor* for whi.h lhis Fmil ( <br />hsucd (Sec.ILD?. Civ. C.). <br />A.PELIIANI.DECI.AMtrON <br />I hgrt y afim undcr Dcnrlryofpcrhry.i. ofllr lollo*i.E d(Lturion\: <br />DcnFlition Pc nillAsirslos Notincation Fcd.n! Rcsulationr{'Int ll1). Psn6) <br />-Rcqutcd <br />Lcttcr o{ NoliaEarion <br />l.cnil!rh r rhc Ldcrrl l e noi rptli.rhlc t,rhi\ |j(+rr <br />xrkinrr. rhrrrlx rhn. <br />rucrion. frth.rcbyrurlxtrnrrrtrc\rtrr.lrvc\.1 rhi\Ciry <br />trc <br />Communications Cable <br />Sub-Panels <br />Service IVleter <br />,{pplic!nl or Agtnl Si(nnturc <br />--------T------