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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <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 />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />"ffi.4/Rough z/7v//,1 ' <br />/1M?4Service lvleter zJt//4 <br />FINAL dLl La hai*-/0> <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCARATION <br />, h.reby aIItrm und( pcn lty ol pojury td I an .r@pl 6on lhe Conlttcro Lic.hs. ti* for rh. follownt3 r€Mn (SE 70] I 5 <br />Busi.6s and Prof*ion Cod.)r Any City or Counly shich r.quts . psn lo co.!lod. ah6. i.rProvc. dimollh or r.tair ey <br />srtucu.. F6r ro its isumc€. rLeo retut6 lhc arplical lot such pdnit io 61. i si8n.{ slotdEl lhat h. or $. b lic.N.d Pwanl- ro llE povi.iotu ol6c ConlEctor s Liccnsed t w (Chapts 9. Cond.ncing snh Sdtion ?000 ofDirision.l oflh. BusinN dd <br />Prcf.sioDs Codc) o! thar hc or shc is cicnpr rh6.6om ed fi. bsis for th. all.r.d $.opiion Any violdion of Sction 70115 by an, <br />appli.ml lor a ptri subj*rs Ihc applicor ro . civil p@lly of nol morc llm fiv. hunit.d dollds ($500). <br />f r. * o* n.t otrr'" p-na), nr my mplo)€6 tr h lasd s lheir sole comp.Ntion. uilldo lh. wort and rh.3ln&1uc is nol <br />rk€d or o r6.d for slc ( Sa 701,1, Bulodr dd PmfNions Code ]1E conl.iclois Li.ftc L.s d!6 not @ply to e oMd of <br />rh. Fopdry *h. toil& or impov6 lhddn, tnd s'ho &E such Md Mreclaor h.elaor rlmush his or td o*n .nlplovB. <br />provided rhar !u.h inFolan srcnol inldrd.d oro,Tdd roreh,ll ho\rdc,lhtr buildins or in!,ovdar i. sld wnhin ooc )@ <br />of conpkio( th€ o,^nd Builda wil t rc 0E b&ko ofpmvirg lhd fic or she dd ml build or imFo!€ lh€ p,opsly lo, rlt plrFoe of <br />-1.6o\rd <br />olthc pmpaly, m exclsiv.lyconlBclins {ilh licd*d con[adou to connrud lh. Foj*r {s6. 7044. Bsins <br />md PrDlisin Cod€: I h. Contrcrof s Licetuc lrw do6 not aptly ro ovnq of plopg1y who builds or inprov6 lh66o. <br />snd who conr€ds for su.h rrojet with a Co <br />*l n crcnpr u.d6 Sdr <br />o"" /t. €: a elE <br />I hcrehy nlfimr undcr prnnliy.l rEtu4 o.eot <br />_I h,!c dd $ ill maimain a Cen ilicat€ of lo s.lr lriurc lor NorkeB ConD.nlarnn, d Folid.d ror byS(lion3700orrhe <br />Labo! Co!c. for rh€ pdforl@( ollh€ *ork lor <br />"'nich <br />the p.nn is issued <br />-l <br />hav. dnd sill .r.inr.in workec cornpsalion iNrancc, B rdpn.d by S..1ion :1700 ol lhc libor Codc, aor thc psfomru.c of <br />rh. wor{ aor which rhis pdnil is isu€d. My worl*- comDeerio. iBrmce cdi6 ad policy nunb.r a.: <br />Policy Numbd:-Erpir6: <br />-l <br />cenifyrllal in rhc A{loIn c€ ol lhc Nolk for which lhis pmil is i$ued. I shall .or mploy any DEsoo in aoy mend <br />so I Io bdomc sxbld lo the wort6 .ldp.Nrion laM ol ctliromit, ed asr thdt 'l I should b..omc subjsi lo lh. <br />workdt comp.Bation pror6n,6 oasdrio. I700 of thc hllor Code I shau. nrnhtr nh comply wnh Ihos ptovisioc . <br />\d RNINC: l_ailurc ro BUc *o*m' compcrs.lion dnployY ro oimiml tEnahi6 ed <br />ion. d@,gd a providcd lor rhccivil lincs up ro o.. hundr.d thoxsand doll6 ($l !4din6i ro rh. con or <br />Sdrion 10?6.frhc l-alnr C.n.. i.id6r ed anomev <br />1/ -, - 2,",1 F <br />I ha.b, amnn undd Fnally of p.iury lhal I <br />or th. Busi.* ed Pmf6ioc Codc.0d <br />vnh Sari,. ?0O0) of D'visnrn l <br />y lic.N is in full iorc. and cfih-r <br />CAIiIAIJCIAITEdDIIG.AGEICI <br />I hmby amd undd p.nahy o f Fju.y thot thae is ! onnrudk'n Lddjos aBdcy aor rhe pslo,rmcc ol lhc *oil fot which rhis Fmil ie <br />hu.d (S(.109?, Civ C.). <br />AIIUCAUI.DECL6NAIIAd <br />I hady atrnn undr p€nalty of Frju.y o.. oarhc aollowing <L.lerlions: <br />D.molirion Pmn$Asbc$os Nolificarion F.dda! Rcgulalion! (rnE 40. Pal6) <br />-Rqoircd <br />LdldolNotifi edon <br />I cdify rhd rh. faldrl r€gularions r.audiog Bb6ros rsovdd..or applic.blc lo lnis prujrl <br />nnation iscodcn.I lgre lo conply wilh allCnyand Qrunly <br />horiz. lerxc$ralivd oalhis Cny and Counq ro srd trpon lh. <br />abovc nmrioneil pmp.ny for <br />\t,t,li(rtrr o' \r{r Si*nir on" /r - €. Zot f,. <br />Per iie., r€(prnrt):