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ELECTRICAL-INSPECTOH RECORD
<br />APPROVALS DATE rD/stG,COMMENTS OWNER BUILDI]R DELCARATION
<br />I hcrchy afinn lndur pen0lry of pc,jur, rhrr I !m cxemll from rhc Ornrmcnn\' l-i...\c tis ror rhc rolk,wirr8 tcisn (Scc 7031 5
<br />Busincs rnd Pror.ssi.tr Codc) Any Ciry or Counry whi.h rcquirs tr Frnrir io con$rucr. rlrcr. imu*r. dc,rlli{h or rcrJalr lny
<br />srrucxrc. prhr 1o ns kuorcc- als rcquncs rhc amliclrll nr such rrmil to file a \isncd darcftnr rhor t or sh. is liccncd I'uFumlt' rh. lfi,lnnJns .tlrE Codn ttrt Liccnscd tjw (Cn pr.r 9, ComnBrcnrS sith Scdion IOOO ol Dirhioo I of rh. Brsin.s,nd
<br />Pn)r.rsbn\Corl.)orrhrth.o.sh.iscxcnprthcrcfnnnd th. basis lor lhc allc8cd cxcmplion An,liolation.tS..riotr7011.5by,ny
<br />apflicatrlfor.p.flnilsubjcctslhc,mliclnlroa.irilpcnnllyo,nolnntrclhnnfivchuodrcdaolLh($50o)
<br />L a\ o*ocrotrhc pop(ny.or ycntpl.yes sirh wrscs"sihcir v,lc c. r|ctrs n r. willd. rhc work .nd lhc slml!rc is mr
<br />iNcrdd.ioflircdlmsrc(SN.?Or4.Bnsinc$mdPmfcsio.sCodqThcConlacroisl,icc.$h*L!.c\nornpplyt,anoqRrDl
<br />rtu p@Fny who builds or ioDmlcs ficNr, unrwhi,docs{'chs1)d(htrs.lf.rh.'sclfdr rhnnr8hhk or lN o*n cnrrloy.cs.
<br />F,vid.d thlr sudh inD(nsrnhrrcnn i.rctrdcd orolTcEd for salc lt lkrscvcr. rh! t{iHiu n in{'mvcmnl is skl wirhin, m r'tr
<br />oi conlplcrion. rh. Oqmr Buildq will h0!c rhc hudctr of tlrovi']B rh r hc .r shc dil mr t{ild .r improK rhc pmpcny ftr rhc puqi,* of
<br />-l..sown$olrhcnmpcny-amcrclusivclyco.trodingwirhliccnsdco.rrlcrorsroondtucrrhcln,Fr(sc.7Lv,t.Buqnc$and PDL\ranC{ c: Th.Contr.td s Liccns. Lrw d6s nor rrplyti inowrcr.fEo!.flywho buiUsor irF verrhcrcon,
<br />rnd who uotuachInrsuchpmjcchwirhrc:onrrlcro(srliccnscdprrsu3 r ro rhc Contsck,\ l-i..nsd hw ).
<br />I
<br />IIEII.ANAII!}N
<br />I hcEby otlirnr undcr p.nrlry of !6jury om ol rhc l'ollowiry dslarlrion\
<br />-l
<br />h!!. art sill nrinhin r Ccniftarc of C.tr*nr ro SclI l trsurc tu norkc.r c.nllxnur ii'n. rs pft,vid.a ror bt Sr.lion .Ufil of rhc
<br />ljttr)r Codc.lor rhc lcrf.rnrrcc ofrhc work for qhichrhc pcrnrn is issucd
<br />I havc nnd w llmtrinrlin sork.rs con,p.tr\rrtun in\orrn.c- r\ rcqutc hySc.rn lTqrol rhc Lrhor ()tlc. l'or lhe Frli,nnnm. ol
<br />rlr*orkli,r{hi.hrhisl.iiniri\i\sdcnMywork.r\'.rnnrr,\Jri{nri'N'i.cratric.rrdFrlicyNnrbcrarcl
<br />l.cniry rlur in thr pcrroirMncc olthc work lor w[kh rhh lcn thi$ucd-I\hrllNlcmpl'ryanyncNrninrtrym.trrcr
<br />s !s ro hc(r'nE sut'jd ro rhe so*cn m'nFNxri{n' hss olCllituniL trid asN rlu ,rI stFuld h.onE ruhjNt l. tt8
<br />workcF.ompcnsrri{nrlovkion!ofSdi.n.l?(X).frh.l-rhrCod..l\) ll. nf [wirh Mfly *ith ll]osc pmvisbn\
<br />civil liic\ !p b otrc hrndrcd rhou$nd dbll$s (51(n,fi f cotrDcns io.- donmpca ns ptulid.d Lr rh."::;??iws:^^
<br />DECI ARATT(}N
<br />I herchy oflirm unds r.nah, n, lcriury rhd I aF lienyd undq pnrvtioh orChap'd 9(.ommminB wilh Sstion 7000, ofDirisii,n -1
<br />of lhc Busincs ed Pmlcssions Code. and uy liccnsc is in full lorce lrn €lINr.
<br />IONSIBI,]CIIONIENDINIi.ACDNCI
<br />I hcEby Blfi,m hdcr pcnalry or Frjry lh.r $d€ i. . con{ru.ri,n l€nding agcfty for rlr Fsformmc of lhc sorl f6t whkh rhis ,.rnit is
<br />nslcd (Sc.. :1097, Civ. C.).
<br />AIIUT:ANLDESAAAIIIJN
<br />I lr'$ynltnmunncr pctrrhy ofpcrjury onc o{lhc fo!lowinS declmtions:
<br />DcnFlirbn P. nhlAsb.slos Notilication ktcol Rc8ulalions lTitlc.r0. Pan6)
<br />Rcquncd I.rlcr of NolifE.tirtr
<br />_t ccnilyrhrr rhc ltdcrrlrc8rldiotrs rgdin! a\h.do\ rsnr)vllrtu'ior rtflicnhh r, rli\ Dn,j.ct
<br />I cnilyrhrrll rrM rhnim gre ro comrly *irh all Citynnd Coutrry
<br />.,dinrncc\ rnd srrr.ltr*\ r.l rin!
<br />rhnu morionci pmpcny i,
<br />,\pt'lir.Dl or ]\A(tr1 Signrlu
<br />-""-**''"))"'7*'i:''/*
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundino / UFER rdzltXtt D)
<br />Transformers II U\\-
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service Meter tplvln'lo >>)
<br />FINAL rrtl> lfi 1 -l'-z-l)
<br />Notes, Remarks, Etc.(r(\
<br />Policy Numhq
<br />-Ertirci:
<br />-
<br />Site-Work
<br />Air Conditioners
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