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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monumenl)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Bough
<br />Service Meter tf,I
<br />FINAL K/zv//l /-ffi-d )
<br />Notes, Remarks, Etc. /
<br />'lr '
<br />L.
<br />OWNER BUILDEN DELCARATION
<br />I h.rch, lmnn undcr ,cnahr [l perjury rh l an ci.mnr fr.m tbc Co.lr&ro^ Lt.ok Liw for rhc rollowing rc!$n (S.r 70]l 5
<br />Busiocss lnd Prda.$nln Codc)r Any Ciry oi C.unry whi.h r.qniros n pcrmn ro co.stdcl. ahcr. impmrc. &mlish or qan lny
<br />strudure. l,ior ro ns issuamc, oho rcquncs rhc arpli.rn b. such lf,lnit ro lilc . sigred sr emnt rhor tE or she i\ liccnsd pxr$6r
<br />ro rh. trcvhn,n! drrrb Co.tE irr's Lic.n*d tf,* (Chrprer s, Co,m i.E *ilh SNrion 7m0ofDilkinn I ofltc Busincss lnd
<br />Pmfcsions Codc) or lhsr he or shc is cxcmpr rh.rcrmm and thc hqsis tor rhc 0ltcscd cxcnprtun. Any violarioodtSccthnT0.rl.5 byrny
<br />aptlicanr ror ! pcmir \ul,jcch rhe stpli.a.r ro a.i!ilpcn,lry.anor morcrhdn nvc hundrcddoll-. (Ssoo).
<br />I. * owmr or Ihc phFdy. or ny cnrrloitcs wi h srgcs rhcn bh compctrsrrion. will do ltE Bo.t lnd lhc nniie i\ dn
<br />i ctucd or orlcrcd lnr *lc (5(.7044. Dusircss 0trd P:ofcsior Codc l hc Contrlcrof r l,iccosc L!, do.\ nor aml, b an owncr or
<br />rhc nRrFny who builds or impmrs rh.Nn. iid Bho d{Es \uch m hims.lrorkiscltorthrcr8hhisorh.row.cnrrloycc!,
<br />prolidcd rhtrr such imoovcmnk m nor inrcnddl or ottlrcd lbr slc I I homKr. ihc tloilding or nrymvc'mnr is srld wirhin otrc ,!t
<br />ofconDlclion. thc Owncr tsuildcr will havc lhc burdcn olpovin8 thor lE o. shc did mr tDilt or imptr,er lnc pR,rcny ror th. purtx,s.r
<br />Orne.:
<br />tl()RxFtlL$ c(wIPl.rts^ rl()N
<br />DI,CIAA TO!
<br />I hcrchy rlTn uidcr Ntrrhyof0.rjryonc ofrhc followirB d{lardiotrr
<br />-l
<br />hrve aJxl will mntrlin a Ccn irrob of Consnl to Scll'lnrurc rm tr orkc6 c{mpcn$l i,)n- as pmidcd ror hy sdrion 1700 or rlr
<br />kbor codc. lor rh. p.rr.mu(r or rhc wort for q hi.h rh. ,)emil is issucd.
<br />-l
<br />hlvc {nd trill nuinrrir *orkc^ co.rrcrsalioo inslramc- us rcquiedbyS..rion-1700olrhcDborCodr,Iorlhcpc,lormtrcco{
<br />lhnFlnr n i\\uci My *orkr^ c.'npen\rtion in\ufufrr c ricr mt tr,lirt nu'nhcr m:
<br />L
<br />lccdity rhrr i'r rhc pcrfornu'(,,f rhc rork tur $l,ich rhi\ rurmir ir is\u.d. I drll nor.,nploy{ny I'cNon in lny m!nncr
<br />r ns h h...nr subir' kr rhc *. cB comp.nsalion hes ol Cililnrnir. rnd l3rcc rhar it l rholld bccoar bjccr kJ rh.
<br />workch compcnsdmn [ovhions ofSccrion 37u)of rhc Latn Codc.Ishrll, fonh*irh comrly sirh rhoy,ovnions
<br />WARNINC: lailurc h $curc $orlcr conrpcnern,n coveEsc is nnhstul. a d \hall suh.Fcr an cmplolc, ro sinrinalFnahics dnd
<br />clvil lnlc\ ur r,) onc hutrdrcd rhonsand dolhr lSlu)-(Ur -or.o'nncnsolnrn. drm.Bcs 0s t'rovidcd tor rhc
<br />,hrh,a,fi'mund.nc.shrlnUr',thnrIrnl'(n..dulc't6qq.nolChoFcra'commncing*nhS(r
<br />nr '\c Bulnc* rnd Pn,rc{,,n. c.dr. anl mJ lxrn,. tr n idllLro{.nRr
<br />1
<br />\v
<br />egIUlX!l.U0lLlliJllnC,XJleL
<br />Ihcrehyafllrnundcrlr.!h,orpcrjuryihairh.rcisaco.$.rionlc.dingog.ncyfor'hcl.rlbrmrccoflhcwork
<br />ksucdlScc. 3097,Civ. C.)
<br />AIEUCAIfDECI.ABAIII}!
<br />I tEnby onhr undcr Fntrhy of pcrjury ore of th€ follo*ing dcclarllionx:
<br />Dcmlnioo Pcdns Arh{o! Norindtion Fcd€ral Rcgul,ii.ns (Tnh40. Pd6)
<br />_R.qxncd Lcu..of Noiifi c.rbn
<br />As::liiyrhit I havc rcldlhn llpl i.rri(nr {rrr rl,xrrhcrh,!c i',lo'tr,rri(m r\comrr I ,gm ro mmply wirh rll Cir, rnd Counry
<br />h.rcby luth,nc Eprc\cn'divcr ofrhis Cny Md
<br />rboL nrc ri,tri.tll,R)tf, ! lnrnN
<br />h01
<br />iUK-
<br />Sub-Panels
<br />-1.
<br />asowncrorrhc pmpcnr. 0h crctusivcly conrding {irh liccn€d contEctoB to on(rucl lhc pmj$r (Ss 7044. Btrsinc\s
<br />and Pnhsim c{dc: Tnc Conr,lcroas Lkcnse Li* dci nor lpnly ro an o*ncr ofproFny *ho buildr or impmvcs rh.rcon.
<br />and who .oma.k ror rEh tmjcds with r Conrsdo(s) li.cnsn pursMnr ro rhc C,nro.rois LicetrE tiw)
<br />lrmcic rDl Lnds Scclio0 .B &PC nr lhn rrJr.n
<br />tJtuleis N!m.. _
<br />t ndc' q AdJrcq
<br />-
<br />I ccdiiynd rhc fcdcftlrcsuhrioos rcBnnlins hc{os rcnNvrl arc nor applic,hlc b rni\ pn+d
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