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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER BUILT'ER DELCARATION <br />I hceby lntnr undcr llcn.lly of pcrjury rnat I am cx.m fmm lhc ConlEcr.^ Li.cni. tlw rrr rh. followins Ei$n (Scc?0315 <br />0usincs ond Prolt$ion Code): Any Cily or Colnl, shkh aqlncs a Fr.rir ro .ofl{fl.t. ahn. improrq dcmlhh or El'oir nny <br />srtu.rur.. Driorro irs issuncc. lho Equtca (hc snplicr.r fq ru.h Frfrir r. fiL a siBrcd stat.mnl lh,' h. o! shc t licensd puisanr <br />to rhc tmrnions of lhc Conroclols Licenscd tIw (Cfiaplcr 9. CommcmioB $irh Sccrior 7000.r Divhion 1 of ft ausincss trnd <br />ltofc$ionsCod€)orlhol heorsnc tcrcmpl rhc,ef.omaDd rhe boris ror lhc r llclcd cxcnD! ion Any viohli.nofscrion?0115 ty!o, <br />44k ***il*ffi;."'*ffiffi;-"*::$ffi n .*. ., <br />rhc pn,!.d, wk boildx or irlt)roEs lhcNn. a *ho df,! sNn n)rl him*U or h.rclf.r rhmuSh hh M hcr osn.mplorccs. <br />providcd rharsuch imprcrm.h m nor inrcndcd orolT.ftd for $L. l( howEr. rhc h{ildinB or nqmwmnl t sB *nhin otu tfu <br />ofs'nplc(ion. rhc Owncr Buillcr willttrrc Ihc burdfl oflmvinS rhot lrorshc did mr toild or impmlc rhc pmliny for th. purlD$ of <br />L $ ow.cr of ihc pmtcny. nn cxclusively contractins sirh liccn$d conlr4t,F ro .on{flc' ltr trt)jr{ (Scc 7044. BuiinA\ <br />and L\nrishn Codc: Thc Conrracrois Liccis. Law docs not +rlyt, M.Rn$ orlropcnyqho huildsor improvcs rhcr.on, <br />and who c.macB lor such pmjccs wirh , C. r,cro(, licctrrd pursuanr ro rhc Conrrudin s Liccnsc lj$) <br />;:-ral <br />I hrrchyrlTnmtr cr pcmlryof pcrlurron olrhc f()lk)*i'rg <br />_lhavcald*illoEi.tainrCcnifi.rr.olA,nscnrk,Sclirln{r.for$orkcrr'conlEnsrlion.aslrovid.dfnrbySc.rionl?(Xlofrhc <br />lrlq Conc. a{r rhc pertormn.c of rh. w.ik f(tr whi.h rh. lcrmft it nsu.d <br />-lhnvc.ndwillnminhinwortcncotrqEnsationiNurumc,a\rcquircdbySccri.n]Tfi).rrhcttrrborCodc.forlhctctlotnunccofine work for whichlhhrcmil is nscn. Myworkcn conrcn\arionin rr.cc cati.r did tblky numbcr m: <br />fmu"nr, 'n, 'n <br />,* n.r*ruNc ' rhc wr ro, sh'.h rhir r..n n issucd. I shrtt mt cnDroy anr rNn ,n any mlnerrmls ro t"om <utler ro rtrc wnA.F conrr{n{rion lnws ofcalifortri.. !d agr lhll if I rhould hecom $b}rl lo llE <br />Ndrr.6' .onn nstn ! pmvisions ofSmliotr:l?00ollhc tjbor Codc.I shall. forlh*ilh comtly wiih rho* Ptulhioh.. <br />WARNIN(I: Frihrc ro \cctrc worlcA .ofrfcnsnri(,r colcf!. '\ uhh$tj. r0,l shrll \rtj..r m crrDloyrr t, ri'ni'[l n ,lri.s rit] <br />:*.tJ <br />oN hrntlrcd rhou\ nd dolh (SI(X).(XX)). i'r ddii(itr ro rhc .o{ ,n con,Fn{ri,'n. <br />.4," ' <br />I h.rby.lnrm unJc, Fn,hyoflf,riury rhlr I rN liensd unlcr ,lCl!$r.r 9lconn cnci0g wirh ScciNtr 7(Xx)) olDni\n,n l <br />of rhc Arsindss{ l Pmf.s{i.nsCodc. drd my lkcns k ir full lire.nd clfccr <br />icctrsc Nun$cr: <br />-IANIiIBI]IIIONIINI]IIC.AGENCT <br />I hcEl,y !r]tm undcr pcnllrynll.rjlry rhar rhcr i\ dconirucrion lcndine iBc..y tur rhc Frformincc oflhc $ork tor whirh rhis rcinir ir <br />i$ucd (Scc 30i)7. Civ C.). <br />A.IIIICAXLDECLABAIIQN <br />I hd$y ammundn F.n,llyofpcriury om olrhe followin8 dcclarutions: <br />Dcmohion Pernrih A\l,.sros Norii.aiion Fcd€rnl Rcgulrrions (Tirlc40. P!n6) <br />-Requircd <br />l.ncr of Ndtifr ion <br />4/#-i;iffiil;il*ffi;ilffi;;I B!,ero.onuly wnh allCil <br />Jh,r 'rttrriurd prtipcny for i',\prrrnnr NrJx)\cs <br />Applicnnl or Agcnl Sienntur: <br />I k6 <br />-" <br />:.:':il;ila <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />LiIe Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under SIab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueino <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unil <br />Walls (Conduit) <br />Walls (Bouqh) <br />Ceilings (Hard & Soflit Rouoh <br />Ceilings (T-Bar Rouoh) <br />l\4eter Release <br />Rough lr <br />FINAL bra ifi &J01\1 <br />Notes, Remarks, Etc rJ <br />COMMENTS <br />Sub-Panels <br />Service lVleter <br />J0 .".". <br />Itr r''.^JJrr <br />I