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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, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Rool Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffil Rouqh <br />Ceilings (T-Bar Rouoh) <br />Meter Release <br />Rough <br />FINAL /--3-t9 u44-/tr) <br />Notes, Remarks, Etc <br />OWNER BUILDER DELCIRATION <br />I hcrcby aftrn undcr Fnolly or lcrjury thot I im cxcm nom rhc Coniracrors Liccn\c Li*,Dr thc tullowine rclsn (Scc?031.5 <br />Busincs and Pn{crsion Codc): Aiy Cny or Colnr, lhich Equirci s Fnnir t, .onslfl.t. olb. i,Ilprov.. thmli\h or t,,on diy <br />(ru.ruc. prt r ro irs issoa@, dho r.quir.s rh. {plk.m to su.h Fnnir b fik ! siSncd stitc'Etrr th.l tE nr shc ir li.cnscd Nisuani <br />to rl* prcvisions offic ConImcrois Liccnscd Lrw (Cfiaprcr 9. Com!rcncing wirh sccrio. 7un ol Oivkion I oflhe Blsine$ and <br />Prolcssions Codcl or thot h. or she iscicnpr rher€from and thc blsh for rhc "llcgcd.kmprion Any viohlionofScclion 70115 by any <br />ryplicad hr a Ilcflnit subjdslhc applica ro!.ivilpcnahyofnol modrhan nvc hundrcd dollds (5500). <br />I. as o{n$ nr r h. pmfrny. or my c,nplo)€s wilh vagcs ns lhct sL co.{Ensarion. $ill do rhc work ltl rlE ifruc G mt <br />inlc.{jcd or orcrcd for salc (Ss 7l}44. Busine$ and lrrofcsions Codc Thc Conrd.tn s Liccnsc hw docs nnr amly ro !0 owk'or <br />rh. p6D.ny *h. blilds or nr{r,B rlErcn. 0d rho d{$ sch wd{ hnn\clf .r hcBll or rnm gh hk or h.r ow. cmtl,rycc.. <br />provkl.drhar \u.h nvtuKmnh rrc mr inrcndcd or oflcrcd l'or sh. lt how.e.. rhc tlildin8 o! imprcEmnr h sold wirhi',onc )cr <br />of.on!)lcri,n. rlE O*n.r Auiklcr sill h!rc rhe bordcn of rrn lr8 thd h. .r shc d{l nol build or imlro\e ric pmFny t, rlt Nno* of <br />l. N D*.cr orlhc !tupcny. rnrcxclusivelyconlrnctir-r rvirh licetrsd conrraclosro d,n{rtucr rrB tmFtl (sc..7(114. BuMc$ <br />anl hoac\shnCodc lhcConrrucioisl-iccnrcLnwd@qnorspplrrornown.rorrro!.nyshonuibsorinlrovcsrhcr.6n,rtrd who.omBchrorsu.hnmlt.tswirhaConhclo(nlicctr*dlusurrrorheConrrocroirLteh\rh*). <br />I rnrcxcrnrutrd.r scdiotr-,ll &P.C ln rhi\ r.N,n <br />Daie OBn€r <br />III.IBf,EB5:.CA!'fiiNSAIIAN <br />DECITIBAUA! <br />I hcrcby difi nnu.dcr pc.ally oipcrrury.nc oilhc n k,wir8 dcclsslion\: <br />I hxvc od will tuinrain a C.nir.Ntc of Con$trr h Scla lnsurc fur *orkss clnpcnsrion. &s Imlidcd ror bt sElirn 1700 oi lhc <br />bbor Codc. lor rhe p.rformonc. of rhd work loi *hich rhc pmir n i$ucd. <br />I hrvcrnd willnrlnrar workcrl conDcnsrrion insuEflcc. is rcquted hy Sccri.n.l7ff) ofrhc Libor Codc.lor rhc Pcrlhrrutrcc ol <br />.onrpcneli.n insunkc .adid nM polay numh.r sc <br />.121 rr,(6 ,t ,dAf I <br />I Lrnify rhar in rh. p.rfornDkc of rl[ wr.k for which $i( pcrmi k h\ucd.l shrllnoi en,tray rny I'.6on in any manmr <br />sr $ ro bc.om subjcct to rlrc workcs cohpctrsdn,n hv\ oiCtrlir{,ni,. md 4ruc rh if I should hccom subid h rtr <br />qqkql comFnsar ion In,vhion\ of Sccrion :l7lD of rhc btsr Cdtd. I shrll. fonhwilh comply with th.s povtn,ni <br />WARNING taibru h s.urc w.rkc^ (,npcn\rion covcrsc br.r m cnDlolcr ro oiminal pcnrlric\ nnd <br />.iril fi.cr un lo onc hundrcd rhousand dollar ($l ofconDcnsatiotr. danuses rs prdvidcd rot thc <br />I hcrchy affi.n!ndcr p.uhyorFrjnry rhar I rn lilrn$d und$ Iovkion ofChlrrls 9 (o'mErcing wirh scdn 7000)olDivkiotrI <br />of thc Busincsnnd Pn'lcssions Codc. ord nry liccosc h in frrllaolcddcftdr <br />0 <br />I hcrcbynfrtr'nuld.r pcnally of Frjrry rh thcrc h ! consltuclhtr lcndin8 .8cn , h, rh. lxrfornlmc of ln work lbrwhi.hlhh lfrnir i3 <br />hslcn 156.1097. Cie. C ) <br />aftllc NLDEclAEaua! <br />I lrEby allld rndcr pcnrlry Drpcrjury on. olrhc n,ll.win8 d..lduln,ns: <br />Dcnmlirn'n Pcrnrirs AslEio\ Norificarion Fcd.ralR.Sulnrioni (Tirlc.t0. PinO <br />Rcqun d htr.iof N({iforbn <br />I ccdifyrhd (hc f.drEl r.8uhrions Eg6"dinS 0strsros rcrmulffc nor lPplicablch rh( PmF.r <br />I ccdily thar I hlvc rc|d rhisapplicrlionlod <br />odinr.ccs .d SrdcLtwr rcbtinero building <br />ahovc Enri.ncd fmFnylor in <br />Applionl f ]\I. l SjAnrt <br />n m!Br.I a8c ro omply *irhall cilysnd county***-*"'Jll):;7,{'- <br />Service lt/eter <br />\ <br />--l-- <br />-=- <br />tt