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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.OWNER BUILDER DELCARATION <br />I hcrcby afitm undcr Fnllrt oft rjury lhsl I m cxcnq ln'm Ih. ConhdoF LnIosc L{w f(tr rh. fdlowins r$hn (5&70115 <br />Bu\inc$ !d Pntc*ion Codc)r Any Cny .r Cox.ry whkh rcquies s Frn,it b con$flcr. 0xcr. imir.vc. dcmlhh or rctEn any <br />sdclun, trior to irs i$uakc. lko rcquircs lhc applicrnl aor such Firnil 'o <br />filc o signed stolcmnr ltar tr or shc b liccned pu^uanl <br />to <br />'he Frvkions of rhc Cont&rofr Li..ns.d bw (ChJflcr 9. G,@n.in8 wirh s..lion 7000 or Divhion I oi thc ausincss and <br />Prcf.ssions cod.) or <br />'har <br />h.orshc Lr crcmpl thcrcfrommd rlr bns( lnrth.slE8cdcrcm ion AnyviolaiionoaSdtion?011.5by,ny <br />Jnpflicdn! r.r a Fmr ubjRF rhc aptlrcdtrrr.0ctrrlp.null) olturnorcrhtrr fi\c hun.Lr.d,lollu\ rt5OOr <br />414.n-*, r,* n-*"r. olnyc proycc, q h sr8crasrhdt nncconwtrsrrior. s,rrdr trtwtrkund rhc srmrft h s'r <br />' ,'*trdcd ;r .fic'cd for -lc (5( 7ur4 Butincs rnd l,,ortssions Codc Thc Codr!.roa s Liftn{ tiw &rs nor afi'I, ro e o*n$ of <br />thc lmpcny who builds o. i'rrors Em.. ond wh. docs skh k,ci lrinscli or tursll .r rhrcush hi\ or hcr oNn cnqn y.dr. <br />providcd rhar skh inlrDwrf,n ft nor inr.nddl or oltcrrl lor et ll tx,*c!r. rlt hiuing or nqmkftnr h $U wirhin om tw <br />ofcoDl,lcl ion. ltr Owrcr Buildcr will h!rc rhc ltrd.n of I 'vin3 <br />lha hc or shc dil nolbuild or impmle 0t poricny for rtr purpo$ or <br />-l- <br />as osrcr of thc ImtEny. am crclusivcly c.nk tine wilh liccnscd co.lndor ro ondrud rtryn,Fr ( scc 704-,1. Busftss <br />nnd lt)lc\\inCodc Ihc Co rrnr's l-i.cnrr Lrq docs r nml!h! ownd ol[ore ywho buildsor impovcs rhcrcon <br />;:--util\I <br />I ho$yrfinhundcr p.n ry .l F,rjury orc oi rhc lolbBnr8 <br />_l hf,vc dwillmui ain!Cenifi.xtcorconsdnrrds.lrln\lrcrorworkcrs.on:pcnsnrion.NnmlidcdLrhyScction.lTuroflhc <br />t tor Codc. forlhc pcrlornEtreoflhc trort toruhhhthc lHnril is hsucd. <br />-lhavcr.dwillmflinluinworkcs <br />compco\lrion in\urarcc. !s rcquircd hy sccrion l?fi).rrlr bhorcodc. ior thc rcrlorntrne oI <br />rhc work lhr shich lhis p€rmii is issoed. My sorkc( .onpcnsit,n in\tratur cdhr dd B)licl nunft.rm <br />- Polic\ Nunrhcr'- T\ni'c. <br />1\4,,/4'ry rhJr m rrr f.dn,mRe.r'hc 'o,k ro, shEhrhk p.rmir t hsucd.I sholl nor emrloyanyFNn in 'ny mmn . <br />' $ 6h}rcom abjcd ro rtf, *n'ks s,mncnsrnn rsws oaciliaomio, ann asE. rhd irl shoxld beom suhjer b th. <br />wnrtsa comFosorion trovisions orSd.iio.l70oorrh. Lstbr Co&.1 dEll. r.nhwirh.ompl, wilh lhos povnions.. <br />WARNINC: I'rilLtrc r' scurc $orkcr'conrpcns ion corsrsc is utrla*ful. rnd \hali \trhict rn cnlPbycr t) di'rnfil rnrhics rnd <br />civil fincs up to onc hundrcd lhourlnd dollss ($lm.ourr. in uddirio' <br />lufrdl+ <br />I h.Eh, alltmunderltrnalryoipcrjury rhar lu) liccn*J undcr <br />of (h.Ilu\inc\sn d Pnncssi( rsCod.. i nrr li.cfsc h i rull <br />n ol(-hrfrcr 9rrrtrtrnr . rS\irh <br />AIELUANI.DEILABAIION <br />I hnt y afllnn undcr lcnrhy or p..jurt onc olrhc folkr*ing dc.lni,riotrs <br />DcRnnnrn Permih Arh€sros Norificarion Fcdcral Rcglhrn,ns (Tirlc40. Pd6) <br />-Rcq!ncd <br />lxuer oi Norirrcarion <br />44;rdffi;:; <br />Emvalrc ndr atplicabh lo lhis pmjcd. <br />lboE infomrion t comd I alIl{ ro.osply <br />nd hcr.by trdh.nzc dpdscnl0tivcr ofthis Cily <br />aliolc mnliDmd lropcny for in\ta-.-rionnuqr <br />ADplic.nt or /lActrl SiAml urc <br />\6 <br />-tlt:;T6" <br />Site-Work <br />Unde rground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Translormers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service [t/eter A\ <br />FINAL G.ZI-IN V,W]U <br />Notes, Remarks, Etc. <br />APPROVALS COMMENTS <br />rnd *l$ co N \ for \!ch pmlcci\ *irh a O,nrEchn s) liccn\cd lu6uur b r hc G,.r3.1, r Lkc.{ Ijw). <br />Liccnsc Closs:-Liccnsc N!'nh., <br />- <br />lr.re ( orrftror <br />coxirf,ucuorLExDlN{iScENcr <br />I hcreby firn under Foalr, or pfijury rhar thdrc is d .onsh.ri,n L.din8 igctrcy for lhc Isl'onMcc of lic vorl for which rhk Frnir is <br />hsucd (Sec 3m7. Civ. C.). <br />Lndcl. N.m: <br />- <br />knicir AddFs' <br />T------ <br />=