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COMMENTSAPPROVALSDATEto/stG. <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 />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <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 />Ceilinos (T-Bar Rouqh) <br />Ivleter Release <br />Rouqh llqt\1^* <br />Service Meter <br />FINAL Ztllri z <br />"(dqa)Notes, Remarks, Etc I <br />I <br />ELECTRICAL.INSPECTOR RECORD <br />OWNER BUILDER DELCARATION <br />I hq.b, ailm und6 Fnalty or pdjnry rhd I @ .renfl fmm thc Conri.ro6' Li..ns ljs aot lh. followins Ilen (sd 7011 5 <br />Rsi6s and Proasio. Codc)r Any City or Counl) *hich r.qutr6 a p.rnit lo conslrucl. ahq, imrrovc. .lano[sn or rcPair my - <br />srtu rm, pflor to ir3 issuec€. also r.quiB lhc .ppli.d for su.h rnni lo frlc a sisn.d slalflol fid h. or sh. b lic sed pumiul <br />, <br />lo thc rolisiotu of th. Contractoi! t,icensd Law (Chapld I, Co@edcin8 with Sdion 7C00 ol Divisi.n I oalhc Ausincss d <br />Prof*ions Cod.) or rfiat h. or shc t .rmpr rhactom @d rh. bdis lor thc allcs.d cxdprion. Any violalion ol Salioo 701 L5 by Eny <br />applica for a p6mil subj..ls rh. aptli.d r. a nvil p.mhy oa not <br />'norc <br />thd fiv. huididl dollm (t500) <br />-1, <br />4 orir oalh. FoFny. or my mdo,6 vith wt!6 6 lh.t el. m,nFsrion, will do lh€ s!& tnd th. edE€ n nol <br />intad€d or offcrcd for sle (S( ?044, BGin6 md Pmf6ioN code Thc Co.tdol! Lic@ k* do6 nol apply to d o*n.r of <br />rh. Inopdy $1a) bdl& or impovelh@n. dd Bho (l.6 sch $!rk hitr.ltot hdscllot tbrcush his or hd own mplo,6. <br />prcvided that such ioFov@.rs d. nol idad.d or o,I6.d for sl. I I no*qE rh. hrilding or inpovonol is Fld wnhin on. )@ <br />olcomplcriotr thc Orvns Buildr will h!!. $c hrd@ of provinS lhal h. or sh. did ml hrild or ingrolc lne pmpqly for lhe purl,* oa <br />-!. <br />6 oM6 olrh. ,ropdy, o .rclGiv.ly conlractins wilh li.os.d co'nDdo6 6 oNhd ltc Fojc.l (St. 7044, BGrns <br />.nd Pl!f6i- Co&: Thc Conri.cror's Lic@ tiv do6 nor ,pt,l, to e o$nd o I propcny {ho hoilds or inpro!6 thdd.. <br />d {ho contrrds for luct Fojds with a Co.lr.cto(s) licm.d puu@r lo lh. Conltlclols Lic.6c Low). <br />-l <br />m.re'.pr und6 s*rhn .1,. & l'.C. tur dlis '@$n <br />uo85li45:(out8xl trq! <br />D[gaaAlIAN <br />I h6eby a,lirn undd pcrahy of p6jry on. of thc aollos ios d<ldalio6: <br />lhav.rndwillnai.roinaCcniicatcorCoNdrlostla-lcur.for\rork6tcon,pen&rion,d!rcvid.dforbyS..lion1700oflh. <br />Labor (ird€, a.r lh. pdfommcc o alhc worl for whi.h lhe p6n b bsmd. <br />-l hav. and willoaimain pork.ru' cor.pcNstion iNurancc. s requt€d b! setio.1700 ollh€ libor Code. foi th. pdiomncc ot <br />lhb Fmh is isu.d My vork <br />e <br />lnAl, tl7 qgq <br />-l <br />cdilythar i.lhc psfoflnanc. orlh€ Nork aorwhich rhisp.ann is issu.d.l shallnol dpby any pd$n in 5ny nrdno <br />s 6 to b4rm. subj€cl lo lhc wort6' compeBdion laws of (-alitomi.. trd asr* lhdt if I snouB be.o'nc subiEl to lhe <br />rort6' comp@lion prcvtioE of Sc<lion 1700 oaln. Latrr Code. I dEll. lonhs i$ comply siin rhos PmvisioN <br />W RNINC: Flilur. ro sue $ork6' .omp.Ntion ovms€ s u.lawfol, and sh.ll subjd an @ployd ro rnniml p.nahis ud <br />civil fin.!uproon hundr.d rnousd dou6 it100.000). in addilion ro rhc co! olcomp€nerio.. dma&s a provid.d lnlh€ <br />Cddq inrer.sl d allorney <br />D};TL$AIIA.J <br />I hftby omm undd poaly of ptjury rhd I m li.6..d undd pmvision ofchlpid 9 (.omdcins Eilh S6lion 7000) of Dnision l <br />of lhe BEins md Pml*ioN Cod.. ad ny Ii.eM is in full forc dd cff(r. <br />./1f) <br />/y';ro,?.2J)t "t <br />c.oNu3r(1r0.r_Ll:lutll,ii1iItrlr <br />I hocby alfim und6 p.raly of pojury 0t,l lhe is a consld.tion kndins ,ga.y lor th. Faoll@c. oflh. worL 6r $'l*h thb Fmil is <br />issued (Sd.1097, Civ. C.) <br />AIIUCANLDECI.ASA:I,IO! <br />I he4 amd uoder paa[y ofpdjrry on. ofthe follovifls d(ldalions: <br />D.Dolirion Pmils-Asbelos Norificdion F.deral R.Bulalions (Tille 40. Pa16) <br />-R.quircd <br />L.rts of Noi6oaion <br />I .diry thar lh. fcd.r.! r.sulllios rcsading abdot tmral d. nol spplictblc lo lhis prcjdr' <br />I .6lify lfial I havc rad lhir ,ppli.tlioi ai 3tar. tha! th. ahov. i.folmlion ie corc.l. I .grc ro .omply vhh .ll Cny ard Countt <br />ordin.n.s .l srd. La\s.eiatulo lu ildins co6rtucl i, . dll authort.'cprcmmn6 ol <br />::';'1"**'- <br />.lJlt! <br />Lcnder'r Name <br />- <br />Lend.' \ AddrN <br />- <br />abov€ mdlioncd prcp.ny aor nsp.rtion <br />Applicrnr or A,lctr( Sig..rure <br />=