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ID/SIG.COMMENTSAPPROVALSDATE OWNAN BUILDER DELCARATION <br />I h6.by lIIm urdq pa.lt, of p6j!r, lhlr I D cx.npl frcm th. Contr&1o Li<t@ t w for rlE follo\ig ta)o (Sd 70ll 5 <br />ltrli.B ,nd PolBior CcL)r Ary Cily or Coudy whkh r.qun6 ! pdnit lo ondru.l, .h6. ihprevc. &mlit or r.Fn ey <br />srructuc prnrro irr i,s!e.. ilr. r.qnt6 lhc eplicol for ch Fnit lo fik a 3iercd ndaetn $i h.or ir t li.6s.d Ftuad <br />lo rh. FDvbrro of ttE Contlsrol! Liccnscd bw ((luptd 9. Comn@i!8 wnh S.dion 7000 ol Divi.ioi I of $. BBiB ad <br />Pmf6ioG Co&) or rhi h. G rh. is .tdpr rhfclion ed ih. b.!ir aor th. JLB.d .roDFio.. Any viobion olscrbn ?01 1.5 by ry <br />!ppli.6r hr r paoir iubjEl! lhc .r?licul to ! civil t Mhy ofnol oor. lhD 6t. huftlr.d & hF ( t500) <br />I. s o*nd oarh. Fopcny. or my .mdo,6 warh w.A6 s fi6r sl. ompdrioc * &r dE wt !d UE rrudE t ml <br />iirerLd or or(€d tor slc {Sa.?0,14, Buin< &d Prof<od Cod.: Th. Coorlitr 3 LtE& Lrv (iE rcl lpply lo u owE of <br />rh. F.p6ry \\.ho lnil& or hpro6 Es{\ ad s'lb .lc sh mn hi@lf or hd*lf or lhrcu8t hE or ha om hploy6, <br />pJorid.i, th.r s!.t inFoffi e mr i' drLd ordH for sl at lFlrtG.0. hliuiie d inp.owlr i. hld wilhii o.c rG <br />orcorpkio'r rrE O*ns tiilb vi[ h.t. 0E hdc! ol FovirB th, h. or 3nc dil ml hrild or irFo( lh. FDtEl, tur lh. Fl?]$ of <br />t. s NG of rh. FoFry. M .rlBi!.ly conr..ring wnh licd.d co.tdclo6 lo @rsDcl llE Fljel (!iE. 704.1, BGiB <br />dd hDtu b6 Codc: th. Conhicror'r Li.. . La* do6 nor apply lo s ownd ofprordry wl'o t{itL or inPrct6 lhd6o, <br />d *ho cot r..t aor slch F$j..r! wnh . Coir6cro(i) lt.N.d prriMr b th. Co' r-rq r Li.@ ltw). <br />Ieao unda SdM . B. & P.C.6rlnit,6or <br />lrj.: O-n6: <br />!YO85I:BI-(]Q!I[[TIAIIO! <br />DECI"MA]TAX <br />I lEcby amm unds p.flaltv of pdjury on. ofrh. folh$ i.! d..ls!l ioNl <br />Ihr!.mdwillmintain!CaiirE.ofco.drro&lt-ln3@lq*sI6onFuniorsFiviLdtotb,S6lioi1700of(h. <br />trhor Cod., for lhc Ffotuc. orlh. wrt for *hi.h lhc Fnn i! is.d <br />_l ll,vc rnd wilts.inr.in rortB comFslrion inuM.. s r.+iEd try sBtion !700 o(lh. Lrbor Cod.. lor thc Ffo''l@. ol <br />0E e.[ fo $ttn thir Fmn b is].d. My vorl6 @nposdbn i4uE. .eit !d Polky tunba 4., <br />I .diry lh.l in lh. Ffotucc of rh. e,l 16 wni.h lti! Fmn is isu.d. I slEll el orrloy D, FMn in &t ltMq <br />s s ro h.$n. lubjd ro rlE @16'@mFEdion llqs otcditodir nrd tBE $r if I slsuld b6.tu ebidl lo llt <br />eit6 .uFNriotr FovtioN otsdrion 17@ olrhc t bo. ccL, I dtrll. lonhwilh omPly wath ltb* phltioN <br />W RNINCT Falurc ro sue s 6 conFrdion 6vds. i. u.h$tul ed 3trll $bid d onplolq ro annin.l Fuhit ud <br />civil fin6 up lo onc h@d,ql thour!'d dolc (llm.mo). in lddnioi h $. con oacon'FE rion. daru86 B provid.d ror lhc <br />Ssrroi 1076of th.kbo.Codc. i .r.nrdrlorEy s f6 <br />IICINTELCOIIITAqIAB <br />IEC|J8AIIOS <br />I hatiy alIm undo pady ot Fjury rh,l I u li.o!.d ui&r Fvilion otorgq 9 (sffiin8 wnh S.dnn 7000) ol Divnion l <br />of rh. BBind ed ProfdioN Cod.. !d my licas ir in tull fot. &ld.ltct. <br />SAIIIBIJCIIA!,IEDIIG.AGIICI <br />I heby.Itm u.da poullyofFdjurylht llE. ir.6*ntu(ibn lodlu.gory for tlE Ff6tu. of th. wl fr snich lh! Fsi i <br />i$u.d (Sa. 1097, Civ. C ). <br />tada r N.6c. <br />A}PLICA]IT DT.CIIXATION <br />! hd!t' lrm uidr pcn.lt, or Fjury on. otrh. rollowin8 ddl&{ ioB: <br />D.dolition Pmil}Asb<Nt Nori,j.{ion F.dol R.!!l.rbE (TnE,!0. P8r6) <br />Rcqun.d Lai6 ot Mnfic6lion <br />I cs! if, lhd lh. fcddll r.*uldios r.s6ding 6hdos ronoval s. nol applicabl. to $i! Pmj.d <br />I .qtifo rhsr I h!v. ud rhir rrgliotion 6d lrarc rhd $c 6bo!. inforulion ir codEl I ts@ lo o6dy wnh a Cny Dd Couly <br />ordiEkB .nd Slsr. L.ws Elar hs ro build,ns coldru.1io( &ld ha.t, &tbrnt rcFBsndivB ollhn Cily od Cour, to orc opon tlE <br />ab.v. moriondl FoFny for iNpdlion purFs <br />AIrli.rnr or At6r si*rrlurc: <br />f.mltd oo.(p.in0: <br />Drt.: <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <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 o <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc. <br />Rev 08-07-2015 <br />ELECTRICAL.INSPECTOR RECORD <br />I <br />I <br />I