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ELE INSPECTOR RECORD
<br />EN ,APPROVALS ID/SIG.coM
<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 /-23-/9 (2i",
<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 Rough
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lrleter
<br />FINAL
<br />2t O -/a-la,.-ITTI H
<br />Notes, Remarks, Etc
<br />Z
<br />OWNER BUILDER DELCARATION
<br />I h6cby afiim und6 pdahy of pcjury rhat I m 6mpl 6on lh. Contracbn Lic.nse t w lor lhc iollowio8 rffit (S4 79 1.5
<br />Businss d Pmldion cod.): Any Cily or County qhich requtG 0 p6mir Io co6rtucl, dna, imprcv., &tulbb "r Ep.n e)
<br />srru.lua Fior lo ils tsua., abo r.qun6 lhc atpli.Mt lor such penil lo lilc . siso.d slalcmol thdt h. or 3h. b licdscn pu$aflt
<br />ro th. pmvisiore olthe Conr,crori Lic.ns.d l-aw (Chlptd 9. ConnocinB sith Srlbn 7000 ol Divisio.I ofrh. BBins and
<br />Proa.sDns Cod.) oi tb h. or sh. i! cx.mpt th6efto,n md ilE b6is lor th. all.s€d crdoiod An, riolttionofsc.lion?0115 bye}
<br />applicaot tor a p..nit subjtrrs lh€ ryplicanrlo scililplnahyofnor ftorc rhm n!. hun&.d dollds ($500).
<br />-1.
<br />d o$ nd of Uc pNn ny, o. my .,nploy6 rilh w.g6 s th.ir $1. comFr,lion. f,ill do thc wolt ed th. sflclr a nol
<br />i a&d or ofld.d aor eL (Se.7014. ltuinG sd Prcfsions Cod.: The coitacroas Licn* t w dod not apply lo M ow.q of
<br />thcfllpsry vho builds or i,nplov6 lhsen. od who do6 $ch *o* hinsell or hdlf o. dmuSh nis or hd o*r cnplorc,
<br />provid.d thrr strch inrmr6@E e nol iniqr&l or oru.d aor e]. lt ho*a6. ih. hrildnB or m!rc\mt is $ld wirlii o.. tr
<br />oacompkliotr rhe (x n6 Buildg will hav. ltE hrdo ofl'orins lha hc or dt did nor buikr or improv. $. pt psry tor lt. purpos ol
<br />-l.
<br />6 ovnq ofrhe pmpdy. d qcluiv.ly cont cri.g wnh [.ds.d coflra.toE lo consrucl
<br />'h.
<br />p(j6l {S< 7044, BNms
<br />md Rrtssion Cod.: I'h. Conrr.croi s Li..nsc Law do6 not apply ro u o{.a of proFr, who blilds or nnprovcs lh6.on.
<br />aod who .o d.ls lor such projers$ h. Conhcro(s) lic6$d pu6wl lo the Co mdd.'sI
<br />l n r\rm un $ Sc.ru -1c(c\
<br />DECIASAIIO!
<br />I h.rcb, afllrm und6 p.n.l'y ot Fjury one ofltc follovin8 deleariore
<br />I harc sd vill minrain s Cglifical. oicoMl ro Sclf.InsuE aor worl.ts conrp.nsolioo, s prcvid.d for by Sdlio. 1700 oarh.
<br />kbor Code lor lh. psfonmcc ofrhc wo* for *,hich lh. pdn i,s Gucd.
<br />! have and vill maintain workert .ompo6alio. iBurd.q s requt.d by Sdiotr 1700 ol lhe llbor Cod.. aor lh. Pofo,rrEce of
<br />lh€ work lor which this pdit is is.I My workec coftp.@rion isurmc€ cffiid ud policy nu'nhd e.:
<br />-l
<br />ccnif, thd inrhc pofomanc€ oflhe{ork for which this p6mit is issu.d.I shall nol oploy yFMn inlnymdog
<br />s 6 to hdomc ubjd lo lhc wo*4' comp.Nlion l.ws of Cauloiia. ed rSr fi, if I should b<oh. subid lo rh.
<br />*ork6'conFMlionFovisioBolselion3?O0ofthcljboiCodolsltsll,fonhwilhco,nplywiththoFpovisioE.
<br />WARNINC: Failur.lo sue *oie6' coDFelioo .or.m8c is onlawtul. od shall subjd a. mplorc io oiminal pqEhi6 Md
<br />c'",1 l''n* up r. onc hrd.J rl'ousd dolltrs r$100,00u1,ion rth€ cosl ofconpdErioi,
<br />56lion 1076 ofrhc L,sbor Codq Er6d edanor.ey s
<br />^![clSlarla!
<br />I h*by artrrn uodcr peBlty oa psjury that I @ licotsqi undd Fovision of ( h.gc a (co
<br />of th. BusinN and PmftssioN Cod.. dd my lictrc is in futl lorcr od crld
<br />rvirh Sdrion 70001ofOivision l
<br />co!flalclloll,DlDtNc"acElcr
<br />I hs€br affrm unds pcmhy of pdjury lhd $6e i! a cooltuclion hndinB .g.ncy for thc p6fomu.. of th. sol aor shich this Fnnn is
<br />irq,.drse louT an ar,a>,r.,i"u-.
<br />A8TI.ICAILTECIABAIIO!
<br />I bdrby.rm rnd6 pa.hy ofpsjlry onc olthe lollowins dalaalioB:
<br />D.nolirio. P.rmirs Astct6 Norilicarion F.ddl Rc3uldions ('litlc40. Pa.r6)
<br />-R.qutcd
<br />t lldof Nolifrcaliofl
<br />-t
<br />c.rrify lhal rhc l.dcral rcsllariom (strdins ab.sros rdnolal m nor applicabl€ lo lhis pojal
<br />-l
<br />cdify rhal I 6avc rdd rhh appli.didn md st e rhrt de ,bv. inaonnalion is corccl. l trtd ro comply sith dl Cny and Counly
<br />odinancs and Slalc ln*s Elatiix rize rerrsei arn 6 o l rhis City ed County to .ntr upon llE
<br />al,\. ndrion d popdy for (::to'
<br />\ppli.tr r n,',\tr rSiA rl
<br />a
<br />Cr --{
<br />{L
<br />DATE
<br />Meter Release
<br />,,,,-t\ At I V
<br />PolicyNumbs: Erpn6:-
<br />,..",{?4 t{
<br />L€nd.r s AddrB
<br />O\+
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