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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />w,Underground I
<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 />Buildinq
<br />Under Slab / Floor /A
<br />Bonding / Grounding / UFER t8 |]u/fi-rlJ\J
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouoh
<br />Service lvleler
<br />-?-7-q
<br />'dt IFINALYM
<br />Notes, Remarks, Etc.
<br />Bakt/,1/c5.'l-l/.lc)U
<br />OWNER BUII-DER DELCARATION
<br />I hcrcby rr6m und.r p.mlly of rrjlry thot I m cxcnr/ irom rhc Conrr!.roN t-i.cn\c kw nr rhc lollowir8 rcrnn ( scc 7031 5
<br />Busincss md Profe$ion C(xlc): Any Cir, or Colnr, which rcqunc\ r Fiinit lo conslruct. oltet. inrrrovc, dcmlist or rhn any
<br />idcrurr. lni,ro irs ksnakc.,ho r.quncsrhc amli.0nr lor suchtcrmilto lile. sismdsrlrc'renr rtar h.or\hc ir li.cnsd Nftu.nr
<br />ro lhc nmvnnrns of rhc ConrEcrois l,iccnscd ti* (Chatrcr 9. GnmkncinS qilh Scclio. TIxxJ of Divhion I ofuh. Busir'.s and
<br />Pii,tc$ions C6dc) .r rhar trorshc iscrcmpr thcrcfomand rh. bNis lnr rhc llhscd crmpl ioo Any violarn,nolscclhn 70315l,yrny
<br />0pflicnflforrpcnnirsubjc.lsth.al,Pliclnrro!civilpcaahyolnor.orcrhrnfivchunilr.ddollnr(Ssm).
<br />-l-
<br />us osrcr ofrhc poFny,.r nry cmnlores wirh RnecMs thci slc ro.lcncrrion. silldo rhc $ork ind rhc {fldm i\ rer
<br />inrcMLn or dff.r.d ror *rh (S( 7l!4. Busirc$ md Pmnssionr Codc l lE Conrrlcxtr r l.iccn* Law ducs nor trPply lo m o* ncr of
<br />rhc pDpcrty vho l,lilds o, i@n\ts rl[m,n. &n whr doel such s{nl hinscllor hctscllor dmuSh his or her own 8'npby.d.
<br />nnrvidcd rhd su.h impmwmnrs N nor id.n .{ .. orl:ftd for kk. ll bscvr, lhc ttrildinA ot i.Dmtmnr is q,U wirhin om Fr
<br />of co'npLrhn. rhr Own& Brildd aill h.E rh. toftl.n of rmving rlxf h. or stE dil mr hui0 o. iq,mrc lhc pFlrny fo. rhc purrx]* ot
<br />l. !sowRr ofrhc Folf,ny. r,ncxclurivcly coniacring sirh licenscd cont,cttrs roconntud ttr Frccl (Scc. ?044. Bu'i,,c$
<br />nnd Pmlixsirn Gdc: Thc Contr.tr's Liccnsc Law do.s n.r rpnlylo anowDc. of|x)F.ny sho huilds or in,ptuvcs rhcrstr.
<br />lnrl Bho .otrtrach lor such rm,.cls *irh u Co rocx,(s) lEcnsed l)lrsuanr ro rh.cotunclor'\ Lic.nsc l,wl
<br />I rcxcDu u.ticr S(l
<br />l)Bne.:
<br />lrcB(Ii&r:l(ltuiN,5AlrltN
<br />IIEIIIaA.IIQN
<br />I hcrchyiitnmutrdcr p.tr.lryol lcrjrroncoirhc finb*in8dcclamrions
<br />-lhircs.d*illminrlinaCcdificaicorCo.scnrros€lrln\rrcrorworkcdennpctrsrti{nr.nsJmvidcdtu.bySecri.n:17{Dolrhctlhor Codc. ror lhc psfoirmrcc oI lhc work foi *hich rnc pcmir t isslcd
<br />_l hrve lndNillruirrnin sorkcB conrpc.snrbi in\urrnc.. r\ rcquirclbySccli(r.17{l()oilhclihorQdc.ntrrh.p.rloirun.col'
<br />rhc sork lq shich rhi\ p.nnir i. isu.d. My workc.' .otrrpriurn,n nNnrnnccmn[r and Fnicy numh.' ft:
<br />I.cd'ryrh,r hrhc l[rrornM ne .i r hc q'ork lol whi.h rhi\ p(nnil ir is{rcd,I $nllnoi cnnk,r any tE son in any m3nner
<br />y, 6lol[com sui,F.^'r x,'hc $or[cn compcnra'i.n lnss orCslir.nria. ,.d aBN Ihll ii l\hould t'.coN \rh].d kJ rl'.
<br />wo*cn onD!trsrlio.Imlhiois olSc.rn,n.l7d)ofrh.ljlrr C'tdc.I {hall.lorthsilh conrnly sirh rho{ IRrviliois
<br />$ARNIN(; rrilrrc b {drc q.rkcr\ .onBtr$tion c.Lcrrgc is un[\inl. xnJ \hxll suhic cn[lo]rr to criritrll pcnahts and
<br />rnil fir.\ uJr n) onr hdndrcd rhousrna doll \ 151fi).(xxr. r rd(lirifi r. rh. .f{th h!.s i\ no\ d.d ntr rh.
<br />Il-Ql"tb'jer'il:";
<br />DECL6.S UAN
<br />I hcrcby {litn undcr lrnrllyorpcrjury rh.l l.D lie.wl undft flovisio. olC n*ncin! wirh Se.rbn TO00roiDivision l
<br />ur rhr Buvncs r d Prolt$nn C,'oc.. trr ntr ltrcn{ | rn rull rnr.c l rn.'
<br />;:"'gzB I
<br />I hcrcbyailirnund.rrcnrlryorFrjuryrh llEc isr.oniru.ri hndi[a
<br />hsucd (SN 109?. Cir C.)
<br />pcrhn,uur.. ol rhcs.* lorshich rhis pcnnir is
<br />dPIICANI-DEII.dEAIIA!
<br />I lEr'$y rmnn u ndcr tcmlty oltcrjury onc oflnc ihuowins dElar,in,n{l
<br />Dcnblnior Pcrnir$A.b.slos Noiinc.lion tudcrll RcBuhl ions {Titlc .l0- Pan6r
<br />Rcquircd lltrcr ol Notifi orion
<br />lccnifyrhrr rhc tcdrrxl'csulIn,tr{ rloir! str$oJr0 n)vrl trc hr rltfll0hl. r) rhi\ Pn,jcrr
<br />Iccnilyrln lhnvcrcldlhn{'i,licarionmdshrcIhi ion i{$nfrt.Iot..r lo con$ly {nh rll Ciryr dC
<br />odnrtrrc! rnl SrIc lrtrr NLIing t,
<br />,84-aAlrlio or a€nlSitnrlu ,,S[]a",A
<br />€
<br />DATE
<br />lo-lV-lY
<br />v.w
<br />Translormers
<br />C,r*,
<br />-
<br />Policy Numhcr
<br />-Lxt'ncs:
<br />L. .i\AJdrc$
<br />-
<br />rhilc nrnri,)n d pn,I.ny fd
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