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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS
<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 />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />It/eler Release
<br />Rouqh
<br />Service Meler f",FINAL +A-/8 JJcJ ria
<br />Notes, Remarks, Etc.
<br />OWNER BUII-DER DELCARATION
<br />I heEby ofirm undcr pcnrlry or F.Jury rhar I a6 cr.mpr rftnn rhe co.tncros Lkcnsc Llw for
<br />'hc
<br />ii,lbwi.g Msn (scc?0.115
<br />ar\inc* und Pr.fcssion Codc): Any Ciry or Counly whi.h rcquncs ! Frmil to con{tuc|. alr$, improvc. {hmlnh or rcI'in any
<br />nrudurc, Ir!,io irs issusncc, also rcauircs lhc apdic0 for such pcmil ro filcr riBn.d srdcnEnl rh,t rror shc h liccntd pusuul
<br />ro rhc polisn,ns ol rhc Conrrucr(tr\ t-ic.n*d Liw (Chaprcr L Comnr.cin8 wilh Scclion ?OO0 ol DivGion :l of dc Bueinc$ ,nd
<br />Pmtcsioi\ C.dc).r rhnr h. or srE k.x.mpr lhcrcno$ aftj rhc basn ro hc lllcged cxcmprn,n A.y violarionorsclion?031.5 by lny
<br />,pplic0nl rora pcrnril subr.ck lhc ollliconl lo acivilpcnoltyoinor mrcllan fiv. hundrcddoum (lstxil.
<br />-1.
<br />a\ owncr of rhc thFny. (tr ny cq)lolt{s wirh w{Fcs ,s rhct knc compctrsatnnr. *ill do rhc {{r* ald l1r {mlurc h nor
<br />intcMLn or oniEn fo. slc 1Sa.7Or4. Busimss lnd Pmfc$ions Gdc: 'l'h. C(rt,ctl s Liccns! Ijw docs nol amly ro d .snd or
<br />rh. pmFn, wtxl hxilC\ or improEs rhrEn. atn Bh. dc sch sd. himsclf or hc^.lf Dr rhmu8h hk or hcr ow' .n{'loycs.
<br />providcd rhar Frch idpowmtu m frn idcndcd or oficrcn for salt ll ho*cKr. thc ldildin8 or i.lpmvc'ftnr h sold wiihin nN ,!rr
<br />o(.on{,Libh. lh. o* mr Buildn wil h,!e rhc huden of lrcvin8 thot hc or \hc dil mr hird or iryrot lhc pmFny for ltE purlns of
<br />I. $ owm or rhc potlcdr, um cxclusivcly cootradins *ith liccnrd conrftcnB tu consrdcr rlf ,rmjd (Scc 7044. BusiEs
<br />s PDf.asion Cod.: 'r'ic Contr.roi's Liccnsc Lrw docs noi rrply ro an owncr oftrop€ny who hlildr or im[ovcs thcrcon,
<br />and who conlrlck lor such l,Dj(ls wirh aConrEcrorls) liccnrd plrsxr.r r, rhcc.nt,.ttr\ Liccnsc tiw).
<br />lJnr.\.nrnr url$ Sr.ri,r .Il &PC,n.rhtrruxlrl
<br />lhlr ()$ner
<br />ITABtrE&5:I.OIIIENIAIION
<br />DEII.AN{UON
<br />I hcrchy afl n utrdcr pcnllrrolrdjuryon. orrhc r.lhwing d.tlara..is
<br />-l
<br />h!!c and qillruinrlio a Cc,rifrar. orOrnscm t, s.r Insur. rd $orkcs conlEnsrion. !r po{idcd liir bysc.rionlT(x}otrh.
<br />tjbor Codc. for rhc lcrformrcc oi rhc *ork aor whkh lhc p€rnil i{ i{$dl
<br />rho wo f(, whihrhh p.rnr is hsL{d M s comrcnsolion insurancc c,ricr nid F)lic, nunrh.r m
<br />ta-
<br />\N roa[Dt(0H4SsLfr
<br />I.cdilyrh,r inrhe t r,ormnccoflhc *,rt lo, shichlhh pcnnir is isskd.l rh,ll ot .mlloy 0ny ncnon in anynu.tur
<br />so Nro bcs,mc slhrcr h rhc workc^ conpcnsarion hwrorcrlifnari,, and a3rcc rh ifI shorld bcftnft subjNr tottr
<br />workcn corpcnsarbn pturhion\ .f Sd! ion l7(x)olrh. bb.r Codc., shlll. f.nhwirhsmply wirh tb{ povtions..
<br />Wr\nNINC: rsihtrc lo $c!,c work.ra..mrcnsdrio. L1,v.Bsr ir uihwtul. d sholl suhFr an cn{k,rtr h dimin,l trMlri.s rtrd
<br />ci{il fincs llproom hundEd rhous,.d doll,^ ($100,(xlo). i'r rddirir lo rhc cost ofcompcosarn,n. datu8.s rs prorAcd rot lhc
<br />-\r
<br />inr.rc{ Md rnrmy'. fNi.
<br />^,,-"- bnnaete-So\r
<br />LICENSED CONTRTCTOR
<br />pFr'r
<br />^RATr(ih
<br />-1q
<br />Q-_\O ?o rqgB.
<br />""," F-f\dE COrnpKn\etr
<br />CAN$BICIONIIND,INGIGENCI
<br />I hcrcby afftrm undcr Fnslly of p€lury lhal thcE h a conslrucrio, lcnding agcey fot rh. p.rfomncc of llE *ork for whi.h thh Fnnir is
<br />nsucd (Scc.3097. Ci! C.)
<br />Lcndn s Nom
<br />-
<br />AIIIICANLDECIdAAUON
<br />I hdrtry ,trm und$ F.ax, of lErjuy om of thc followin8 dcclnd ions
<br />De'nolirioi Pcrnik Asberl6 Nolirrcdion Fed.ral RcBulolions (Tnb4u PrnO
<br />R.quird lrnd of lloliitralion
<br />-l
<br />ccnily thd rh. lcdc8l agilarion\ ftgardi4 $h.i.s Efr,vrldr. nor rmlicrhlc n' lnt I](,Fr
<br />-l
<br />ccnifyrhlr I hnlc rcad rhG ,mli.atdn uld st.rcrhar Ihc atnrc inlonMrhn ncom.r I aEIe ro .onPlt wirh all Cny !trd County
<br />orliirxD.c\ x Srr.l rr\.d rrn,N k) htr,ldtr'g ivcs ofrhi\ Cny Md Counlylo cnlq lJnnr rlE
<br />abotr ornln'ncd pr)r.ny ntr
<br />ADt,li(r or EolSitnnhr.€toM ,"," s-i!19
<br />e{6:6[0l--
<br />Communications Cable
<br />Air Conditioners
<br />I hcnby fiirmund$ pcnulryofp.rjuryrhar I um lietrRn uodcr rmvtn orchnl,ld9(comntncinssirhS€clioi7t{n)orDivtion3
<br />of rhe Brsires snd Pn,fcsio.s Codc. trnd my licctrsc is full l'ore lnd cfltcr
<br />trnil.a( Addr.s
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