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ELECTRICAL-INSPECTOB RECORD
<br />APPROVALS DATE COMMENTS
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleler Release
<br />I I
<br />Rough U u tb .\c3?-
<br />Service lvleter
<br />FINAL IT 14
<br />Notes, Remarks, Etc.u \ <_-/
<br />OWNER BUILT'ER DELCARATION
<br />I h.r.by 0nir und.r pcnolly ol lciury rhlr I am cxempl liom rhc Conk0cl.n Li.ensc L{w lor lhc followinS rcN,n (Scclo3l5
<br />ausircsl a Profc$ioo Cdc): An, Ciry or C6!nl, *hth eqxits a IErn lo consrrct. !hc,, i'i0rovc. dcmlth or rc!'an lny
<br />srru.rurc. dor to its hsurnce. rho rcqun i rhc 'lpli.d for euch tr mit lo filc r sis*d ddcftnr rhtr r* or stu h liccnsd puNanl
<br />r. rhc tmvhions or lhc Conlroctois t-i.cnsd L3$ (Chaprcr 9. Coh'n.Ni.B wilh S.clion 7fi10 of ltilhion I ofrh. susin.ss and
<br />Pmac$iohs Codc) or lhur hc or shc h cr.dpr lh$crrom nnd rh. b.sh lor lhe lllcscd cxeDprion Aot violtrionotSstion?031.5 byen,
<br />apllicr forap.mirrubjccbrhc.ptlicantroacivilp.nalrtolnormorcrhan0!chundrcddolles(S5$).
<br />I. .( oBnn of thc roFny, or m, en!,lolei wirh wdg.s as rh.ir slc compctrs{tion. vill d{, lh. wdk iJrl lhc srrlm n mr
<br />inreded oroficrcd for sle (Sr.7o44. Bnsnr$and Profe$ions Codq Tic Conlncrois Lic.ns tjw do.s not amly ro an ownd or
<br />rhc EnrDcny who burlds or ii{,mss lhcrn. uryl tho do$ $ch sork himr.lfot hlrslfor lhr.u8h hn o, hcr 6wn cmployccs.
<br />pmridcd rhd su.h inl|lowmn* N mr intcndcd or otrcrd for sh Ii ho*eki rhc boiHi4 or in sEmnl n $t *irhin nm ,tr
<br />ot@,lplcliod. rh€ Owdr Euilljer *ill haE rbodcnolJrovin8lhdhcorshcdilmrt ild or irrmrc thc pmFry forllE puqrsor
<br />l. N owtrq of lhc Jrercn y- am cxcl!\irrly colfrNi inp knh li(n{d contsror{ ro oNrrud rlE pn,rccr (Sdc l(x'|. Bun.cs
<br />end Pn,rs\imC.d.rTh.ContrcrolsLiccrscLawdocsNnarplyro o*n.r of pn,p.d y who hujlds or imF,vcs rhrR,n,
<br />.nd qho contfl.ts lor such rojcch wnh a Conracrorl\) lkcnscd pxnxam hrhcConra.his t-iccn\c tiw).
<br />I !mcxcn0l undcr Sccr
<br />lloarE&tr:llMfENsafloN
<br />ITCI ARATION
<br />I h.rcby rfirm undcr r.nrhy ol rcrjury oN ollhc n'lhwins dccbrarions:
<br />I hrvc nRl *illnrirlri.0 Crd itiurc of Conscnr krS.lfIn$ru tr wmk..r coDl,cn{rn,n, a\ [ovidtd fdbySccrion ]TLrOoi rhc
<br />Libor Cudc. for rhc l)c droEc olrhc work tr *hich rhc ncn,ir i\ ksu.d
<br />_l hrvc od will tuinr,in uorkcR .ompcnsatiotr inq.lncc. r\ .cquired by Scd b. l7{D ithc tjhor Codc- ior IIE Frbnmn.cof
<br />rh. *orl Idwhihrhir pcnnil is issucn Myworkss mmpcnsrn,n insudn.c.nnicr ffd Fltynuml,c.uc
<br />-l
<br />ccnilylhlr in rhc pc.formancc orrhc *orr rot *hich rhi\ t'cirnir is n$'.d. I sh3ll nor.nrnloya.y Frson in any mrrDcr
<br />s, ast, b..omc sub]l'cl lo lhc worlcr dn.pcn\artD l,s{ oiCalinn b. aM r8N thd itl should t codc \rbi.d tu Ihc
<br />woturs..nrlrnsalioa!ftivisn'n\oiSccrion:lTfDofrlrtjhrCtxic.lshall,li,rrhwirhcon,plr{irhrh.*pruv(ioDs
<br />WARNINC: ljailurc ro sc!,e so cr' .ooFns,ri.n .ov{ragc is unlawrul. snd shau suhrrr an.nDlort. to dninol Ilcnalticl lnd
<br />.i!il liNs up lo onc hu red lhousrnd dolldrs (Sloo.txn). irl dilion lo thc cosl otconfcn\arnrn. drmgcs as Providcd ior lhc
<br />:::spiZfr i rrcll and rnormy'\ fce\
<br />t hcrhyr,ltmlndcr p.islryoftr4ury rld I anr li*trq1
<br />ol rlrc tlusiN$and Prclcsn,n\ CoJc,.nd.ry li:cn{ is
<br />c.9 (sm,mncins wirh Sccrion 71Xn) ofDivhion l
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<br />Ihcr.tyrlrjr utrd.r |inrlrvofnrrJUrt rllar rhrJc i\ tr.otr{rx.r for rlt Nrfonmrcc olthc $or\ nn shich rhir Fnnir is
<br />nnr(l (S.e 3(D7.Civ ( )
<br />,\ttt,t r(:ANl Du(tLARAl rt)N
<br />Ilrnbynlltnu dcr rctrnllyolFrj'ny om ol rtu lnlkrwi't! d.rln'dNrs:
<br />I).nn)liriotr PrrrniB nf,i.s Norillcdi.tr |cdcral ltcguhrion\ I rirlc .ll). l)rrr6)
<br />_ Roqui'r lxn.r.l Nor ii.di(
<br />I.cdnvrhd rltr lc(lcrrl rcgulrriotrs r.grdi',Ar\hr{o\ r.n$vnl nrc n.r ,,fJnlca[L ft) rhi\ f(,jd
<br />lcon ln rhrr lhnv. rc d rhnrmli.rri(,nffi1{[crhir rh.rt vc intrmrtn n.orc.r l.!rccrocon]J,ly t rhrllCir]rr Coutry
<br />o'dimruc\ nd SrrrcLr*r rlding kr huitlingcon(rucri,)n. r,xt hrrchtrurhorno of rht Ciry md Connry ro.ntcr uBnr rh€
<br />T {+LAL
<br />uhovc nriin 'cd
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<br />Applio or pcnlSlgtuloE:
<br />Pem'ilft nanelprint,l
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<br />AiJA E
<br />ID/SIG.
<br />Site-Work
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