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ELECTRICAL-INSPECTOR BECORD
<br />APPROVALS DATE COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor ,4,
<br />Bonding / Grounding / UFEFI 5-r-n \rIM,v)\
<br />Translormers UIJ
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilinqs (Hard & Sollit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />I\/eter Release
<br />.
<br />Rouqh 3rL4&-5-{-t1 YJz"fuJ
<br />Service lvleter vrl
<br />FINAL s -{"t1 >"vkt)
<br />Notes, Remarks, Etc v
<br />OWNAR BUILDER DELCARAT!ON
<br />I hc,cby amrin undcr pcnlhy ol perjury rhal I m cxc'npr tin'n lhc C.nrrktn I-i..tr* Law ror rh.lollowins r.rson l$c 70.)l5
<br />Busnrc$ lnd Profc$ion O e): Any Ci'y .r Cotr.ry whih r.quncs , pcnnil ro onsrrucl. ahcl nnpr6!c, dcmolhh or tPar My
<br />nocrrc. lrhi k, irs issuancc. rlso requnes rhc rynlicanr lor slch llcn.n ro filcarigncd sr.mdr rhd h.orshc is lic.nscn pdrsrnr
<br />b rhc lfrvi\iuns of rh Contr.ror's Liccnsed tiq (Chrptcr 9, Conxrercirg wirt Sccri,n 7UX) of Division 3 ol thc Busine$ 3nd
<br />PofcssidN Cod.) or ihrl h.or\nc iscicryt lhcrclrom ond lnc busi\ fttrrhc !ll.g.d cxcnDrion Afly riokrion ol SNrb. Tl)-11.5 by ony
<br />!mlica.! for n p.rnril suhjdsrhc apnlicanr lo acivilpcnalryof&lnsr.rhan fiit hu.drcd dolh,s (S5ff )
<br />L ,s .wftr or rh. lt,pcny. o. rly cmployccs Rith wrBcs $ lhcn solc onrn nsarion, will do r}r wolt tmr Ilt srul@ is ior
<br />inrcMcd or ofcrcd for elc (Sc 7144. Busine$ and Pror.rsions CGlc: Thc conr.clols Ltcns L.u des nor alfly ro snorncr ol
<br />rhc rn,peny who b{ilds or i4n,Bl rhcmn. arld sho des skh wort himscllor hcncllor rhtuulh hk or hc. owncoPloycc\.
<br />pn,virlcd rhlt such i,npnNcnrnk m nori'ncndetorofi.rcd fff srlc.ll howcvd. rh: huiHing or illrlrowtnr k$l wirhir.nc )qt
<br />of cowlliotr. lhc OwNr Blildcr $ill halc rh. hnlcn oapmvirs rhnr lf ot shc dil rct tuil] or i'Iltrmt rh. lr,Ixry nlr rhc !urF$ ol
<br />_l.rso$ncrofrhcpropcny.rrcrclu\ikl!.onkacrirg*irhli..\cd..trL..loFh(otr(rulrrhrn'FcriS(7(!-{.BunNs
<br />atui tbrr\si)i Codc Thc C.ntd.ror'\ Li..trs. Lrw des mr atr ly b ,n o{ D.r ol ln,N ! ! ho bu ild\ or inrprcrcs rhcrcon.
<br />rnd rvho conin(rslhrsurhfn,rcc^ eirh rConka.t (() li.cn\.d nuFnrnrlorhc(onrracrois t-iccn{ lis)
<br />-l
<br />mcicnrpt under Sccrion .B &PC l'orriGr.r\on
<br />Dnler Ovn.r:
<br />wonxr.nii t r tuprls,lrron
<br />DECI.Af,AII{JN
<br />I hcrchyotftrnundcr pcnalrtor,.rjuryoncorrh. nnk,wirsdc.laturiotrs
<br />-l
<br />hrvc dwillnHintrin0Ccnifrsr.rfC.tr\cn!roSclrlnrur.n,\rork.rJ.onr(nsrri.n.a\ PovidcdnnbySc.rionlT00olrhc
<br />LlhorC.{c. fdrhcpcrlonMncc oflhcwork lor *hichlhc pcnlir i\ isntd
<br />_l havc rnd will uinrrin workcrj.onrNNrrii trNur.n.c..s rcquiicd hySccrion.lT0Oofrhc blxiC.ric.lor rhcI. formn.c ol
<br />rhc workforwhich rhis Firnir is k$cn. M, workcr' conlusir ion iNunr.c crri Nd Fli.ynumhcr arcl
<br />Iccriilyrh0rinlhcNrfoflnrmc{)lihc(orkntrwhi.hrhispei,irisi\sucil.Idr(lltrorcrrf!,,yrnypcrv,ninatrynmnncl
<br />er N b bccorE shiyr io rhc sorkc^ .onrFn\.ridr L*( ofCrlilarnir. ind alrcc rh?r itI .hould L.oir n$jccr r. rhc
<br />worlcr! coNpctr$rtD pn,vi\n,i\ ofSc.ri,,i l?m.lrh. Lnbr CRlc.I shrll. lonh{irh.anntlt trlrh rhrt Pmvi\ion\
<br />lVARlilN(; Frilurc ro su!. $orkcis'conrtcneri{)n covcmgc l utrl nrhirr nn cnlplorr h oinlnral ltmlris rnd
<br />compcnsatio". lrrog.\ ds pmvid.d for rhc. l fincs ul) ro otrc hundrcd lnousand dollais ($lm.rNx)). in lddir
<br />,,,,^ p'^!lX
<br />i.n{xxlxtorf,y\li.\
<br />I hcrcbyrllilnrlnier pcmlryolp.rjuryrha! I r li..n*dundci[.visiotrolChlrrcr9(connttunEEirhsccr
<br />.J rh. nn\i'r( r Pmn\sionsCodc. an nrv liccnsc is i'r hrllf.'!c and clltct.
<br />L,s C1V vz"<b1@rq
<br />cotflxl]utQllrrutNli ]!!.i!;]l.t
<br />I hcEby amrm undf Folly oi pcdury rhar lhcrc t a .on(flction lcndinB (sency roi thc Frformne of lh. wrk for whkh rhis Fflnn is
<br />issucd (s(.3097. civ. c ).
<br />ATILICANI.DECLASAUgN
<br />I trnby af,ian undcr pcnah y of pcrjur, one.rih€ LllowinS d..l,rorions:
<br />Dcmliion Pcrmns Arhnos Norificarion Fcdcral RcSulalhtrs (1illc40. P 16)
<br />-Rcq!ncd
<br />L.rr.rolN.rirs on
<br />-r
<br />ccnilyrh rhc ltdcra I ..-!u l, t ion\ rcardinr *bcstN rcnn,vrl rrc norrp|]lic&lc ro rhnpnrccr
<br />I r.niryrhnr Ihxr. rcnd rhir r!plicnnnr url (0lclhd rnc inf.irrBlnnr i\(onc.r l.Erccro..nDly*irhrllCiry.tr ('ounry
<br />ordi,rn..sn d Srrtd Lf,ss ru nrx b buildirE ( ir,rtrdC.uniyk, cnrcr trti,' rrr
<br />Jl,au f,nri. ,ql l,',,IlcnJ ntr i'^turi. r
<br />,r rrt,.,n, .. ,r *"n, Sr*"*,* /\,,," 11>b1 l8
<br />tllern t& nanrc(pri r:Qn\ 4.4.
<br />ID/SIG.
<br />trnduis Addrcs
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