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ELECTRICAL-INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soff it Rouqh
<br />Ceilinos (T-Bar Rouqh)
<br />lVleter Flelease
<br />Rouqh
<br />Service lvleter
<br />I <L.-FINAL clhl lL{'tntl rntl-
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARAIION
<br />I hcrcby imirn uMcr pcnally (,i perjury rhd I am cx.mpr rmm lhc Codloc,on' Lkcnsc hs lor thc follosins tin,n1s.c 7Cn1.5
<br />Eusincss ond t'otsbn Codc) Any cily or C-ounry which rcquirc\ a pcrdir l. .onsrucr. !llc,. improw. d,mlish or rcIlon anv
<br />srfl.rrr.. trin tu irr isurftc. aho rcquncslhe qrllicDnl rb! uch pcmir r.liL r siBrEd sl ensnr rh{ rr.r shc h liccasd Puruani
<br />ro rhc pmvhions oi rhc Conrrocttr's Li.cns.d kw (chlpln 9. ComnEnci.C wnh s.crion 70fiJ ol Divisn,n I olthc Bnsnrs {nd
<br />Piolc*6n\ coiLrorrhar tuorrhc iscrcnpr rhcrcli n ud lhc l,a\i\ ror rtr lllcBcd qempr ioo Anyviol,rio.ofSccrionT0:ll5tyany
<br />Jft,lic0trl tor o pcanir suhjccrsrhc appli.,m ro rciviltcnrlryofnoi nnre lnln fiv. hundr.d dolldis (S500).
<br />I.aso*rcrofrhcfrot(ny.ormycmDbrre\sirhwEciasrlttsnlcconfcnsorion.willdo(h.qort,lh€ndmi{n,
<br />i cndcn or oficE\i t . sk (S( 71)44. Busincs rd ftofcssiotrs Codc Th. C.rtt l.ls Licctrs lj, docs nor aptlyro an owret oi
<br />rhc pn,Fny *h, brilds or i.pDrcs 6cmn, ard slnl dms \*h so* hnmclfor hcMlf or rhhugh his or hq own cnPk,r.cs
<br />prcvidcd Ihlr such inDmrcmltls m nor iitrcnd.d or oficrcd fd slc. li lFs!'d, rlr buildin8 or i,npn,vcrcnr h $lll within onc vw
<br />ol NnDlcrirn. rh. owror Buiun will hlE rhe hU.nofpovinsrhnr.orshcdamltuiUoti.r{'dhUrlmlgiylorritputlxM(r
<br />-1.
<br />as.*ncro, rh. pDpcrry. rncx.lusivcly.onrdcrirrg *irh lienicd contd.rod k, con(rucr rh. rnjrcr (Se. 7(!'r. Bunnc$
<br />dxl Pn'fc*si, Codc TlrcConlracrorsl,iccnscLdwddsnoraptlylo.no*ncrorpn,pcnywhobuildsorn.p0vcslhcrcon.
<br />rnd who conirlc( r.r such floj.rh with 0 Contm.M(n liccnrcd pu^u]nr tu lhc Cotrllrclois l-ten* usl
<br />,liD.xcn,I u cr Sc.rnnr-.li. & PC lnrrhisrcnnni
<br />Dolc: Own€r
<br />wonrrt-s;t:olrpms,lr:rol
<br />NECLARATION
<br />I hcreby arlirfr xn&r p.nilryolNrjuryonc ollhc folbwi'rs dccl(arions:
<br />l hak klwillmnr{n.CcnifcatcofCon\cnlloSclflnsordfrtrsorkctr@nrP.nslrion.as F.vid.d for by SNtion.1700.frh.
<br />l,rhorCodc- for rhc pc.to'tunlr orik sork,n!whichlhc p.nnil ir is\kd
<br />Iluvc.ndNillnui nitr*o crr conpcns idr nsurri.c. r\ rcqtrircd hy S(r ion .17fl) of rh. lnhor Codc. tor ihc Pcrli,rnratu. of
<br />rhc Rork tor*hich lhhpcnnir i\ i\$Ed Ily sorkcrJ .ompctrqrion innmrce.ndcr nnd F,ltrytrun'hcrarc:
<br />-l.cniiy
<br />rhll ir rhc pcrforu .c.frhc sork lor whEh rhs ttrnril i\ issucd. I nrll nor cnrPloy trny pc^on i. a y mrflmr
<br />s, t, b.coft $bj.rr r. rhc workcr.ompcnsdion hes ., CDlir{nnia. rnd ll8N rhar it Iihould hcco!ft srhrc.r lolhc
<br />sork&\' .o rp.trsrion provNions olScdion.lTlnofrh. tihtr Codc.l d,rll- l'onhq irh convly wirh rhos ln)vhion\
<br />WARNING I0ilurc ro *!!r. lorkc( .o'nFtrs,Lon.ovcriSc is unlawf!|. 3nd shall subJ.ct on clnPloyct ro d,ninal Fmhi* md
<br />.ivil fincs ut lo onc Nndrcd rh.usand dolliN (SllX).001)). il.ddilion ro rhc co{ of.onrPcns{ion, donu8$ as [.vdcd for rhc
<br />sccrion ]076 ofrhc uktr cod.. inr.rc{ and anorrcy-s fces
<br />u,'", k 3o t( orou-,,, V -2/Lr(]Pii!Llf a oNTR-acroR
<br />DEII.AEAII!}N
<br />I hcrchy rlfirm ud$ Fndlty of Frjury that I om liccnrn und.r povision orchapH 9 icon rEnc ins sn
<br />oI rhc Busirc$ and Pmacssion\ Cbd.. .rri my licctrs is ir lull forN a,n cff.cr
<br />,.-ot" V- JQ - 1(
<br />I horcby dfl,muMci pcnrlly ol rErjlry lhrr
<br />is\ucd (S$ l$)7, Civ c.)
<br />'[sz z-,
<br />,,***t/*,
<br />c()Nslllticl loN I I,l\I)I\(i ,\(;lt\cl
<br />rh.tu isr.o sru.rirn lcndirp rlcncy forrh.lrrr
<br />AIIIIIANfDICIABAIION
<br />I hcrcny riinundcr pdnaxy.rrcqrtryonc o{ihc lollowin8 dcclmlnrns:
<br />Dcnnlirio. Pcrnih A\hcsror No'incarion Fcderal RcSulariors (Tirlc 40. Pun6)
<br />Rcquncd I !llcr ol Norifi cnrion
<br />-l.cnilyrhir
<br />rhc tcdcral rcsuldi.nc rcgdd g r{rstos i.nhval m rcr +tli.rl,lc ro lhis |noi.cr
<br />l.cnilvrhd I h \t trl rhi\ .rpllcrr
<br />orthnxncc\ rtrdSrdc tiw\rclarin8 lo hu
<br />rhi!, nr trrFilo(nrd\ rtr {rrion
<br />n,,r,,."", ,,. n*,r, a,rr",,* D(
<br />i,)n rfrl {irc ih rhc rh)v. inntr i(( n comcr l rsr(-. k,..nlfl ly wnh.ll ( ilyrnd C.utrry
<br />ildi',g coni ruci i(n xl hcrch!horlzcrlrc{nrarir.\of rhilCityrndCouDlyk,cnrrrtrtx rlt
<br />*,Q -jct' L''
<br />P.mire nnm€ ( prrno, Z? csy Ut!-tt
<br />Under Slab / Floor
<br />Lctrds : Add'c{
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