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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / 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 />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouqh 4 P a\u\)
<br />FINAL tt PI rr -I fi{,latS lt;rt )
<br />Notes, Remarks, Etc ra
<br />OWNER BUILDER DEI,CARATION
<br />I hcEby afirn lnder lcnrlry or Frjury rhd ! m cr.'@r lonr rhe G)nkrt,n t-tcn{ rjq rttr rhr f.lbant8 rci$n lSR.?o.1,1.5
<br />Busnrss and Profc$n,n Cqlc): Any Ciry o. Coutrty whi.h rcqrnd( r Fmir b .otr rucr. 8lct, impovc. d.nmhh or rcprn ony
<br />srru.rurc. prior ro its nsudrcc..lso rcquncs rh{ {tlicr.r lor such p.rnrn tu fibn sirtrcd {dcnrctrl thit hcor sh. is li.cntd l)Uisu"nr
<br />h rhc F,visio.s ofrhc Cont..rofs Li.cnrd Law (Chinrcr 9, C.nrmrRir8 wirh SccLon 7OU) of Divnion I oI rhc Busincss rnd
<br />Prcfcsions Codc ) or lhar hcorshc hcxempr lhcrcfiomand rhcbalh ior lhc illcscdc{emprion liyltrhrt,norscclion 7oll5 byuy
<br />appliunr nn aF.n,ir subj.ckrh. dprli.rnrroacivilpcnllryolnorno.clnlofiv.hundrcddollaB($500)
<br />L ns ownfi or rh. pft,rcny. or nry.nplorrcs wilh wn8.r $ rh.ir sk conu(nsll i(,n. aill do lhc w( unlhc ntum Ln.r
<br />inrcndcn .roitrcd fu' elc (Sa.7(!44- Businc$ and Prorassnns Codc Thc Conksci{trlLi.cn* bw d€r not.ptly rn !nowncro,
<br />rhc pm0cny wtb huilds or iqroK Emn. lnd wno des such w.rt himscllor lrcr*ll'or rhftugh his orh.r.wn cnplorcs,
<br />,rolidcd rhar s!.h ifrpmrcftnn m nor intcnd.rl or dlTcrcd ft, elc. ll k)sdlr( th. buikti.a or inDmrcmnt is $U lilhin om )rr
<br />ol comDbrion. rhc Osrcr Buildcr *ill har rhe hrdcn ot pnvins rhd he or dr dil nor buikl .r n ptuh ih. tstxiy for lhc Fuqnc oi
<br />L rsownrrofrhd pr.tcdy. rrcx.hnivclycotrtrcrir8 with li.crrd coftacrns lo .otr\Iru.t rhc proFr {S( 7O.r4. Bus.c\\
<br />u hrlc\lhnColc:lhcConl.rcioisl-iccnscl,0wdocsnorupt'lrl.!nowneror'piorcrr,wh{,brild\ornnpntrcsrhrcotr.
<br />Jfd *ho conrrcls itr such !mF1s wirhr s) li..n\.tl tursurd i,rhc Cin 'r(rr'\
<br />I rn,.\.n,fr trn,l.r S.r1tr)n
<br />u[!t !!rll!!u
<br />I hcrcby.ilrrn undcr pcnllry.ipcrjuryonc ollhc f(
<br />-lnavclndwillminroinaCcninc(corConrnrroScltlNurci(*orkc..of.Narion,,stmvidcdlorbyScclion3TO0oirh.tibor Codc. for lhc ,crform0n.c ol thc vork tu which thc Frnril h hsuLn
<br />Ihrvu ndwillm inr ( lvorkcri conf.isdrn i'rntumc,trs rcqrncdhrS..rir lT(Xlolrhc lihnr Onlc. forlhcpcrfomun.c.I
<br />rhc uork tur$hi.hihis pcmiir is issucd. My workcr\' .onr!.n\rrion nrsurriN.dri$d nolicynun$cr rc
<br />Policy Nunrhcr:-Lrtter
<br />-
<br />WAltNlN(;: r,ilur b *ur. *.rkcn ..nr.tr\.rn,r .ovcrr8c,s unlawtul. nnd shrll subjcct an cmp
<br />('rrl lnrc\ trt r. .no hundrcJ thotrsr d dollnrs maScs rs tmvidcd f(tr rhc
<br />scrroi .1076 0frhc l-ahtr codc. irictun.n'l
<br />I hcrchyafitm unncr p.nrllyniperilry
<br />DECLAEAIION
<br />under rrclision ofCtapl.r 9 (comnttins wirh s.crion 70()0) olOivision l
<br />of rhc Busiftsand Pofcsions Cod.. my li.cnsc
<br />ca$iralJquoNLExuNc.dliDxlI
<br />I tur.hy xrlirm undcr pcnalrr.rr*rjrry rhrr rhcd is a con(dcrhn lcndin8 4.my ln hc l).donrMcc.f rM aork lor which rht lcrmil is
<br />ksucd 1S{. :l(Y)7, Civ. C.)
<br />AIETANLDECLAN{IPN
<br />I lrrch, afljnn uadcr |xnally of pcrjury onc ofrhc rbllowing d(hmtions:
<br />D.fr,lirion Pc.mns Asbc(.\ Norifidtion F.dciol Rcguldions (Tnlc 40. PM6)
<br />_RcqliEd Latr( of Ndrificdrin
<br />-l.cni,
<br />thd rlE ndcnlrcsuhlions rcradins !\hcstos ,cmvrl lrc nor srpli.nhlc ro lhil Prcj.{r
<br />tuxd rlr^ rnt,luritrrrxl {11clhrr ion G corccr. I asre tommnly wirh ull Cirydd ('outrrt
<br />rizc rcprcBnhrivcs otrhn Ciylnd Coonry kr.nro upoi rlf,\
<br />""rtf q q./^kb,\lz-
<br />ID/SIG.COMMENTS
<br />Pole Bases
<br />Service lvleter
<br />-l
<br />ccniiy rhor in lhc pcrlonnrncr olrhc work ior Nhich thh Fnnir h issucd. I rhxll nor cmpby !i, pck,n n' trtry n'jtrncr
<br />$ tr h hccqnc shjed ro rhc wortcri coopc \arion lxws ol Ctrlifqnir riJ rgtt rhr if I lk,uld h..oN subl,ct lo lhc
<br />workc compcnsarion poli\n,ns ofSccrnnr.l7U)ofrhc tahr Codc.I shall. tudh*irh.o,nt)ly wirh rho* [olisbns
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