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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCARATION
<br />I hcrcby afirm undcr !.n0lty of p.rlury thrr I nm cxcnu from thc Co.tradtrr Lkcn€ t r for rh. tolL$ifls Ea$o (sec 70.1 I 5
<br />Bu\ihc\\ and hoacsiion Codc): Any Ciry or Connry $hict ,cquircs n !f,m r ro co.{d.!. alid. in[ov.. &mlhh or rct,n lny
<br />nructurc. prior ro ns hsu!n.c. d$ rcqun$ rhc npplh, lor su.h Frnnl k) nh 0 si8tud (lkmnt rhar h. or shc n licctrsd pureo
<br />h rhc pmvhn,nr ofrh. Coiractr\ l.ien.cd ljw (Chapl.r 9, Commc.ci.C wirh Sc.rion 70fi) of Division I ofrhc Busitrcss and
<br />Pmlcsio.sC.d.)orrhrt h.orshc iscrcmpr lhc,.fnnn Md rhc basir rorrlrtrllc8.d.xcmption A.yvioldionofSerion?03l.5hyuny
<br />lptliconl lor o pcflnil subjcch thc rrpli.ani lo..ivilt'cmlryofnot nMclh,n nvc hundrcddollis (S5$).
<br />_1. !s osncr of rhc rol]cny. nr m, cmtloFcs sirh s!sc( os rh.t slc on'pcn\dn,n, *nl do Ih( w{rk drl rhc situ1N n nor
<br />i'ncndcd or offc[d tor st (Sd 7044. arsiftss and hotc\sion\ Cod.: Thc Contn(tr'\ Licc.e tiq docs nnramly to atr osncrof
<br />rnc pn'Fty who hilds or in{,mrrs rh.mn. ud s,x' df,\ suci sort him{llor hcrcllor rhnrugfi ht or hdr o*n c.Dl.yccr.
<br />nrolidcdrilr su.h impmEnrnk N mt inrcndcd or o0ircd ,or eh ll hou.vcr. rhc hiklin8.r inrpmlc'tnr is $ld Nirhin,ft trr
<br />orconl|lcrirn. dc o*rcr Builtlcrwillh0!cficbudctroilruvirS rhd hc orshc Jid mr h,iklori'npmvc rhc pR,lcnt ror rh. rF,$or
<br />l.$owncruirltrpml*ny.a cxclusivcly conhdir!-s wirh licnsd co run,n k' onsrruct rhc rnjccr (Scc 7(}r4. Bd\i'!L\r
<br />tol Ptr'll\sin Codc: lhc Contrciix s l-iccnsc l-.s doc\ mr rpply tr an D(ndr ofln'p.i!y*ho builds or nntors lhcrcon-
<br />and who cotuacts for such pojcd s with s Conlruclo( s) liccn{d plrlanr lo rhc Conrrachis l,i.ens tf,w)
<br />-l
<br />a'n cxcmpt u.dcr Sel iotr-. B & P.C. for lnis rcason
<br />Drle: Orner:
<br />llOBf,Df,,I.caMtDNS/UlaA
<br />DEIIA&IIA!
<br />I hcrchynllirmundcrpcMlt)oiEiuryotrcoIllElnllowir8dcc[ rions:
<br />lhrvc *ill rnnrinrCcnrficrrcotCotr*rn)Sclild\urclnr$ortcrr.unra'cnsliion,6tnnridcdli,rhySc.lion.lTm.trhc
<br />lrhr (irtc- nrrhc lf,ri. nan..ofrhcwork r(nwhi(hrhcp.nnii is is\urd
<br />lhnv.dndwillnrainrairw.rkcmconrr.nscrioninsuDNc.,rrcqunadbyS.crionlTmolltcliborCodc,lorlheFrfortu.cof
<br />'h.
<br />work lor wlri.h $i !.rmn is nsu.rl. My workc^ ompcnern,n nNur.rcc..nirr a.d Flicy numbcr uc:
<br />LxFncs
<br />I.cnify rhrr in rhe p.rrontuiccofrhc w.rk ror which rhis p.rnir ir i\su.d.l shrlln.l cnrployant [l.son in0nynunncr
<br />s, rs ro hccon* ruhl.cr k) rhc \roltcn ompctrsdtio. l.ws o, C.liforni.. and lArce thar il I slnluld trrom subF o rtr
<br />wtrkcr\.onrp.nsrridrtNvhnrnsoiScoionlT0oolrhctjLrCode.lshalln)nhwirh.onrlysirhrtx,{pm!irn,n\..
<br />WARNIN(;: Failurc to $.rc wo .tr coq*nlalon covcrgc is unlawtul. a"d shall suhi.l cmdoyer lo rioinal FrDlrts and
<br />civil ind up ro or hundrcd rhousnd dollaN ($l{D.0O0). i. addiliod b tlE cosl ofcompctrsllion. dlm8cs as poridcd for llrc
<br />SRrtrn1 1076o,r\cbh aodc.trrcrcqrnd, orm,\ r.ci, ,^ fi t _
<br />LICFN\E' C(IN IRACiDf,-- \
<br />DECI.ABAIION
<br />I h.rcby artrnu.dc. Fnallyolpcrjurythal I r lie.$d u.dcr pmvision olChrflq 9 ($n'reNi.s $irh Sdlion 70U)).rDiviqnrn -l
<br />.f rh. Buiifts and PtuLsion\ C.d.. aid my lh..e k i. tull fod dJrl .ffdr.
<br />b t515to3
<br />8-t?-tt c^ma.7\
<br />(:ONSTXUCTI(TN LENDIN(: A(;ENCI
<br />I hcrcby artrm u.dcr Fn{ltyol,Erjurylhal lhsc h a c.nstNclion hndiry oEctrcy r'or rhc pqrommc orrhc uork ldr which rhn Frnril is
<br />i*xcd (se.:109?, cir. c.)
<br />ATIUqANLDEIIAMIIQ!
<br />I hcr]t,y aninn u nd.r pcntrlry ofp.rlury.n. ofrh. folloNin8 dcclmrions:
<br />Dcmnirion Pemirs Asbc\lo\ Norincario. redclrl Rcguhrioos Ont.lo. PJn6)
<br />-Rcquircn
<br />Lettcr ol NolifrBrion
<br />I c.difyrhrr rh fcdcrnl r.!uhrn,n\ nganli',! r\h.no\rcnnxrlrrc mr$tli. blr r, rhr pniLrr
<br />ordimn.cr rtrd Slrh Lrws rcl ire to n,r,fil hcrcbyuth.riz. ru[crntarivcs olthisCilyn Cor yrocnrcr uF,nlhl
<br />trlxxc nurnnd F)prnr ln i'npd.r
<br />,.,", t- l? -r tAppli.nnl or Ag.rl Sia Hl
<br />Lau re<r
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />as, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough 1 ri 6 /(4fii1 ) W^/2 6tu1 eahlq,
<br />Service [l]eter I
<br />FINAL 0t r7 t I -.<,t//E ftD
<br />Notes, Remarks, Etc \.:,,
<br />Translormers
<br />Sub-Panels
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