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ELECTRICAL-INSPECTOR RECOHD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Lile Satety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soflit Rouoh <br />Ceilinos (T-Bar Rouoh) <br />It/eter Release <br />Rouqh <br />Service lt/leler <br />FINAL 4 tl rr t&?"^*r^J/O ,) <br />Notes, Remarks, Etc.UI <br />OWNER OUILDER DELCARATION <br />I hcrcby lrfirm undcr pcndry ()r lcrjury rhar I m cxcrpt rmm rhc Conrrbn Licctr* ljw au rhc f.llowing rcasn 1SN.7011.5 <br />Burincss .nd Pi(,fcsn,. Codc): Ary Cny or Cou.ry whi.h rcquircs u pcflnir b @n{rucr. 0hcr. improvc. dcmlnh or rcPat u, <br />srrudurc, rrior to irs hsurmc. dso requircs rhc cplli.anr itr slch Frmir ro llL d si8trcd sol.mnl rhll hc or shc i li..h\cil t)U6uinl <br />ro Irk Fhviriotrs oi rhc Cotrtochls Li.cnsd tiw (Chaptcr 9. Corrmcmins *irh sc.rion 70oo or Divisiofl I oflh. Bu\inc* ,nd <br />Proli$idNCodc)orih0lhcorshcheicmprlherefmmaftdrhcbasnfotrhcrll.e.d.xcmption.Anyvi{,latiotrorSdrb6T0ll5byrny <br />atplicn.rforalemirsubjsrsrh.appli.anr'.acirilFnalryortu mrc th.n fivc hundrcd dollafi (!500) <br />-1. <br />ar owndr or rh. pbltny. or nry cmlk tes silh wlgcs 0s lh.n sk compeneri.n, witl do rlf solk 0d ltr slr1w i\ fr)l <br />inrcndcd or drcrcd Lr klc (sd.7o14, BusiR$ md Poltsions Codc: l'tc Conrreloir l-i.ns rlw do.s m' al)l,ly ro dn o*ncr of <br />th. pmpcny sho blild\ or in{,roB rhcdn. and sho dms seh w)rt hinMlf or h.sclfor rhough ih or hc. o*ncmployccs. <br />lhvidcd rhor such impmEmnB N rcr inleotu or offcrd ,or elc lt howrw. rh- hildinl or inlltmlcflEnr is skl *irhin om <br />'cdofconpLrirr!.rhcOvnrBuildswillh!rclh.burdenof!rcvinSrhalheorshcdilfrrh{ildorin mrc lhc Impen, aortlrc prlstof <br />l. !\ otrrcr oi lhc pmp.ny- uN c(lusilcly onkacr ing wirh lircn{d .ouka.k,\ lo conslnrcr rhc lr'oj(r (se 7{x{, auvncss <br />r Pnlssi[Adc: lhcCont,.ifirl-ic.nscLawdocsnoratrlyro0n.wncrolpronrn,shohoild\orinprovcsrhcrcon. <br />nnd who cotrk".h roi ru.h rmjcch sith o Conrracrorl9 liccnwl purun' tu rhc contrttrl Lt ctrs trl r <br />lvaatrD8s:lQtrlgENlAro! <br />D[.q/.BtrIlQN <br />I hcrchy.fl irnrutrdcr Nnrllyol'Nrj!tryoncof rhc li)llo*ing,lc.h.rri,nr\ <br />lh,vcmdwillmi ainaCcniar.rcolConsenlloSclflnsuEaor*. da conpc.sorn L$ rrolidcd lorhyS..rnrn r?fiJorrhc <br />Lrtu Cds. n, rhc l.rfonunN oi lhc wolk for whth thc p.nnir h hsuen <br />Ihrv. dwitlrii rin w.rliers campcnslrion insnrrncc. as rcqrt.d hySc.rirlT(X)olric l-fior Ctdc. fd rh. |rrfoiirkc oI <br />rhc w.rkforwhi.hthn |c rnit is hsucd. My *orkc6 i{,! nNhmc.mi.r md r.licr nnmtEr nc <br />I ccnilyrhlr nr r hc lcrfonmrcc ot rhe wort lor whichrth Frmn is itiu. ,l rhtll ml enuloyanrFr$i in,nymnmr <br />$ N k, &rotrc slh]cd t, rh. $6llds snpcnsrion loes olc iaonri!.lnloSrucrh ifl \h,uld h(onf, sunFd hrhe <br />eorkcrs compcnsarion pm!isn,6 or sdtio. 17m or rhc hhtr cltdc. ! shru. turh(irhonDly wirh rtst povisions.. <br />tN(l sorkcN conrpcnslrion .ovcra rtrrt1,,j-r l0 .nn,inrl 0.drlri\ md <br />ion. nrrrgcs r\ fro\nlcd Lr rhcrhou\xtrlr .l]]^ tsror).r{nri.-fmT <br />I rn liccnscd u d$rovniotrolChoprcr9(comnrcncinSwirhSc.lion7(xXJ)ol'Divhion.] <br />llusif.\iNlProl.ssotr\ Con.. tDd n,y liccns. ir in lnllln.cc dclli{r <br />6 <br />h |xhlry ol ncriurr rhd rherc i\ r.oD{rucrhn lcndins r!(n.j- litr rlt Fnnrnrnc..lrh. $ork lnr \hi.h rhi |tirnir ir <br />I ccnili rrhn rhc ludcrnl rcAUl.rion(ir8 rshcno\rc ^trLrc f,[ x|rfl.rnl. r, rh^ |f,tc.r <br />l.cnifrrhnr I htrvc rc rhis tr9tu! lo comtly wirh rll City.nd Coutrry <br />ordirin.cs rnn S'rrcl r$\ rclor <br />rlnn. n'c rittrrd t)rft.'lt n{ <br />ADpli(trnr 0r A!(nl sisml <br />/ r\-{ 4 4L( <br />lri.crc nnu rrscrrnn n &PC f. rh^'.J",i <br />l)nl. ()*n.r <br />7a <br />iist.d (se .1097, civ. c.) <br />l.trds . N.rm <br />- <br />AfILICANII'EII.AAA.IIOA <br />I hdL{,y,mm und$ p.nahy or t'.rjury orc oflhc followin8 d(lararn,nr: <br />Dcnblirioh PonirsAsb.sros Notiicalion Fcd.!!l Rcaulrl ions lTnt .()- Pul6) <br />-Rcquircd <br />Lcrrcr 6f Noffcarbn <br />U