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ELECTRICAL.INSPECTOR RECORD <br />DATE tD/stG.COMMENTS <br />Site-Work <br />Und erground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />To rquerng <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouoh) <br />Itleler Release <br />Rough <br />Service Meter WFINALq,IA ta'r?+ ) <br />Notes, Remarks, Etc trlr-I <br />OII|'NER BUILDER DEL( ARATION <br />, hqcby amrm undd p.mlty of p.rjury ltul I aD .rempr frlm rh. cnnh.tnis' l.i..n!e lis lor rhe tnllosinr rwn (SG 7031 5 <br />Bus'n6 aod Prolsion Cod.) Aoy Cily or Cou.ly whi.h Equt6 a pqnil lo .oBrtuc', ahc, iryrole &molisfi or !.ruir my <br />sdclrc, rio. ro its isroc., .lso r.1ut6 lhc applicd for soch ,Enn to fiI. a sisncd stoImcnt lhal hc or sh. it li.dscd p@a <br />to (hc prcviliotu ol thc Conklctois Lic.ns.d Ldw (Chaptn 9. Comm.ing $ith Sarion 7000 oa Division I oalhc Busin6s dd <br />hoa.sioDs Cod.) or lhnl h. or sh€ is .xdpl ltd.iiom md ln. b.sis aor th. all.sed cxmplion. Any violalion of Sdlio. ?01 I 5 b, any <br />applic$l lor a p€nnit subj*ls th. applicfi to a civil p€nahy o f nol mor€ thd l''ve hu.dr.d dolls ($500) <br />I. a osad ofllE poFny. or my.'nploy6 vil h w.g6 c then sk compdsarion. s ill do lh. work erd thc nruclE i nor <br />ilnad.d or olts.rl aor sl€ (Sd.70,1-J. a6ine &d &or6sioN Code: 'th. conkacror's Li.d* tlw doe n6t rpply b ow.d ol <br />th.popaly who hrilds or nnp.ov6 th€en, erd who doB such *oi{ hins.lf or tcellor lhrcush his or hd oM.nployc6, <br />provi'lcd rh.t such nIpmvdE s m nol intsd.d o! or6cd ior ek. lt ho$6q. rh! buiuios or lqro\onar is $d wnhin on. ya <br />ot compl.tion. rh. ovnd Btrildd will hav. rh. hrkn oiFori.g thar h. or sh. did nor h d or impmv. th. FoFry tor lhe pu.loe of <br />-I. <br />d oM.r olrhc prorsry, d .xclBn!! .onradins Nith licda.n ..ilrados to coErflcl lhe pmjEl (Sc. 7044. t)Gin6 <br />d l\ll6ion cod.: Th. Conlra€lo.s Lic..se Law do*.or appl, io eo$nd oiproFny who builG or nnprov6 lhd€on. <br />and Nho.onhclsforsuchplojdrswnhsConr6cro(rlicds.dpursuurrorhc('onthdolsLic@Law) <br />I rn crc undd Scdn) <br />Drter Ornr: <br />WOR(T:RS' COMPE,\SATION <br />DECIAAAIIg! <br />I hcrcty amrm und6 pmalty ol pajlry one ollhc fouo! in3 delsarionsl <br />I h6r. anii will mai.rain 0 Cdificatc ol Co6nr to S€ltuErrc for sorksi @nip.neiridn, 6 provid.d lor by s.lion 1700 o f the <br />kbo. ( odq lor rhc I,&fome.c of thc wolt fo! *hi.h thc pftnir is issu.d <br />I hav.nnd$ill maint.in *orl.r' comp.Nation insu.aflcc.6 requircd bySdio! 1700 ofth. Labor Cod., for th. pcfommc ol <br />thc qort for {hich rnis ptrnit is iscd My workds onp€Mion iNurme ffi6 and Fl,.y nufrbd a.: <br />_l ccniay rhar in rh. paaorde.. of lh. $ort ror which fiis pemn is Gsued. I shallnol mploy 3ny p.e. in anynrMnd <br />$ 6 ro beom€ subl€t to rhe ro ss conDaetiofl lawsofc.lifomh. aod arrc rhar ifl rhould b€ooc bjdt lorh€ <br />sol{ss comp€Nlion provisioG ol Setion 3 700 of thc Lnbor Code , shall. lonhwirh comply $nh lho* ptolisioB. <br />wAR ING: F.ilm b sN workm conp.Mion covasc is unlaslul. d shall subj4l an oplo)s lo odinal p.Elri6 ..d <br />civil finca up ro on. hun&ed thousd dolltrs rhe cost ol comp.nerion. danus* a providcn for ih. <br />Scdnrn 11076 orltu l-abor (idc. in1.J6r <br />Drui3rL&t <br />I hftby arnn udd pd,lry o t pEjury that I m lic€ns€d undq Fovision of Chapls I (comh@ins wirh sdion 7000) oa Division l <br />of lhe BoshN dd Pmfsiod Cod.. od ny lic.s. Ls in aull forc. md drct. <br />>4/7d/ <br />I h6€by amrm und€r Dcnahy of pgjury $ar <br />issucd (Sd. :1097. Ci!. (r ). <br />ilclio. kndins aldcy aor lh. pcaommc. olnE rork for *hich this Fnil i.s <br />AfIIICANLIIEqTAAAIION <br />I hddry.Jrm und6 poalry of pdjury on. oath. follo*i.g d€kar ionsl <br />D€nolirion Pdlnns-Asbdlos Notificarion icd6al RcsularioN (Tirl. 40, Pan6) <br />-R€quned <br />L.rrd ol Nofificahn <br />abcros r.lnDv.l tre nor aDpli.able lo Ihis proist <br />c lhar th€ abov. infomation is cortrl. I asr ro comtly$nh a[ Cilyed Counl, <br />authornc rcpr6dr.ri!6 ofrhis Cnyrld couniy ro..16 up.tr tn. <br />*..*f,.g",,/>4zr- fle944 <br />APPROVALS <br />Sub-Panels <br />tindd ! ACrt*: _