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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/srG.COMMENTS <br />Site-Work <br />Pole Bases <br />S S Pool, Fountains <br />Life Safety /Low Volta ge <br />Fire Alarm / Dam <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />/ UFER <br />Transformers <br />Sub-Panels <br />Roof To ut ment <br />Facto Wired Unit <br />Conduit <br />hWallsRo <br />Ceilin hSHard & Soffit Rou <br />Ceilin S T-Bar Ro <br />Meter Release <br />Rou h <br />Service Meter <br />FINAL 0-flp/tz 5DtrT <br />Notes, Remarks Etc <br />OWNER BUILDER DDLCARATION <br />I h6.by amm u.der F.ahy of pdjury thi I d crcmpr ah:n rhc co.r,.roB Liccns. rj$, ror rhc tolowins r@n (se ?0L j <br />au.in6s and Prcfsion Codc): Any Cnr o. Counry which rcqutd ! pdftil ro con$ruct. atl6. inprov., ddnolish or r€r,.n my <br />slrctm, prior ro ils issumc., also icquirs lh. .ppli.dl for su.h [mn to frL a sign.d stalomr th.l hc or sh. i! li.mcd p6uat l <br />lo rb. provisioE of th. Conhcrd s Licens.d ll{ (Chapts 9, Com.n ins wnh SNlior TI]OO oa Divisio. I otthc BsiDs md <br />FYoacsions Codc) or tbar lt or shc is cxcmrl lhdcftoin od $. besis aor rhe sltcS.d croplion Any viohiionofs..lion 703t.5 byany <br />applicantforapmnsubjslstt€applic&rloacivilpcnal(tornortoor.lnm6v.bundr.Jdole($joo). <br />-I. <br />$ ownq olth. prop.dr, or ny .mploy6 with \Eg6 as th€n sL compcns.tion, *,ill do $c work tud lh. srruclq. 6 mr <br />inlad.d or offrcd fo! elc (Sd ?044, B6ins ed ProfBioG Codq 'rhc ConrEciois LicGc L,w do6 mr apply to m oMo of <br />lhcpDp.ny $ho buil.h or iqmv6lh6on. &d *ho do6 such Bo* hnBcror hGcttorthouSh his or hn o"nnptoyc6. <br />provid.d rhot such i,nprovonaa e not odcd or olldel lor sL. tt howM. rhe buildn8 or iol[).ovmor is eld wirh,n on. ,uroaconpklion. th€ OM.r Btilda wiu hare lh. hido orFovins dd h. or shc dt nor build or inwlvc thc prlFiy for $. porpoe of <br />l. a osro ol rh. prop€tn m ci.lsilcly cont ding \ith licos€d sonrdou b s.eru.l lhc prcjct (Sd 7044, aEnB <br />6nd Eolisin Cod.: Th. cont.clois Licm. Law do6 ror applylo d owo6 ofpropBly who buil& or inprovd thaon.and who co mds tor such p(j(lsrin a Conracro(s) licc.rcd pu*ler io rh. Cdnrmclofs t_ico* Law). <br />I e .x.npt undd Setio <br />\\ ORI<ERS' COIII PENSA'TION <br />DECT,ARA1'ION <br />I hreby amnn undd p.nally ot psjury one olthc follosins deldarioB <br />-l <br />h,v. md will iai.lain a Ccit ificarc of Co6dl lo S.la-IBUrc for vorkdt @npensario\ s ,yovidcd tor by Sdrion l7O0 of th. <br />bbor Cod., for th. p6fomdc. or ih. @it for which lh. tEtn b isu€d. <br />I havc and will <br />'nrintai. <br />workdi cohpcmatio. inuranc€. 6 r.quir.d by sdion ITOO of rhc Labor Cod., ao. th. Ftumdc. of <br />rh. w6r! lor rvhich lhir pmnit is i!su.d. My wo,ksr .ooposalion ireurmc. ffir &d policy nunbs scl <br />-l.cnify <br />thal nr nrc !.rlomdc. oftheNolk for rhi.h rhis rnrnir is issued. l shitlnor o.pto,.ny pdson in any tom.d$ a to b..oie sbj6l lo lhr rodm' cotup.e! ion lass of Catitomia. d as!€e rhar ifr rholld b€ome subi..l lolhc <br />tr "116' comF.ner on p o' sroB of Sd'cn 1r0O or rh. tjh.' Cnde. I nutt. ,onhn trn co'npt, * <br />'r <br />h r h.R pr o\ ijrons <br />WARNINC: Failur. ro BW vork6' compdelior covmBe is olasful od shatl subjer m dploF lo oihinat FElrks edcilil li.ca up to on. hmdrcd thousud dollEs ($loo.(]Oo). in addilio. ro th..osr orcompeNlion. dona!.s 6 piovid.d ior the <br />ser'on 10,6 otrh.l abor Cod.. mi(d ed lnorm s tG <br />^ppllont: _ <br />LICFNSI,D CONTRACTOR <br />DECI.ABAIIAX <br />I h.r.by amm und.r p.nalr, ol pajury lhal I m liccB.d unds pmvisio. of Chrflo 9 (comfrocins rviln Sarion TI]OO) ot Division Iof rh. Buins md Poleions Cod€. ad my li.Gc is in tutl foR ed.Itdr <br />(.ONSTRUCTION I FNDING ACENCY <br />I hmby aitnn mdcr pdaltyofpejurythd th6c h3 coGlrucri.n ladins aracy torthc pdfom ccofrh.rvo 6r which this pdtn i! <br />issucd (Sd 109?. Civ C ) <br />APPLICANT DT.'I ARATION <br />I hotSy rtrm n.ds p.flahy oI pcjury on. ol thc fouowing ddl@lioB: <br />Dmolirio. Pcmirs-Asbdros Notifi.alion F-€ddal R.gulalions (Tilt.40, P0n6) <br />R.qun€d klld of Notifi$rion <br />-l <br />c6lif, Er lh. fed.rl r.sulaiions rcsddins 6b6ros rdnoul e. nor apticabte lo rhis pol.(1 <br />-I <br />cdily $ar I h,v. rcrd thi! appli.arion dd slarc rn.r lh. abov. inaomation is cord r dsr* to @mpl, with all City a.d County <br />ordinancd ed Srat€ liws Ehliru to blildins coNiruclion. ad hacby aulhorize r.?.Miari!6 otthis Cny dd Coulryro dr6 rpoo th€ <br />abov. noriond pmp.rry f.. isp<rion pulos. <br />Appllcr orAgotslgn.tuft: Drt.: <br />Underground <br />Light Standards <br />Signs (monument) <br />Bonding / Groundinq <br />Torqueing <br />Air Conditioners <br />Walls ( <br />h) <br />Poli.t N,mbs_ ErDir: _