|
APPROVALS ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor ./, ./
<br />Bondino / Groundinq / UFER tt', Z.?-tt ,K''f2 7
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough
<br />--4
<br />FINAL Q.27-tt\0a(,
<br />Notes, Remarks, Etc
<br />;;;;;*",*.,,,.,*,*,*,,ufli5,iii,llr"%Yifl"lfJlu,x*",*.,,",n,.*.***,.,.*[
<br />ausincss ad Profc$ion Cdc): An, Ciry ot Cou y shich rcqxtcs a Frmn Io con(tucl. ahc,, idprnrc. dcmlish or q'rn otry !
<br />strucruE. lrhr k, its nslane. rko .dtun* rh. rrFlic.nr ro. cuch pcmir lo lik r \iBtd rrxr.mn h,r rE or shc Ls liccnd nrumr ''l
<br />h rh. rmvhions oI the ConrErois l-iccnscd tiw (Chapter 9, conn ftin8 with Scclion 70OO or Divhn,n I otrhc suiincs ond
<br />I
<br />Pn,rcsions Codc) or rhtl h. or \h. h cxcnrr rhcrclrom ind rhc bash for rhc alt red .r.mpri.n. Anrvbl.rionofSccrionTnrl rhyany
<br />I
<br />dprli.dnr rora pcmir sublc{ts thc lnplicalr k, aci!,ilFtrlhy{fnor nmre'han nrc hutrdrcddollss (S50o)
<br />I
<br />l. as o*ncr of rhc In,tEnt. or ny c'ntlolss wir h wilcs as rhct slc mmpcnsarnrn. willdt, rrt $&k nlh.slmrmnB{ |
<br />inrc'xLil or.lttEd lor srlc rSft 70{4. Busin.*nnd Profcsions Codc Thc Conrrucrq \ I-i.cn$ tawdocsnolaPplylosnorncr',f Irhcpmrdy who ttrilds or inlprolcs rhern. sd rho dcr {cn w, hinsclforhcisclf.rlhmughhnortcro*n.'nrtlo}cci l
<br />povid.d rhr so.h i.pruwrEnh ae nor inlc ed orortrci for ekr Il howcwi dr hriklin8 ot ilq)mEmnr is sld qithin , rc ltr
<br />ol conrpl.rion. rhc Ownci auiun willhrvc d. b{dctr o! FovinS thll hc or shc did nor bxild or imtrcrc lnc FnPoly for rh. nuq-{ of
<br />{h,
<br />-,,a\.wrcrorrhctrop.rly.0trrcx.lusivclyco
<br />raclirs wilh li.cnscd contaci{ns ro cotrsfl.l lh. p(,rccr (Scc 70,!l.8usnrs
<br />rnil Bllcsiotr C.dc ThcConlroctofsl"icenscl-rwdoc\norapplyrodnowNrofP(,Ii.nywiohildsornnptovcsthcrcon.
<br />aM sho conrEct for su.h pru,c.* pirh 0 C.trrn.lrl s ) li.cnscd IUfiuDr t, rhc Cotua.rofs l-iccne Law )
<br />-l
<br />ad€xcdnr nndcr s..ti.
<br />raxf,D&tlarlt[Ns .rIQN
<br />II&CLAEAIIO!
<br />I hcrcl,y aflnrund.r pcflalry olpcrjury onc oalhc follnrin8 d(ld,rn'nt:
<br />-l
<br />hale a.d will tuintatr r ccnifi.0re of Conscnt to Sclalnsurc lor sorkd\' snD.nsdion. as povidcd fot by S*r mn l70o ol thc
<br />tjbor Codc. for rhc peraomnc. olrh. M.k for whkh rhc ,,nrbi n kucd
<br />Ihavca *illnrnair{.rlcF.onrNn\.rinrirnnrmc.r\rcquncdhySc.rtnrl7(X)ollhcl,rhorCodc,r{rrhcFrlornnnceoi
<br />rtu sork tur shich rhis |f,anir i\ nN.rl Myworkcrs conrcnsarioninsufu..c.rrricrnndFricytrtrnrhcr c:
<br />Policy Nun$ei-Ertircs
<br />-l.crlili thd i. the pcrhrnun.c {,rrhc wo fttrehi.hrhhFflDir is nsucd- I shlu nor cmp hy ,ny rcKr inanymanrcr
<br />v, 6 to hc.om sul,JlTr ro rhc *orkc^ .onU(,rsrriofl l0ss of Calibmia- ,nd asF. rhar irI should tE$m suhjer b rlr
<br />wo.lcrc' crmpcnsur ion pmvisions or SmriM 3?o{r or lh. tjho! Co<lc. I shrll. aonhsirh .omplt wirh thos Pmvnd
<br />Sl\hon .1076 oilh.Iilxr gqlc. ii,crc{
<br />Bl11l1 I qv\ren €sVnPzz
<br />ur.!Nlu1r,2lLB,!e !l)B
<br />I hcrh, nflirnrndf Nrilryol li.lj,tr y I
<br />DECLABAIION
<br />uDdcr rnvhiotr ofChnDrer 9 (c.mnEncin! wirh Sc.rnn 7m0l otDivi\ion l
<br />I rlt ln\nr$r l",)irsr,r(irlL'
<br />L L)V ["oQ,? bo
<br />at LLt(lO
<br />I turc5r- rrni,ntn{l.r p.nnlrr" o{ pc!ury rucr i.n Lnding ,ecft! lor r h. pcrlorrorcc or rh. *oik n, which lth P.mi n
<br />n\uc'l lScc.l0i)7. Civ. C I
<br />AIPILCANIDECLAEAIIAN
<br />Ih[$y ltinnundcr pcnolry oipcrjury.N otrhc Llk)win! dNlr.tions:
<br />Dc.Fliri6n PfmirlAsh.nos Notifictrlion Fcdcrol Rc-qllarions (Tnle 40. Prl6)
<br />_Rcqtrircd l.ncr of Nolifi crlion
<br />),\ hrll('ii\ rn,l (-, ir
<br />y ind (irun(j_t) c rcr!|xr]rlr
<br />s$llo
<br />ELECTRICAL-INSPECTOH RECORD
<br />DATE
<br />Communications Cable
<br />Service Meter
<br />WAiNINC F.ilurc ro surc *ork 6 $mrcnurion..v..rCc is unlrrful. ot shall \uhj(r ,n cnll'loycr r. oniixl Pcmlrtr and
<br />civil lines ut lo one filndred rhou\and dollirs i!100.Ux)). in lddnion ro rhc co{.f.onfctrs iotr. dnn{8cs ]\ Pft,lidcd for rhc
<br />nry li.cnsc n in lullforcc dcffer.
<br />rhcicdcrrlrcEUlarion\ rc!itrdn,g r\hcno\runhqlrrc nor 0i,fli.trhlc n, n,n rtujc.r
<br />prepcny for iNl.-{r i{m p0rFro\
<br />Lqe3,
<br />--------r------
|