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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/slG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liohl Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Salety /Low Voltage <br />Fire Alarm / Dampers <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rough) <br />lVleter Release <br />Rouqh <br />Service lvleter -'ra\FINAL tola ta c?,"/Notes Remarks Etc. <br />()\\NF:R Il LDUR Dl) ( ARI rI()N <br />I hcrcby nflnm ond.r Nn0lry oi,Erjury rh3r I m cxcmpr fiom lhc Coirt!.r.N Liccnr l!* nt fic bllowin8 rcdr lsc.70]15 <br />Busincss sid Prorc\sion Codc) Any city or Counry which r.qun \ 0 ltir.il ro con$flcr. ahcr. irProrc- &nrlish or EIun rn, <br />$nrtorc, I}lirr lo ns h\latuc. nho rcquircs lh.lPplicrir foi \uchrErmit ro lik r \i8ncd sllicaEnt rhsr hcorshe n liccn\cd ltrr\u' r <br />io rhe pdvhnns oi rnc C.nlrackr\ Li.cnsd Liw (ChrPlcr 9. ConrmcNin8 wirt sc.riotr 7000 of l)ivision I olrh' Busincs trnd <br />PtultssionsCodc) orrhlr lEor \hc kcxcmpr lh.rc,ron rnd rh. basn lor rhc rllc!.d cxctnPrion AnvvnndionolSccrbnT0.ll5 hv inv <br />!prli.Bni ru r p$nril suucch rhc applicanrroa.ivilpcnollyoinornndrhrnrirchutrdEddullnrs($5(x)l <br />tL. <br />thc Imlrny whr haildsor innovs rhcrcn. arld who docs sch *o.t hims.lror hc!*lfor rhtuugh hk or lrcr o$n cnnlovccs. <br />pdvidcd rhar such inqDkftn* m mr inlcd.n ot oflcnd for slc li tr$q rh. htildi4 or iq'rowftnl h $ld *irhin o'c ]tr <br />;fcompldnD. thc owncr Buildcr ,ill hslt thc t rdcn ol [ovins lh3l h. or rhc did mt hild or it{'mvc rhc Impcnv ror rhc purlns o{ <br />L a\osRrorlhc pmlxny. mctlusivclyconrtaclins wnh li.cntd conl6t'u ro $n(rud llE t'mjccl (S*. 70'14. Btrsirr$ <br />and Ptnf6shn Coder ThcCo reclors t,iccns. Liw d.cs nol ryplyro anowncroffmpcnvtho builds orimlrovcs rhcrmn. <br />and who .onk .ls for such trc}Ik wnh ! Ct ntBdo(r) li.dnsd lu(unr to lhc Conta.t t Liccns lj*) <br />I inrcxc r0 un,l.r S..ri,) <br />z/q/te <br />11 0R(nRs' (l()l\lrltr.'s41r( lN <br />UIIIA.BIIIAN <br />I hcrby rm.f,un&r peM,ry or pdjury orc otrhc lollosins dftlddionsl <br />-l <br />hrvc ,fil will nDinlain a Ccditi.alc oi Con*nl ro Sclalnrurc rr workcG coq$\{ bn. as pn'vidd ror bv Sslion l?fir or lh' <br />L!h, Gnq ror thc lcdotrmrcc ofrhc wolk lorrhth lhercnnit i\ irsucd <br />-l <br />hrvc and Nill nraiorain workcrs comPensdrnnr insunrcc. {s rcquncd by sdr ion 3?(N) ot rhc tibor Codc. rbt rhc |).rrol mc or <br />rh. *o for whkh tht pcrmit is Gslcd My*otkc^ .omlensrion io\!tok sric! ud F,lkv nuhbcr acl <br />dccnny fi,t i ttft $no Mxcc of rhc qork ror which rhn l).rnln i1 i!\ucd l shall noi cnDlov lnt PcMn in rnv Drnrcr <br />"aris ro b.oE subiEl lo rh. so*cr conrFnsal ion h*s or Califotnia. ond rEte rhar if I stFuld lEco@ subjcd lo t& <br />srk B coflrEnel ion pmvisirns of Scclion 3?00 of rhc tjh)r Codc. l shlll ronhwirh omllv sirh rhd* povkions <br />WARNING Fiilnrc ro scurc wortch conlPcn$lion $vcmse is rnllwrul. rtrd shell rubJccr 0n cmplovcr b ain <br />'ml ltmhi! lnd <br />civil lincs u! ro onc hundrcn rhousrnd doll0r ($lO0.O0Or. in addirnrn ro lhc tr\t'li,rn. dxnrgr: tr! trfuvi,ldJ lnr rh..?ilr:: <br />u!.!t!ra-: <br />I hercbyamirnundcr pcnah!.rPcrjury rhar I ad li.cn{d undcr pn,vision ofChrt)la 9 (commncins unh Scclhn ?fin) ofDivGion:l <br />ot rhc ausimsand Pmrcrsions Codc. ml myliccn* is h turl lorc ad cll<r. <br />COISIB]IqUANIEIDINGIIiENCI <br />I hcrcby afl-rnn ond.r ,rn.hy olPc.Jury rhat rhcrc ii ! onslruclion lcnding 4ctrcy for lnc pdn m*c orthc sork lor whi'h rhir Frmir is <br />hsrcd rscc.3097- Ci!. C ) <br />APPLICANT T'ECI ARATION <br />I horbydimund$ p.nrlly ofpcrrury on ol$.lolloaitrg dslanrhn\: <br />D..mlirion Pcflnih-Asbc{os Noriticrlion ltd*al R.!xhrbns (Titlc.l0. Pud6) <br />-Rcquircd <br />Lcrrer 6r Norificalion <br />rc 'cr,r rh'. dnnlrcdnnmJ Lorc rhrrrh'Jtrarc rl,rrlri r i.ccrc(r <br />L!". "r,r"i io huidinc..nrtur".. -y6,9/.,h".it,.Fr{n <br />n nyft{ m\nccriln nu4\rcs ./ //, <br />s,Ena,u( C-..,/U//7,\---.--, <br />,ly wirh !llcnyand counry <br />ry lnd Courry ro.nld utsnrtE <br />,/o X ?kk <br />Communications Cable '()4% <br />trn,lci\ Addrc* <br />- <br />-lccnifyrhdrh.fcdcralrcsulali,,n\rB*ding6bcslosrcN)vul3r..dr,fl'liQhlcrorhi\proF.r'