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ELECTRICAL.INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />.Spras, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Vollaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / 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 & Solfit Rouqh
<br />c eilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service Meter tt 1
<br />FINAL glLtl (e[,z(-,u/4t tx)
<br />Notes Remarks Etc - \a=7
<br />-t
<br />OWNER AUILDf, N DEL(ARATION
<br />I h.dhy o,ltm lndcr lcnalr, ot pcrjury ihnr I flm cxcmDl r'nm rh. GrntmdoF Licensc l r* for l hc ftrlo*irrr *iq,n ( sc. ?0.r 1 5
<br />Busincs{ rtrd Pturc\sion C,dc): Ant Ciry or G,Dnry which r.quiE\ ! I(rnrir t' c.nNdcr, rm, inF.vc.'d.flrish ". Nt.tr J y
<br />nrudurc. rior lo ils issuanc.. aho rcauncslhc rrplic0 l ror su.h pcnnn ro filc. siSmd sr.rcnrtrl rhal hcor shc is liccn$:l purunnl
<br />ro rhe tmvtio\ otrtE Conrrrtr\ t-ic.nkd I-!w (Chaprer 9, Conmc.ci.g *irh S.ction 70(n of fJilhn,n .l of rh. Burnrrs rnd
<br />Pro,assions Codc)orrh h.orshc iscxcnpr rh.r.l nrndrh.basirldrrhcrllcgcdcx.nfln)n. AnyviolrrionrfS..iiotr7031.5by try
<br />rprlica nrarcnnir suhjr-'h lhc aFplicstrr ro scililpcnlxyolnor morc lhnn 6vc hutrdrcd dollafi (65$)
<br />-1.
<br />!s ow.cr of lhc l)loll.ny, or my cmfloyccs wilh Mgcs $ rltrir $lc .unpcN{rirnr. wi]ldo rlr *orl and Eslndur. k nor
<br />inrcnd:l oroffcrcdrbr\alc(56?014.BlsincsandPmlcssions(-odc:lhcCnnlmcrr'sLiccnscLlwdoesnollpplrroanoenerol'
<br />lhcpn,!cn, who builds or in{mvs lh.Mtr drd who dds rkh eorl hinFclfo. h.rsclf.r rhbu8h his oi h.r 0*6.nDloyccs.
<br />F,rid.d rhar sn.h impoEnrnk e rcr inrcnlql or nnLaln lor *h. lt ho{trcr. rhc hlililins or inr0mvcmnl is sU wirhin onc }IU
<br />otcoq'Ltion.lhc owncr Buills will h.rc lh. burdcnofFhvin8 lh1ll hc or dr did mr hoild or irqor $c pmocny,i,rrhe purTns of
<br />L nsowrcroirhc nmpcnt- amcrclusivclrconrlaclinr wilh liccn\cdconlrr.roFrocon(tucrlhe pmjccl(Str 70{4 Bu\i',r\\
<br />arxl Pirfssbn Codc: Thc Contrk s Li.cnsc Lawdo.\ nor lpplyb an osncr ot pn,Fnt wh(, build!or rh|(,vcs rh.ron.
<br />,nd sho mnraclsrorruch pmjcch $irh n Conacn)( s ) liccnscd pusurtrr rorhcO,nrackr's Liccnsc Lls)
<br />l r or.n,fl urlcr Sr.r
<br />Drr. __ O$n$._wonxrffi
<br />NECLAIAIION
<br />I hcr.by .mrm trnd.r p.n.lly of p.riury orc or rhc followil8 decluationsr
<br />-l
<br />h!v. ,rxt will nDi.tain r CcniaEo'. of Consnr lo sclr-l.snE for wo*cF 6ml,.n$rion. 6 Fovihd lor by Selion 3700 of llf,
<br />L,hor C.d.. ror rh. pc,ror@m or rhc rcr* lor sbich rh. pcmir n hslc.d,
<br />_l hat and will mainlain workcs .onpe nsation insumncc. as rcquirEd by S(tion 1700 ot th. bbor C.dc. aor lhe nd{otu. of
<br />lb€ mrt for wnkh $is Fmil i3 nsued. My porlcB conp.nelion irstr@. 6ir !d polty numb.r ml
<br />Poli.y Ntrnrbcr_Ilxpnc\
<br />Ic.nrlyrhdirrhcFni,nnrrce.lrhcsorklor$hrhrhi\p( nir is i(trcd. I stull or cNpl.yinylc6on in any'nrnncr
<br />{'r\t,htcomc\uhjccrt,rhcworkcn'conrFn\dnrnhwsofCrliturnia.rDJr+r.crhrrill\houldhcconr\ubjc.ihrh.
<br />sorkc (o'ryr.n\rrirnr Iovn i(ins of sccrnni :r?(x r of rhc I -rtxtr crxl._ I \h ll. nfl hwirh rcntny q iih rlkN I)nrvsi(rN .
<br />WARNINCT lirilurc ro surc vorkql conllcns ion colcr08c i\ unk'wnrl. {nd rr cnll'bycr i) cri'ninrlrmrio\ rnd
<br />cilil fif.\ trn b onc hund'cd rh.u\J'rd dollrrs i0n. drnugc\ r\ proviilcd lar rh!
<br />i'l;a.TT"'1
<br />I fuEhyrllnDundcr ncmnyol p.rtrry lh I rnr liensd utrdcr pmvisio..iChnplcr 9(connmncin8 wilh Ssri,n ?U)O) orl)ilision:l
<br />.l lhc ansinc$ 0nd Profcsions Codc. and nyliccnsc is ir tull lor.c r]d.ffc.r
<br />c- to a16s36
<br />va", 7 I 3o T i
<br />I hcrcl,y rfiinn undcr pcnahy ol lcrjury
<br />issucd 1Sc. ]097, Civ. C.)
<br />th.rc is a ..nsrfl.rn bnding rBcncy aor rhc pcrlniimrcc o, rhcq lirr*hi.hrhis pcnnii is
<br />A.EUSdNI.IECI.AAAIIAN
<br />I H'y lmnn undcr pcnn[ y of pcrjury ore ofrhc following deler!io.s
<br />Dcrmlirbn Pcflnire.Asb.sos Notificorion F.dchl R.Suldions (Tirl. 40, Pdn6)
<br />-Rcqu'Ed
<br />t lls oaNolir&lion
<br />rcrularions rcBldirs ashc(os rcnn'rdl uc nnr rttlicahlc ro
<br />Ix!,..io.otrrdr\ hr Ici) x
<br />r \s,,rr \r i'1 nl(,,7rJ h
<br />,,","'7/)O
<br />\ xpn iri,)nrnd {r1.1hxrrh.
<br />irB k' h!ildlnE $n(nrcri{hcrcby rulhoriuc rcfl c\rnr
<br />Lit tQ4 Cwa
<br />,ftX
<br />Pole Bases
<br />I
<br />tt
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