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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Sa /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Groundino / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Rool Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />(Hard & Soff it RouqhCeilinS <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Rough <br />Service lVleter <br />FINAL b l2-z ltc .tdc7!) <br />Notes Remarks <br />OWNEN BUILDER DELCART{TION <br />I hcrchy olfirm undcr p.halry of Frjury rhar I am cicmpt liorn llE Conrdus Liccn* tiw f.. dc followine rca$n (S.. 70:l L5 <br />Blsiness and Profcsn,n Codc): A.y Cny or Coliry shkh rcqlncs a lEnnit to .onslflcl. llrLJ. improvc. dDmlnh or rcprt any <br />\locluc. priorlo ils Gsuarcc. aho rcquncs tht amli.tr.t f(r slch pcmn lo fiLr siSncd stotcmnl thot hcor shc n liccn*ri puisudr <br />lo rhc rrcrnions of rh. Conrrbcrors Licensd Llw (Chaplcr 9, Conxftmine *irh s.crion rom.t Divnhn:l orrhc Busincs\ and <br />PnfcssionsCodc)orrhrrh.o.shcilcx.iprrtrclmmandlhcbashforrhcallcgcdcrcn{nion.Anyviot.rionofs{rion70tt5byanv <br />rrtlicrnr fin ! pcrhn subjcch rhc apllic{nl <br />'o <br />acivilFnalryofnor mr rhao fivc hundGddou s($500) <br />l. ^ o*nc. of lhc pmFny. or my cmployccs w irh wuscs as rtct n,lc conDcnqtion- *ill do rhc !ol( od th. nEtu 6 mr <br />i uftn ot dff.*d n, sE ( Ss.?O14, Busitrcss atrd t]ofcsions C.dcr Th. Conkr.tr\ Lk.n* bw dfts frn rptly to En owncr ot <br />rhcpmpcny who b!ikls or irrl|]nvcs llLNn.0nd whd ddr such sd( him{cllor hcRlf or rhmo8h his or her own erfll.yccs. <br />[ovi{]cd rtar $ch imfmrcrftnh m mr i.r.nd.i] or ofic8r for elc lt hoscEi llE huiling or inlmrcmor is sld *irh$ o* }rr <br />ol o'rq)Lr n. lh. owmr Bxilds {ill halc rhc burdcn ol roving thr hc or shc did nor hlild or in{mw rhc ,mFny fir th. purJns of <br />_1. trs ownn .r rhc ptuFiy. rn cx.lu\i{cl, .onrrucrins wirh liccn*d c.nraclo^ io snsrru.l llE prol.cr (scc 7044. Bus $ <br />rfrl lhfcs\ioo Oic: The Conlrncrois Lic.ns. tis docr nor 4r,ly ro !n o*ncr of!rcpcny who hui <br />,id *ho .o tucr\ ,nr \uch pnlcd s wllh r Conrr &kn( 9 licctr{d pu.\unir hihcCo racktr <br />""7,,6-,L---..L-4=.. <br />l\'( )RR l.tRs' ( I )nt PFNSA',T'!()N <br />DIiEt &[tl.): <br />I h.lchyrilnnrundcr!.nrlryol!.!uryoncofrhfollosingilftl rtiqrs: <br />I hdv. and silltuinrin a CcdifElrc ofCon$nt ro Sclf.lnsurc fo. workda L$npcnrdi.n. ds ltr.vidcd for bySc.rion -1700 orrh. <br />trbor Cod.. for rhc pcrforuncc of rhc *ork t'or *hich lhc pc.nn is issudd <br />Ih vcrftiwillnui air w.rkcis .orpctrsdn iNuhncc,ns tuqrned bvScrrion:1?(n.irhc lrlhorGrlc. for r hc pcnbr nun.c ol' <br />rh worl i(tr whi.h rhi\ Fnrir i\ hrud. Myworl.r{. ..nrtc \di(,, ii\uran.c uri.r md lx)li.t ntr'nh(r ar. <br />$rcs: _ <br />I.cn'fyrhar i'rrhc|f,rform0nccoflhcworknnwhi.hrhrprrnrirr\irsucd.Ishallnorcnll,loyrnypc^o i.rny'nuncr <br />$ N lo hcconr uhrcd ri $. sorrc' \ .rmpcnsar ion Lss ol Calilhrnia. $d a8nc th if IsbuldR..onr hJcrhIIr <br />workcr conp.nsrrnrn ,r.v'\n, sofSc.ri(,n:ITOOoftlE Lrhr Ciljc.l shJl. fonhw h mnlry wilh rho{ ptuvision( <br />\VARNIN(; l.nihrc t, {.urc *or[.]5 $nr|tns oD cor.rrgr i\ un!r*tu|. xtrd \hJll \u <br />::llrZY- <br />DIiCI ARAT(TN <br />I hcrby!tfinn undcr Fn0llyofp.rjury rhd Ltrr liccn{d undcr F.vtion ofChrprq 9(.omnErcins wilh Scctioa ?(x)0) olDivhion:} <br />ol thc Busimss{d Pn'laslbnsCodc. nl my liccn* k in iulllilrcc dcltlcr <br />b / <br />CONSIAICEOI{IED|ICAGENCT <br />I h.Eby dmrm undcr Fnllrt of l,crrury ln8l lhse is a onsld.rion lcdirS aEcncy ro. lh. Frrorlme .r rhc hrk ror which this ltmi i <br />nslcd (S(.109?. Civ C.). <br />AITIICANLDECLI8^IIA! <br />Itmt'yflltimundcrp.n lryof pcrjnryon..rrhcnnk,winEdcclar0tn,ns <br />Dcnnnn,. P.rhirr Astt(.r Norific,rion tucalRcsuLrions (Tnh,r0, PM6) <br />Rcquncd Lxrf of NDrifi ctrrir <br />l.cnLlirh[ rhcladcBlr.suLri(]n\ rc!uding i\h.{os rcnmvrt irc rol utplic tcrorInt(!.cr <br />I ccnifyrhrr Ihrvcrcodlhisnnllicrlionrtul t'.c r) rotrrt,lt $ir[ trll (''rv rnl (,)unly <br />odi'rtr.c\ iJ Shr. Li*srclirin3b huildin8 <br />alr,vc tunrion A popeny|or insrdiotrpu <br />.{ppll.ml or Af 6l Sigtrilue:c rL4YldzA{oL <br />Etc. <br />civil fines ur lo orc hund,cd lhouamd dolltrs l$100.0GJ). in <br />: <br />= <br />I