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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Salety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Sollit Rouoh <br />Ceilings (T-Bar Rouoh) <br />r,-.\ <br />Rough V *.\471\ <br />Service Meler <br />FINAL 7.2fi-r A"Yl")c <br />Notes Remarks \Ja7 <br />OWNER BUII,DER DELCARATION <br />I hdrcty atnrh undc, ncnalry o{ I,crjlry lhol I .n crcnDl lmn rhc Cont..roN Lirnr b* trtr rh. rolh*irC rcavr (SN7o:llt <br />Busincss Md Phrdsio. Coder: Any Cn, or County vhicn rcquncs 0 Frnir ro ooslru.r. ollcr, iq)rcvq dcmlhh or rpor My <br />sltocrurc, priorlo ns issu0frc. lho r.quin*rh. amlka for \ochrcm lo nk a sigmd narcmnt lhathcorshc is liccnsed rruNmt . <br />ro rhc prolisions of rh. Contmror's Li..nscd tre (Charrcr 9. Conmcncins wirh Sc.tion 7ul0 of Divisio. 3 ol lhc Businc$ .nd <br />Prot.sidtrs Codc) or rh0l tE or sh€ t cxcmtt thcrclrom.nd rhc basis for rh. alh8.d.r.mp!io. Any violarion oaSc.ri,n 70:l I 5 by lny <br />rytlicanl rd rICnn[ slbjccls rhc applicanr rorcivil!.nahyofno' mrc thnn 6rc hundrcd dollr(!50o). <br />-1. <br />0s owrcr of rhc pmtEdy. or ry cq,l.yes wnh wagcs os rhet vnc ompcnerion. sill do tlE *ort and rhc sndm n mt <br />i .ndql or oflcrcd lor solc (Sa.?(}14. ausincss and Pror.sio.r Gdc] Thc C.nkacroi r Licc.* Li* doc\ nor q,plr ro a owr, ot <br />rhcpmlf,dy wtu htrildr ot impn,vcs rlENn. rnd who Btrn $sd( hnnscllor hcr*lfor $rcu8h his or h.r own cnployccs. <br />prolidcd rhlr such impownEnk e mr inrctolcd or ofi.Nd for {lc lt h.{$s. thc hihirs or in{'olcmnl is $U within om Fr <br />olorylerion. rll Owftr auiud will hk rtE brden oflDvin8 rhlr hc ot rhc dil mr buitl or impmlc rh. potiy Iffrlt pu4x,s of <br />_1. us own(olrnc pn,p.dr. sncrclusiv.ly.dnrrcring wirh liccn*d conlracroE ro co.srrucr rtE rnjccr (scc 7(44- aunncis <br />a l Pmrc\sin Codc: Tnc Conltacktr s Liccnsc tjw do.r nor aprly k, mowncr.tprt,n n, {hD boilds or imrrovcs rhc.con-and pho conh.h ror su.h rroj..k sirhr Conrrscro(9liccnsd pur(uo r. rhc Conrd.tor's Li.cn* trw). <br />-l <br />anrcrcnrfl unds Sdiotr .B &PC rorihis rca{,n <br />u0xtrE&t:rsutrNllr]Jl)! <br />DEIIIIIA.II!}N <br />I hcrcl'y alltmu.dcr pc.dlrt orFrtnrroncorrhc r.u,,*ins d(l[alion\ <br />I h.ec ,xl will mi.rain tr Cenificarc ot Con{nt ro Scll nsuE lor wrkcs oarpcnsriotr. as pmvidcd lbr by Sccrion 3?0o oi ttr <br />Iltbr Codc. tor rhc pcrlorromc o I rhc work ior which lh. Fmn is L$u.d. <br />Ihr\randwillmtrintdinsnrkoaconpcixlrioninsuruNc.asrcqutcdbyScctnnr3?mofrh.tjhor(bdc.forrhcpdfonMncof <br />th. Eork rorwhichlhis p.mir i\ t$cd M y wortcr\' com,Ensal ion insum.cc caricr ud Dolicy numhcr rcl <br />('MEr <br />-l <br />ccnilylhrr inlhc oerlbrnunccol rhcBork l'o. ehi.h rhk,rrnir h n\u.d. I \hallnotrndoy rnypc^on innny 'nr.n.rM, A b lf,cdrc \ubjed lo lhc *ork.ri comp.ns0l ion l.ws ol Ctrlnnrnia. dd i8N rhd il I should h.onr ubjcd to rlr <br />sor*cn co'npcnsrrion pmvi\ions olSediotr -lT00oirhc Lrtn Ollc.l shrll n,nhwi'h conlnt wnhrh.* liovi\hns <br />WARNINGT Frihrc b $rurc workuh conrpcnsuti,in (tstrsc is nnkwtul. nd shall subjcct aI cnun,yrr b ninrinol Dcnallis md <br />civil fifcs up to onc hu dr.d rh.u\rnd d.llr^ lSl(rO.(uD, in rddni.n ro rhc co( or compcn\dion. d.ruscs as p!'vacd ror rhc <br />Scclknr 3076ofrhc tjt CnL. imcrc{trnd dn.mcy s acc\. <br />Dal.: nrr,*r, ( <br />I h.Ebr oifiirn u.dcr p.nalry of F,jury rh,i I nn li€nr.d xodcr povnion ofCharrd 9l.onnrdins *ith Scclion ?On) ofDivisnnr.l <br />of rhc Burift$ dd Prufcsion\ Codc. ind By lt.n\e h in full ihre ad cl'lccr. <br />K <br />coNslBl]c[all.ElDllti-&aDNgr <br />I h.rcb, omrmunder trnally ol lcrrury rhal thsc ( r onsrM!6n knding.!.tut for ihc pridnutuc ofrhc *.rk for whi.h rhir l.rn r i{ <br />hsr.d(s( 1097, civ c ) <br />AITI.ICAI.IDECI.AIAII.IN <br />I ffiy ufm und.r Fmlry of p..jury oe of rh. aollosins d6L! ioos: <br />Dcmlirn,n Pcrmih.Asbcnos Norificrrion FedcEl ReSul.rions (Tirlc.lo. Pan6) <br />-Rcquncd <br />Lcllcrof Nolifi cadon <br />_l ccnrlyrhdr rh.ltd.ral r3ultrirnrs rSrding rstl.(o\ r.Nrvxlurc mi rnaliclhlc i, rhi\ tr+.r <br />-l.fiili <br />rhar I havc rcid rhis apnltalion ed (tlc lhal lhc alnvc nfornElion h.orel I lFe lo conyly *ilh .11 City lnd County <br />ordinaEes and Srarc L€ws rckrins ro huilding co.srdclion.0.d hcrcby aulhorir rcprcpntnrivcs ofrhn Cily 0nd Counry to cntcr upon rh <br />rl.in c riton.d ltri,ltnyror insFcri, <br />,.," t-b. \sADD,ionl or A*$l Sixntrlurr <br />IOATE <br />Policy Numb.r:_ExDircs: <br />Pole Bases <br />Torqueinq <br />Air Conditioners <br />It/eter Release <br />EtC.