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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hdcby oiltrn undd pdalry of tdjury rhar I an .ropr lion rhc Cod4do6 Li.G. b$ lor rh. followif,! r@n (Se 70:t I 5 Bsin6s and Proaesion Cod.) An, Cily or County snich r.qun6 a f6nn to coNrruct. ahr, inpro!.. dcmolish or !@at my srtuct@. prior ro ns iisuancâ‚¬. al$ Equt6 th. applter tor such p.mir ro fik a sisn.d slar..Mr thrl hc or slt. 6 li.os.d pulsur to th. Fovisions of th. Contr*tor's Lic.nsd lnw ((n.F6 9. comn..cing wnh Sfrtion ?0o0 of Division I oalh. BusinN d Prorcsnrns Codc) or rhar h. or sh. is umpr lhFcnom bd lh. bcsis for rhc allcs.d .rdnflion. Any vioklion ofS.clion 70li.t by loy sppli.st a.r r p.flnn subjds rh. rprlicmr lo a civil pcnalry ol ml dor. rhe fi\ . hu.drcd doll6 ($500) l. 6 oqnd oflh. pl!p.ny, or my .mployc wilh wa86 a lh.t eL co,nFnslion. qill do th. \rort 8nd th. nrclu. 6 no! mrdd.d or o,Iq.d for slâ‚¬ (Sc.70{4. Busitrs ud Prof6ioro ( odci -l hc Conrraclois Licm. liw doB not apply lo an o*ns of th.pmpdy *ho hiil& or inFo\6 fi.on. dd *ho d(E luch srn hms.lfor h6df orrhhu8h hi or hd orn.mplov6. provid.d rh.r nr.h inpllrmd* m nor inra$al or ollial for ek lt, h)*ad, th. buiBi.! or nymr .ffi is $ld wirhin on. ,@ oaco,npl<liorl rh. oune Blilda will h,vc rhc bdtkn ol I'oriru rhd h. or shc drd mr tliu or imp6v. rh. Fspdry for $. OrFs ol l. aosrd oarh. prop6rr. m.rclusiv.ly.onr,crins wirh licoFn.ofuadotsro coBrflcr rh. Irsjd (Sd ?044. Bsin* ard ftot sion Cod.:1h. Conlr.clois Lic.ns. Law doB not applyro M oNns olprorcny qho builds o. improv6lhshn.and trho conrdcl3 ftr !!.h Foj.nr*nh. Contrado(s) licoscd r,6u. $lh. (nnta(roas Li.d. trs) ! en.\.mfl undd sdion ,B &PC forihBr.a$n rqaaEaEcaltrEdsara! DES.AAAIIOT I ha.by rrm u.dd p6ln, ofFjury on. oath. follovi.g &.lrilioN: I h{v. ed will nri.rain . Colificd. oacongr to S.la-1N6. for {0116 oml,6!rio,L a Folid.d for ty Selion 1700 oflnc Lrbor Cod.. lor th. paforoc. of thc wort for which rh. pdmil b bsucd. I ha\. artl \ill marna,n rnrlds c.rnp6ar.nn'roumn\.rcquied ht S(lion l7fii ofrh. tibor Codâ‚¬. for thâ‚¬ pffonnanc. ol the $ od lor which rhi. p.mit is n$.d My vort6 iBuram. canid md poli.y nunrh.r de I celii lhal inlhcp.rformancâ‚¬oflhcworl for \Ihis p6 rit h issu.d- I shall nol .mploy any pd,n in anymdnt $ ar ro lrconc slbjdl to rhe *o*6d ompdelion lr$ s oacali,nm,a. dd asre rhar if I shJuld t ..,n. subjd Io lh. * orkad onpo$arion prorisioN oascd ion l T00 or th. l-abor Code l shal!, fonh*irh .onply *irh rhoe pmvisio.s $ RNINC ljoilffc 1o s.u.e uork6' compâ‚¬nsa'ion .o\sa!.tu|. md shall subjal o nployq lo aiarinal Fuhi6 and civil fin6 up to onc hundrcd lhous dollds ($100.0001. in ion ro lhc cosr oiconrp.Naho!. &'naE.s a prod.d for rhc Sshotr 1076 of(h.l.atrr ande inr66iand ./r./tt.L a n,7 l rl.( I \k \ I l(r\ I hftby rtlirm undd pdahy of Fju.y rhar I an licdsj und6 rrovisioo ofcnaprd 9 (coftn..ci.s slh sftrio.7000) ofDirisio.l or lhc A6in6s d Prq[6siod Codc. od my licos b h tull forcc ed c,Id . r,/z g corsrau(IloNrElDllli_&cEllr I n@by lfnnn undd por.hy of Fjury rhrl rhdc is. coErrucrion ladins arm.y for rhc p6romd.c otth. $ork lnr \rni.h rhi pdn n $suâ‚¬d (SE.1097. Civ. C.) AITLICANLDECI.ABAIII)! lMy.fiimund( paahy olperjury on. of lhc follo\eitrA d(I'arions: D.nnnionPd rns-Ash.srosN.rincalionF.d6al R.sul.rions(Tillc,l0, Pan6) Râ‚¬quncd t.etr6 olN.tin.arion I c6tty lh.l drc fcdqa I r.su lal ions rqedins 6b6los r6no!alarc.or apflicablc lo rhis pojccl I.d,firhai lha\.rcadrhlsamh. j.nand(arclharrhcahr\einfo'marionscor(iIalrero.onrplr. \'irhnll(irtad(ouirr ordinan.d.nd Srar. liNs r.Lr buildinA consrn,clion. ud heebr- aurhori,! rcprBcnranv6 orrht C,ry &d ( ornryt) di6 up.n (h. aholc m.ntiotrcd pnpeny lor ,\ppli(rnl or,\penl sitnrltr ^",1912y'.2 e Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Rough It-"5-t \ -vlAi) Service Meter U R( FINAL fi-n"\\Y.\-14$ Notes , Remarks, Etc Meter Release ? ,/<1l.