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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / 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 (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />lrileter Release
<br />Rouqh </'4fiK <r71 0114+^
<br />Service lt/eter
<br />FINAL N/La/"r :\ BI
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />o\tNtiR tlt|tDUR D!:r.( AR,\'r'roN
<br />I hcrcby atlirm undcr Fn,hy oi lcrjury lh l am cien{'r from rhc G,nrd.r{ l-i.ensc tjw lor rhc followin8 rco$n (S€7Oll5
<br />Busnrs aM Pnrlcsiotr Cndc): Any Ciry or Counly which rcquires r F-rmir tu .onsfl.r, ,lrd. inltnvc. dcnDlish or rclln cny
<br />{dcru,c- r.ior ro ir\ issurcc. ilso r.qniftsrhc appli.Mr r{tr su.h F-hrir b ilc a stncd statcnEtrr ltlltror\hc i{ lic.n$d puNmr
<br />to thc prcvisions of rhc Conlrrckn s Liccnsed Llu ((hrllcr e. Coin&tu'ns wirh sc.rion 7{xx).f Divnio.:] oi rh. Ar\ine{ nnd
<br />,'DfcssionsCotlc).rrhsrlrdsh. hcnnDr rhcicfroNand rh. hnsis f.r thcnllc8cdcxcmpli.n. Anyviohrio.oIS.di,'n70ll.5bylny
<br />rfplicrnr rorar.mi suhjNr rh. rpnli.anr roacivilpcnrlrynlnol nDrclh ivc hlinrcd dollu\ (S5m)
<br />-l-osopncrorlhcpmpcny.ormyenrphyas$ilhwlsesaslhcirslccomFnsnrt'n.willdorh.work
<br />dlhc{tur@isEn
<br />inrcndcd or oalcrcd for {lc (Sm.70.14. Bu.incs Md E'of.*nrn{ Codcr 'I hc (lflro.ior's Li..tr$ L3w docs nor upply b tr. ow.cr ol
<br />rhc Impcny wlr, $lilds o! irlrrows rtENn. and whr dfts such u.d iinNclf or lrf*lf or rhroqh hix or hcr o*tr cmploycc\, "pr.vidcd rhar su.h nnphvcrEntsNmr intcnd.n or oficBl for sh.It hoEwr rh. hildiog or irymkft.r h $U enhi.orc Fv
<br />ol coq,lerion- rtr Ourcr Blild€r wiil hzk rh. h!.d.n or pUvins lhd rr or shc rlil fr, build or inlpnvc lhe nnrEly fttr rhc l}nrrn$ or
<br />l-Js.sncrolrhcpn,Fny.rn.x.lxsiv.ly.ontra.inrgwirhliccns0d.otrtr.trsri.onnrucrlhcpm.Jcd(Sc.7(}l4.Bx\i"cn
<br />r hrissrtrCorlc ThcConllacxn st-icenscl-awdoc\noropplybkr.NrtrofprolcrtyQhohuildsotin9rov.\rh.rcon.
<br />and *ho.o mcrs fr \u.h lr..r\ wirh a C.nrncbn n li.cn$d ru6ulnr lo lhc ('.nrrrcttr's l-iccn* t2* )
<br />_l xn,.xcnlpr undcr Seiion B & P( f.rrhhrcr$n
<br />Dolcr Orn.r:
<br />wonxins' cot"ip .rs,trrox
<br />DEII,ATAIION
<br />I hcrcbyofi,nutrdcrDcndlyofp€riurynrcof rhcfoll,,*inPdccl alion\:
<br />I hnvc xl will nDinrain o Ccrl ifi(slc of Con\cnr lo Sclalnsurc li, worldr' .uD.netion. ns Fovidcd fo! ny Sd ioo l7m of
<br />'hcLnbor Code. r.r rhc p.rromtrcc oilhc Eort lor ehich lhc lrirn is nsucd
<br />I hrvc dtrd sillnrirlrir workcri conncnsali{,n nNurlncc- as rcquircd by SNrt lTlDollhc&botCodc.tultepotu@.cof
<br />rhc work lor *hi.h lhh ncrmil is nqcd MyworkcE coDpctrsation insura..c .nifi ,d lolicy nun$cr rc:
<br />,^,*, S<cu.z.f 2 ,,t/4r= -_.s/
<br />fia-c- 11 -?q/62-/ /-/?
<br />_lccnifyrh r inrhc lcrt i,un...flhcworkforwhi.h lhN!.nnir n tsucn.I \hrllnol Eopk,yanyp.mn nt ymrtrrcr
<br />$ rs ro b€onE subirl h lh. wortcF' co nurc nsol ion las\ ol Calif{mif,. and ism rhd irl srbuld lf,com subic' r{, rlt
<br />workc^'co.rrpctrsllionpmvnionsnrsccrinn.lT00ofrhelrtnr(od..l\hrll,rodhwthcoml,lywnhttu$Imvist'.i
<br />f7( b€E
<br />salsrBltcuolrENDlNc-aclNct
<br />I tf,rcby .lftrm utrdc! IEnshy of 0c4ury rhrr rhce is a con(rudio. lcndine 4cncy fo. rhc ltcrforrom ol rhe *ork r(r whih rhk IEmi n
<br />isrucd (sc lo97.civ. c )
<br />A.TIUCANLDECL$AIIO!
<br />I M,, afllhn undcr Fnnhyof Fcrjury om otthc folhwins dcclmlions:
<br />Ocmlnion Prnrnr Ast {os Nolilicdlion Fcnml Rcgulnrions (Tillc40. P!n6)
<br />-Rcquired
<br />kucr oa N.rifrdion
<br />-l
<br />c.nifyrhnrihc ltJcralrcguhrionrrcg3.ding *irno\ !.nr,vdl dc tror{ppli($lc lo lhG nror$t
<br />-l
<br />cc'1ity rhnr I hav. eid rhk ap,,lkatn,n rM $arc lhar $c $ovc informl ion n cntu.r I agtd ro comnly wilh rll Cny a.d Counr,
<br />ordinumcsandSrstcljwsebtingrohuildingconsr ction. md hcrcby aurhoria rcI],csorar i!.\ of rhis Cir y md Cou rlocntquponrhc
<br />oh.vc mnrinNn mncny fnr insr(riinnrqn{\
<br />^Doti"*'", ^e-ts.^"t * ,//?- *r., f'916.
<br />ZZ€J-2-*
<br />I{ARNING: Failu( ro s!r. *orkcN compcnsrlion stcmgc is unldwt!]. and shrll suhid arr dnplorr ro diminll Pciahics and
<br />civil fincs !f ro onc filndrcd rh.usaftl dollrs ($llD,txD), in addnion to nE cost olconpcn\alion. dtmgcs 0s trovidcd for rhc
<br />Scction 3076 otrhc L{hor Code. im.Es and omy\ les.
<br />',*, i:i -/ i - o,,o-,, //a'
<br />uirEusEDl.])lrtAcMB
<br />DECI.ABAIION
<br />I hcrcbynmrm undcr pcnityolF jurr rhai I dd li..n*l und6 ptuvision olCh$E 9(commncins wilh S.crion Tulo) ofDivision 3
<br />ot rh. Busnrss6nd Proic$ions Code. ud nryliccn* n ir lull force ond ctrccr.
<br />72
<br />r'-.n\c( 1,r\ P
<br />Dir. Conlhrlo.:
<br />lxn'h''\ A'lJ(-.
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