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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 Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Nileter <br />FINAL Il-2o'-lr xtt{.10) <br />Notes, Remarks, Etc \f <br />OWNER BUILDER DELCARA lON <br />I hd.by amnn lddd !.nat, ol pdury lhar ! @ .r.npr iion lh. codhdoB Licd$ hs aor the follorvinr rNo (S(.703 1 5. <br />BNins and Profsion Cod.): Any Cily o. Cou,ty $hi(h r.quir6 a p6nil l. c.nslrucl. ah6, nnpr.*. dmolbh or lqEt .n, <br />slrutur..Forloirs issu.nce, al$ r.qun6 th. spdicer f.r su.h p.nnn b fik a si8n.d slahenl r har hc or slE b !ica!.d puBuanl <br />ro rhe pmvGions ol rhe Conrracroas l-icc6.d lr* {Cluprr 9. CoonrcnciE silh sdion 7000 .l Division I oalhc Susins .fld <br />Profesio.s Cod.) or rh n or snc b dcmq rhd.frcm md rlth6t lor lnc oll.rr.rl €xmplion Atry violalionofs.clioi 7'r1l 5 b any. <br />applic.nr forapmir subjck lhc applicanrloacivilpcnatryolnolnDrclh fivc hu.drcd d.lld. ($500) <br />I. d o*n6 of'lE prop.dy. or mt anllorc wnh $ ag6 ds rhcn $t .o,np.neion, will dr lh€ wolt 0.d Ihc nndu. a nol <br />inln(H or ofi6.d aor $lc (Sa.7044. ausinN and ProfsioN Codq ftc Co.tEclois L,i.(sc k* do6 nol aprly lo e olmd of <br />rh. rbpeny who buil& or impoc rh@n. dd sho do6 such \re* hi,ns.lf or hhclaor thm sh hL or h€r oM .'nploys. <br />prov el lhal such imr.oEmrns e not n ad.d or olIq.n for sk I L ho*6q, lh€ buildiry or iarpovddr i. sold \dhin on. ,@ <br />of conrpldion. rh. o1vn6 B{iltr sill hr!. lh. hlrdd of p.ovins lhd h. or sfic did ml huild or imFov. lh. rriFty a.r rh. prrbc of <br />I on €rcmpl undd Sdior <br />D.le: Onn.r <br />'lvotu(Elts' co[rPENsarroN <br />DECIdAAI,!A! <br />I h6eby amd undtr F.ahy olFjury o.. of rhr tollos ins dElddions <br />I hav€ ad Nill mintain 3 acnificar. ofconsdr to Sclf-lnsur€ lor \rork6 comp.Gari.n. &s pNdded for bt Sdlion 1?00 of thc <br />ktor ( ode. aor lh. Faom..c€ of tn€ $ o lor \rhich lh€,6nil ir isu.d. <br />lha\eand Nillnminrain Nortos comFnsarion surance. as r.!(trod hr_s.dn lr00of'fu I-rlFr(orle.lor lh. p6lir nr0nce ot <br />rhc rork ror \ hich Ih's porit is isn'ed. MyMrkEs comrcMlron insurdcc .arir dd Fli.J nu'nb6 &c: <br />cenilyrh.r in rlr Frform.n.. oltl'. *o,k lor *hi.h rr'is p6mn h $udl. I sh.ll nor dnploy.ny pcr$o in.nynrdner <br />$ 6 io b.conr ubld lo lh. woll61 comr€nsnl ion la\ s of ( aliiornia, and asrec lhal ir I should b<omc shjd <br />'o <br />rhc <br />\rcr kc I .on[.nsarion prolisioN of Snlion !?00 oflh. l,t{r Codr. I shall. tonhq ilh coq,ry \ ilh rhos rFvisio6 <br />wARNINC: l.ailuG ro sccre \orre6' comr. sarion .oloase ill sobjd a. anploya to ai,niasl poralti.s and <br />oac. rp.rvrion. darm86 6 previd.d lor lhcciv'l fines up io one hundr€d lhousa.d dollds (tl0o.l)00). <br />'n <br />f o <br />DECIA8AIIQ! <br />I hd.br.aftr,n und.r p.mllyoapdjury that I uD licds€d ondd provision ofch.plq 9 (con'n ncins wilh Strrion 7000) ofDivision l <br />of rh. Busin6 dd PhtdsioE C6d., od ny licd* B in tuU for. &d .lTd/o K*.u5t o <br />t tlf//z >",,.",",, <br />(c t( <br />tadirf,lrc )lLllDllc.Aclticv <br />I hq.b, drro u.do Fnll(y oa pdju.y thd ths. is . coisruclion knding rg6cy for lhc pqfomecc of the Nork for *hich rha pdril b <br />i$ucd (sc. 1097. civ. c.). <br />AIITICAILDIO"AAAIIA! <br />I hG*! arm unda p€naltl o f perjry on€ o t ln. follo" in8 d(learionsl <br />D.nhhion P6lrirs AslBk's Norifi..li.n Fcddll R.gulati{,ns (Tnle 40. Pa16) <br />R.quncd Le er ol Norilicarioi <br />l.driryrhd rhe t ddll r.Bul.rions r.gddinS 6b6tosrdnoLala. ml applimble ro rhis prejat <br />cenily that I lmvc rqd Ihis amlicdln,n al r inrolmarion iscotrer.I a-!rcroco <br />ordi.ancB and Srarc tNs lcl.lins ro hu od n.r€try Nthoriz.relr6drdn$ olrhis <br />ib.!. m.ntioncd proFn, lor iisp.d <br />c {* <br />mtly*nh ill ('ilyand ('ounr, <br />,'-';7;Z; <br />-/ <br />-1. <br />as o\us ofrhc ploptny, eqclusiv.ly coolEclins \nn licord cont6do6 ro .o$ttud tl'. trold (Se 7014, ttusins <br />antl Pioldi.i code Th. conhclors Licms. Law do6 nor lpply h m orvnd of prop.ny who builds or improvB lhd@n, <br />and *ho controcrs tor such projds with a Conlraclon, lkosd pus'qnr k, r& Contadois ljcms. tr\r) <br />ll &PC irrtisraron