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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underground
<br />::
<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 (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter I
<br />FINAL //u/tt -
<br />Notes, Remarks, Etc Ttv
<br />OWNER BUILDER DELCARA''ION
<br />I hoeby amnn undd poahy of pojury 0'ar I o q€,nfl lio.n lhc Conlraclo6 Lic.nse Llw for thc aollowitrg r6on (Sd 701 L5
<br />BGin6s dd Proleio. Codc): A.y Ciry or Cosly stich r.qut6 a p6nil ro connru.r, alrd, inprov., d.moliih or r.p.ir ey
<br />smdu., pnor ro ils i.sue.e, al$ rcqui.6 th€ alplicd lor surh Fmn Io 6L a sitn.d sraroal rhd hc or !h. b licas.<l pcu;r
<br />Io rhc provisioB ol th. Conlracloie Lic.ned Liw (ch.g6 9, Comnminr wnh Sdion 7000 ol Division I olthc Ausin* ed
<br />Prer.sio6 Codc) or rhar h. or sh. n €xdpl thg.fion aod th. bsh for Ih. all.e.d ddption. an, violarionolsdion 70ll 5 by rny
<br />applicanl for a p.mil subjats lh. applicml to acililp.balryoamr,nor.rhe fivc hu.dr.d dollaB($s00)
<br />l. a ownd ofth. prcpqrr. or my .mploya wnh wasd a t.i sL conp..elion. will do tne work ed fic rnde b nol
<br />i.btLd or ofid.d aor sr. (sa 7044. Bcin* sd PioreioB Code Th. ( o.li.cioi! Li..a t w (t)6 ml @ply lo M oMd of
<br />rh.pDpoly who huil& o, idpo6 rh6@i. ed vho do6 such @it hituelt or hddaor rhmqh his or h.. oM.mploy.6.
<br />provid.d thr! sxch ioF.vamlsEior int@ded orofir.d fo.el€ l[ h.wos. dE hiEing or inprovml t eld whhin on. y@
<br />oacompldiotr lh€ OM6 BuiBd will hsw tnc l,trdo ofFwi,g lhd nc or sbc did rcl b'rild or improw lh€ popory for $€ p{qrs ol
<br />l. aowndoathcrroroly, m.rclusiv.lycontadin8 snh hcos.d co.ta.'om
<br />'o
<br />codrucl rhe prord {Sa. 70,1.1. BsmN
<br />d ltofCsin Codc: 'I hc contacloi s Liccnsc ljs do6 not appl_\, ro e orn6 of prop€ny who buil<k or ioprova rhdon.
<br />and sho coiracts for slch poj.cts {ih . CornDclo(s) lic€ded puGudr ro rhc CDnln.tols Li<as. t,w)
<br />-l
<br />ner6fl undo S<tion-. A &PC for rhis r€don
<br />Drle: Osner:
<br />.E946lAs.CqUtENrArA!
<br />oEct alallo!
<br />I h6ct'y amrm und6 pEalry of Fj!ry on. oalh. followine ddl@l io6:
<br />_l h6ve and will
<br />'nainrli. a Cdrincatc olcoNot ro Sclt lauE for {ork.G onrpdelion. s provid.d aor by salion 1700 ol the
<br />l-abor Co<le. for thc Flonnancc of thc wrl fo! ahich Ihe pqmh is issucd.
<br />I hrv. a.d $ill mibtain vo*eo conp.mrion iBurmc., a requiEd by sation 1700 ol lb. kbor Codc. fo, ln€ rEloruncc ol
<br />is isu.d My workdr comp€.elion insurnnce cad.r ud policy nuDb€r uc:
<br />Ir-l-\?
<br />-l
<br />c€niry lh.l i! lhc p.rfoMc. ollhc vork for Nhich lhir p€.nn is Gu.d, I shall.ot @ploy aoy Fson in any mm.d
<br />so aro b.comc slbjd u thc wrlds comt@rion lawsoacalilomia. dd rgd rhar iiI should bqo'n. subjd lolh.
<br />M.[6' .onpdsrion polbioG ofse.rion ]700 of rh. Ilbor Cod., I slhll. fodh$ nh snrply wilh thok pmvisions..
<br />WARNINC Failurc to su€ work6 co'.p.carion cowa. is unh$rul sd sh,ll subjd d 6nphr.r to simiml Fuhid Md
<br />.ivil lincs up lo onc hund,ed lhouend dollaB ($100.1)u0). arlditon I cos ol conlpaerion. denaB6 s povid.d aor lh.
<br />Sdion 3076 ollhe t bor Code inler6l ed itor*y r
<br />DECIASAI,ON
<br />I hd€by arlro undd perhy ol pdjury lh,l I m liccnsj und6 pDlision orchaprd 9 (coB'nacins wnh selio. ?0({) of Division l
<br />ol thc Buin6 ed PrcfsioN Codc. d'd my licN G in full forc. ud .1161.
<br />,",", ( t
<br />h g ct0 LLI b <qo<q6
<br />(e<l-t oo ,>askms
<br />llll-fll3.lrtlA.L-Ililllt]1irlljr (I
<br />I h@b, allm @dd Firlry o apajury rhrt thd. i5 r odtuction L.dir8 a!fty for th. pdfoll]rmc of lh. woi. lor Ei'ich lhh p6an ii
<br />asu.d (sd 1097. ci!. c.).
<br />AITLI(AtrTDICIAAAUO!
<br />I lEi$,afmundd p<alr, ofptrju., on.oarh. aollovinB ddlratio i
<br />Donolirion Pmil'Asbetos Norificarion Fcdaal R.sularions (TnL 40, Pan6)
<br />-R.qut
<br />d lnrd olNolifi carior
<br />-l
<br />cdiry thal d. f.ddsl r.&htioB r.86din8 ah-ios rmov,l r. not rpplicablc to Ihis pmj6t.
<br /><Y**,ry tnu, , *'" * ,nO spplicario. &d $.rc rhai rhe abov. infomario! is coftd I !sr6 ro comtly snh au cny and counly
<br />ordinanc6 d sIal€ Lls Elarirs to buildins connruclion. a'd h6€by aurbort. rF6dr.riv6 o aui Ciry and Colnly lo 6t6 upon th.
<br />atnle nrsrioncd prcpeny lor
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<br />E1ZI
<br />COMMENTS
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<br />L.ndei. Ad&*: _
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