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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS OATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Satety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Bonding / Grounding / UFER <br />Translormers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls Rou h <br />Ceilings (Hard & Soflit Rouoh <br />Ceilings (T-Bar Rouoh) <br />Rough <br />Service It/eter ./--.\ <br />irAqJeAFINAL7lrlu ii ryl <br />Notes Remark s, Ftc a1 <br />tpl24 <br />U' lr'II <br />OWNEN BUILDER DELCARAIION <br />I hcrcht affirm !nd( I'culiy of pcrju,y rh l om cicmor Iiorn rhc Conrracr.r'l-iccnse Law for rhc followins rcnn,n (se.?01!.5 <br />BDsin.ss ,nd Potc*ion codc): A.y ciry or a'ounry *hich d+ncs a trmr h consldcr, alrn. inFrovc. {tc Flnh or rcI!tr r;y <br />ntu tm, prior ro irs nruma. slso rcquncs th.,ppli.Mr ror cu.h p.rmi' ro lik ! si8red salcmnl Ihrl hco. shs i\ liccn$d puruanl <br />tu rnc lnrvhions ol thc Conrlcttr\ Li.enrcd L{w (Chlprcr 9. Comnrncins *irh S.dion ?00o or Divnbn I ofih. B!$nc{s and <br />Pmf.rsionsCod.)orrhath.orslris.x.mprrh.r.lm6,ndlhcb6ri\(trrhcrlhscdcr.nlhon.Anrvnrhli.n.fsetionTO]l5h].iy <br />appli.atrl ror . lcrnir iubr..k lhc rrpli.anl ro a.ivilpcnaxyolnol morcthan iivc hutrdrcndollss ($5LU). <br />L as .wncr of rh. Itur.dy. o. nry cnrtk,rtcs *nh wngcl a\ rh.ir v,lc .o'np.nsln,n. will do IIE wor* uld rh (ndN is mt <br />irrcndcd or ori'crcd ror sk (S( 7(x.4. Alsircs otrd PJofc$ions Codc: lhc Co racroirL,icco\eL{wdo6n.rtrl)pltroinown.ror <br />lhc pm[l.n, who huilds or impmEs tlEmn. a who dra slch so* himscla or h.rsclf or rhrcugi his or hcr own cnlployees. <br />,hvidcd rhar such imttuhmnh @ n, inrendcd or onaEd lor sh ll howcvcr. lhc hoilding or impmlermnr G sold wirhi'r nnc Ftr <br />orcomplclion, lhc Owrcr Buiklcr wiilhaw ltr burdcn olprovin8 thor fuo!\tc d m! toild or in!,mrc rhc pmpcny ror rrt l rlr,s or <br />-l. <br />oso*ncroillrpml,eny.!rcrclusivclrconr,rdirs wirh licctrscdco 6.l(n nr considclhc pnrjer (Sc. 7()ll4. Bdsi'rc,\ <br />aM Pmf.rsi)nCod.: ThcConrNroas Li..nsc t-aw do.c nor rptlynr itrosncr.fpmp. ywho huildr or impmvcsllrrcon. <br />rnd who .o mcts lor such nm rcch withrConhdo(s) licc.rd thc Conlrr.ror\ Liccnr l,*. <br />I hcrcby rflnm uidcr ncmltyoiEriuryorc oirhc folk,w <br />-l <br />hivc md will mrint.in s Ccnific.rc of Co scnr ro sclalnsxr for (orkns cnnp.nsorion. is tmvtin fo, by Sarhn .1700 or rhe <br />bti.r Cod.. for lhc tErf.nMn.. o f rl[ wort for Rhi.h ihc lcmir i\ is\ucd. <br />-l <br />havc ud will mainrnin woricF co.rcnsrr ion insurance. !\ rcqutcd hy SNrion :l7m ol rh. bhntr C.{lt, nn r ncdonm.cc ol <br />rhc sork for whi.h rhisn:nnir i\ i\rudd My *.rkf\' co'nnctr\ation i',surtuc ddicr 0nd l.li.Inu rbcr rrc: <br />PolicyNumhcr:- <br />Icdnifyrhrrirrhcp.rrornmncc.frhc*orkf(tr*hichrhtpcrmir t isrcd.I \hallnor.,nlby rnypcNon in.ryflr ncr <br />eisbb.com\uhj..rroth.w(.n..n[.n\irionl.asorcalir.rnia.drdn8NlhrilIslnuldhccoNsuhidrollt <br />workcrs.onrrnsrt6ntmvisinnsofSccrionlT{roorrlrtjhrCodc.lshrllln hs ilh conl!ly uirh lnoc pmrhn,0s <br />IVARNINI; F.iltrc b vrurc *orkcr\ rompcn\ ri{ .olsrgc i\ nhwfDl.a unploy$ to cnnrinrl Etrdlri\ {nd <br />hutrLlrd rlrr\rtrJ tlollr^ lSllXl.(Xn)). i,, ri,l(rrr I cump.ns,rion. d{roEcs rs prorkk ior lhc <br />('dc. inr.rcd rtrd rrttr'ry \ a.r\ <br />"ft or.(l"]!!lt!j <br />unJq p!traltyol pcrjury rlu I {n liansd u.dcr prcvisnr olChaDlq 9 (conu Sccri,n, ilXX)) ofl)ivi\i{ l <br />ol lhc Au\incs\and Pmlc$io,NCodc. ord nry li..nsc is nr fullfora lnd clltcl <br />C(INSTRUCTION LENDINT; A(:['NCY <br />I hcrby afiirn undcqEndlly ol pc,jury lhal thcrc is i constru.tion lcndin8 a-qcncy for lhc ricrfornuncc of rhc work roi which rhk Fnhir h <br />h{cd tse j097. cir. c ). <br />APILICANLDICLAAAITON <br />I lf,dryanjmundcr !.n,lry ol Frjury oro of rhc ftnbwing d..lrdio.s: <br />Dcnblit ion P.rnirsAsb.{os Noiii.ation Fcdcral Rcgul{irns (Tnb40. Pd6) <br />-Requircd <br />t rrerof N(rni.lrbn <br />-lccnilythat <br />lhc{cdcralre8uhn,ns rcsudins rstEilos rcmval nc tror Bp tohk b rhis tmrl{r <br />lcdili rhrr I hrvc rc rhisnp,rlic ri(mrnd dxrc rhd rheah)vc info n n.or..i I rtrL{h.o rdysirholl( <br />ordirrn.cs otrd Srarc lj*s rcldnB ro huildnrB c rcprc$N.tivcs ol rhh Ciry ind ( <br />nlr)vc nrr r okd |xrj{nr rn. <br />A|lplicant or A8enl Sigmlurc:/1.+//.n L <br />2t <br />Pole Bases <br />Under Slab / Floor <br />lvleter Release <br />(-ahi' <br />I <br />[ -r------ <br />= <br />I <br />I <br />=