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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 />Sions (monument)
<br />Life Safely /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<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 />ftileter Release
<br />Flou q h
<br />Service lvleter (r I ,&,
<br />7FINAL4 \4;t bIIzF 'q7\rNotes, Remarks, Etc
<br />OWNEI{ I'UILDER DELCARA'I]ON
<br />I herehy !flirm uNlr pcndry oI p.rjury rh l m .xetpr tbm th. C.ntadoN Licens L5B fot rh. fofi,*ins rc.sn (S.c 7O:l I 5
<br />Busin.$ and Frcf.sn ' Col.), Any Ci(y or Coonty which rcquiEs r IEmn nr conerud. alrs, i6pmk. d.n,li!h d. kPan rny
<br />nrucru.. ptior b irs issure, als EquiEi tlE npplicdr fDr such p.rnir ru il. . shrcd s.denEd rhar h. o. sh. is lic.ns.d ,nrsa.r
<br />ro ih. ptuvisilns of ih. G,itr&rols Li.ns.d Llw (Chafld 9, Comncing tirh S.dn,i 7lD0 of Divssn I of(h. Busine$ and
<br />Poli*iuns Code) o. rhar h. or sh. h.r.mfl d.reiomand l,l€ hnsi\ lq rh. alLg.d.r.hF i,,i AnyvioLlionofS.dionT0ll.5hylry
<br />ipplicmr fnr a Frmn subjccf.h. applicanrroacivilpenahyofnormt rhm liv. hunJftd dolles ($5m)
<br />I. rs own.r oi rh. pDlxny, o, my.mtLyce\wilhwagesasrhei!g)LconFn\arion. willdo dEwo*a rh.{rudEilmr
<br />ie .d or off.Ed lor s . (SE.?(x4. Busin.rs d Pmf.sions C, .: Th. Conta.r.r's Li...e b$ do.s nol +plyb owrcr of
<br />rlE nNFny who trilds or in$Dwr rh.rM. and wh. dcs $ch m.t iins.lf o, h.u.lf or throush his or h.r owr ?nplry..s,
<br />pmrid.d lhat srch in4ro!.mds .m( id.d.n orod.Ed for sk Ii, h,scE( UE hillingor if,prov.ft.t is $kt stlin orc ru
<br />.f smpLiion, tlE Opn.r auikt r *ill tuE tlE honLn ot Doving dd lx or s& dn d tliu or inptuE rh. pmlEny fot rh. purpoE of
<br />-1.
<br />asown.rofrh. popeny. am.xclusively.onmcrina *nh [..nkJ cotua.1o6 b.oNtocr rh. pn!.cr (Se.7(144. Susinc$
<br />, Pn'Essnn Code: Th. Cofiro r Lic.ns. La* does no( aDly Io o Drn.r Dfpn,pcny wrN buildsor impovc! lhereon,
<br />and *h. olrtuk fitr \uch [,.jars wnh a Cro ra.roi, lic.nqd puhrair ro rlE Clontrdolc l,tcnr lnw)
<br />-,
<br />rncxeolr unlq Strion ,B.&P.C f$rhnr..$i
<br />]rc8KDB!-CO.!I[EN!/!1]OB
<br />DICLAa^I(}N
<br />I h.rcb, irfirm undi p.iolry or !.rjury on. of rh. followins da,ararnrns:
<br />-l
<br />h!v. and will roinr n a c.niaEd. ot Cone ro s.laln{r for hrl.6 .omFns.ii.n. as oDvi.t d in by s.crion l?lD o, .
<br />Labor Cod., fr, rh. pdfoituc. Dt6. sork lor which rh€ p.mi n hiu.d.
<br />_l hav. ond will mintain wo.L.R comp.nsalion insunnc.,,s rquiftd h, SeriDn 3700 of rhc LaborCod..lorlh. D.rfotluc oI
<br />ttE erk fur qhich rhis p.mit i ise.i My work.6 cory).tru irn insunnc. cmi.r md p.lty numb.r ,.:
<br />ft)li.y NuNh.r:-Lrpnc\
<br />-lc.nifyrhrt
<br />inrh. p.rforrunc. olrhr wo* l whrch rhis p.fl!{ is isru.d, I shrll nor emtloy any n r*Ji in rtry mlnn.t
<br />$ $k, hecom subjcd b rhl worr.r comn nsdion bws ofcdifomir and,38. ih.r ifl shruld tEcom sbj.d brlt
<br />*oiI.A coqr.isiion On,visn,nsolS(ri.n 1700 oI $€ t:tnr codc,l \hrll, fof,h*irhcomply rnh lhos pDvtions.
<br />WARNING: Failur. ro scur. work.d conllcnsaiion..vemge is unh*tu|shxll blst an.mploy.r o di,ton.l p.mhir ao
<br />c'viL linN up b on. huinrcJ rhotrsrnd dolLrrr (llO0.rrxl). n l(lllitrni
<br />*.tb!-4$-Zl
<br />DLCL E{UON
<br />I lErbt afiim tnd.r Fn.lry Df p.rjury rhar I am lians.d und.r provisior ofOEI,cr 9 (.onrcming Filh S..tbn 7000) of Division 3
<br />of rhc Busir.ss and PDl|isioDs Cod., dd 6y lic.n€ is in tull fDrc. ird.lfer.
<br />colslaucuoNLlN,lNc-trGrNcr
<br />I h.€by effirm und.r O.ndhy of p.rjury rhd rt$ k a consruc(ion lcndins agctu, for (h. F folm of ilE rotk lor which thh p.rmit is
<br />hsu.d (sd. 309'7, civ. c.)
<br /> LILICAIILDIC!.ABA!!(E
<br />I ltmhyi,nrmnnLr p.nrhyolp.iurronc f rh. nnLJ*inEd..hr i,nr
<br />Dcmnni,n Itrmir\ A\b.rosNorilication F&l.ml Rcgulaiions (Tirl. ,lrr. Prn6)
<br />,Rc(un d Le(er o, NoriaEabn
<br />-l
<br />c.niiyrhd rh. Ld.ral r.gultrrjffs rg!'ding asbedo\ r.n)valrE nor rnllic.bl. b rhis pojecr
<br />-r
<br />ceniry rhd lhove r.ad lnn opdicrlion lrxl {rr.I r8rcc ro cDmply wirhallCirrand Co!nry
<br />Ddinnncc\ md srii. tjqs rcLa,n3 m buildinS ofrhir c(y iid cuunryro enr.r uF)n rtE
<br />rbvc E.rioned pa,Fny ntr in
<br />,rppliLnnr or ,\xenr Six rlurr
<br />ELECTRICAL-INSPECTOB RECORD
<br />Rev. 08-07'2015
<br />Communications Cable
<br />Sccrid l(16 ofrlk lf,F^trCo,l., jnteft{ dn&ricy \
<br />l,tmiko n.m. (prirn)l
<br /><a.-a 9-1J -
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