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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht 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 / Groundinq / 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 Rough <br />Ceilings (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL l-2t-za I xJ4-\L <br />Notes, Remarks, Etc <br />OWNER AUILDER DELCAR TION <br />I hdcby amnn unds pdalry of p.rlory rh.l I m cxcmpl 6o,n thc ContracloE Lic€* Law lor lh. tollowi,S t.e. (Sd.70l I 5 <br />BusinBs d Prci6sion Code): Any City or Counly which r<ut6 a panil lo consrtucl rlt6, ihprove dmolish or rcpan my <br />srtuduiq Fior ro i's islmcc, also r.qrirs rhc rpplicmr lor sucn p.n l to filc a sisncd sal@ftt rhat h. or sh. b licN.{ p6!&n <br />to th. provisioE olthc Conliaclor's Liccnscd l-3w (Chapte 9, Cond.ncing vith Sdlio. 7000 oaDivision I of th€ BuinN Md <br />PreLsions codc) or lhat h. or sh. is exonfl lndcfto!. md rhc b6sb aor th. allcScd .r@piion. Any violalion of s.dion 701 1 .5 by aoy <br />applic.nl lor o p.mit subjels th. arplicanl lo a cilil ptully of nol mor. Om 6!. hun&.d doll# (1500). <br />I. s o$nr of lh€ prcFny, or my €nlployB virh was6 6 then sk coDpcisarion. vill do th. trlrk &d d. $ddm b .ol <br />iniatlal or oitd.n tor sl. (Se.7044. Buins md PmlsioN Code The Co ractoas Li.t@ Lr* do6 nol rpply b e ow.s of <br />rhc po!6ry sle buil.h or inpndvs rhtu., &d sho dc au.h qo,{ hims.lf or h6.lf or lhmqh his or hd ovn .mploy.cs, <br />provid.d rhar such inporsncflls @ ml hlod.d o, oit6€d tu, elc It howqd, th. hildinB oi imPromdr is eld wihin on. )qt <br />ofcoftplerio[ t. O$nd Buiud wiu h3v. fi. t dm ofpming tlsr tEor stE did trol birld or iDprovc ln. lorqty for dE purrD$of <br />L 6 ownd orrhc pmpoly. m erclEiv€lycontacrils wnh licots d codradoa ro.odtud rh. pojel (Sc. ?044. Bs'n6 <br />atrd &of6son Code: Tbc Co.tra.tort Lic..sc Law do6 nor apply ro e ownd oapropgly who builds or improv.s th6€on, <br />a.d who conrEct for such Foj4ls wnh a C.atncto(s) ltGcd puGuan ro $c Conbador's Li.€N tiv). <br />Ln crcmpt und( Secrio . B. & P.C. nrrhN rcam. <br />uoBrEff:caul[lsaIl9! <br />DECIAIAIIO! <br />I h6ebyarm und( poulryofpdjuryon oflhc fol,owinS deItrarioBl <br />I havc md $illmaimain a Cdificarcoaconsnt lo Sclf-lNure for vortos. &npdsllion, a pmrid.d aor by Sdtion 1700 ofthc <br />bb.r codc, fo. rh. psfomdc. olfic wort for *hich lhc p6nit G issu.d <br />I havc and *illmainrain {ork6' cohpcsaiion ifturan e, s r€quir.d byS.clion1700 oflh.L*b.rCode. for lhc pdromecc oa <br />lh€ wo.k ror which rhi. r<nil is isucd M, work6 .o,npcerion n$rmc. cdio dd policy oumb6 &.: <br />l)6t.: Applicml: <br />IICEISED.CAXItrACIAB <br />DlcldaaltQ! <br />I hmby altm und6 F.ahy oi psjlry rhar I M licqN.d uodo provision of Chapta 9 {comcncing wilh Salion ?000) of Division l <br />of lh. Bsins ed Pof6ioE Code, sd my lic.N is in tull lorc. ed .Itdl. <br />_Lic.6.Nunb.r <br />CATSIBUI]IIOII,IIIIIC.ACIICI <br />I h@by arsn undd F.drt of pijory rhnt Lhd. is a on{ruction lcndhs asdcy fo, rhc Ffor@.. of rh. wort aor which thb pa'nn b <br />issucd (Sc 3097. Civ. C.). <br />ar8r.lcaNfoEctaSaua! <br />I hd.tJy afEn undd pddlty of p.rjury on. of lhe followins dcldalions: <br />Dcmolirion P@irs-Arbdos Norili€rioE F.ddal R.8uLrions (Till. 40. Pa16) <br />R.qrired L€uB ol NoliEcnion <br />I csriay thll rh. l€dsal Esulatiore rcs dins db6tos r.ooval d. not applicable <br />'o <br />rhis prcid <br />\.-,,,I hrv/ad rhis +9l(diod rnn nar.lywnnall Cnyand Counry <br />y ed Counry lo dra upon trelarinB ro buildins c.nntucr <br />ADplic!trt or &etrt SEn4ure tl\c lr()L'l--trflt<(--- <br />I <br />Rev. 0B-07-2015 <br />I cdlify thar in thc p.rfomncc oilh. worl lor whkh lhis psiil i3 i3su.d, I shall not dplo, a.y Fson in any mannd <br />s 6 to beooe subjdt lo lhc *oi!6 @,npsalion la{s of Crlifomia, md asr thal if I should b.conc aubj*l lo $. <br />$0116'.o,q,mdtionpmvilioNofsalionST00otlh.llhorCodc.lslull,lonhwihcosplywlhthosprovisioN <br />WARNING l_ailur. to su€ 10*6 co'nposalion covsasc i! unla{tuI. dd thall subj.ci m Bployd lo diminal p53lti6 &d <br />civil finB up ro orc hun.lr.d rhoMd dollm (1100.000). i. addiion lo rh. cosl oa.omp.n$lion, damsd d provid.d tor lhc <br />sdnon 10ao ol rh. Labor Code trls.d dd afiom.y ! fc <br />I dJft s <br />^dJr6\ <br />L