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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG. <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 />Bonding / Groundinq / UFER <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 />Ceilin gs (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter ,D) <br />Y-->t\^/\?)FINAL 4141".a 1 v <br />Notes, Remarks, Etc at <br />OWNER BUILI'ER DET,CARATION <br />I hs.by amm undd Fnalry oa pcrjury rhar I d dcefl fron th. Conrrdoc' Lic.ne bs aor rh. followinS r.ae; (S( 7Ol1.5' <br />Busin$s ,.d Prof*ion Code): An, Ciry or Coudy which r.qun6 a pemn ro codru.l. allr. improve ddolnh or r+atr e) <br />shdu., Fio. ro nr isumc€, also ..qon6 th. applicd ao. sucn Fmir lo fl. a sisncd sldqd rn8r tE or shc ir licft.d Nr$sr <br />lo thc provisions of lh. Conra.tol. Licened lrv (Chaptd 9, Conm.ncins snh Smiio. 7000 oaDivision I ofth€ BBio6s od <br />PBtsioN Cod.) or rhar h. or shc i! crcmpt thr.arom and thc bsis for rhc alles.d ermflion. Any vidario. ol Scdion 701 1.5 b, ey <br />applic&rr.rapmnitsubjdlsthcapplic&rlo6civilp€nalryofnot6orcrhtu6v.hun&eddolltrs($s00). <br />1.6 oqno oathcproFrty. or my.'nploy6 rilh was6 6 thcn $b.onrpGaion. will do fi. work od th. shclm i! mt <br />inrd&j or oflk€d lor elc (Sd.?04,1, Busi.< ed Prol*io6 Cod. Th. Conlr0ctol s Licms. ks do6 nol apply to d om6 ot <br />rh. pmpeny *ho builde or inprovB tlE6n. $d wh. dG $ch Kdr himself or h.Mlf or lhmush his or h6 oM .dploye6. <br />prorid.n rh.r 3uch imFovmb e. m( inrqrd.d or orard 6,eL.l[ ho!6 d. th. h{ikina or inp.ovmr G sU witliuon }Br <br />ofooplcrioo. th. (rnq Buiird will hlr lh. hirdo ofFoiins rhar h. or sh. dd nor tnild or inpro\. th. FoFry for lh. RrF F of <br />I. a ovnd ofrhc Fopdr. tun .rclGi!.1, co.lracti.g silh licns.d contrclou to onnrud lhe pro.j.cl (56. 7044, BNds <br />dd lrofsion Cod.: Th€ contractofs Lic.ns. Law do6 nor apply to d otrnr olprcpdy s'ho buil& or inprovcs lfiqan. <br />ed sho .obt.crslorsu.h wnh a Co mdo(,licffie{ pursumr to rh. Co.tracrors Licosc l,ew). <br />I h.r.by amrm utrdn pcnrliyotpajuryo..of rh. lollorving d(lrarions <br />-l <br />h.v. dd *ill @inrain a Cfiincd. of Consr lo sell lBure for Nork.B conp..sarion, 6 Fovidcd for by Serio. 1700 ol rh. <br />Llbor C6dc, lor lhc pdfomdc. ol rh. *orl lor which lhc pqnn is isu.i. <br />-l halcand will maintain uorteG comr.nsalion iNurance. s rcqun.d by s(rion 1700 oarh. tnbor Cod..lor thc psfomscc ol <br />lhc \ork ior Nhich this pmil is issu.d. My $orkc( comlENlion iNurance canid dd poli.y nunbd d.l <br />_l.edifyrhar inrhcpdaonnadccofrhc work lor shi.hrhis!s.rn is issud.l shollnor cmployanyp{6on in an} mdnd <br />s s lo become subjGr ro Ihe work6' comoe.sar ion laws ol Califomia, ad arc. rhal if I should b..o,n€ subl(l to lhe <br />Norks'conrpmsolio.provsionsolS€ctionl?00oftheL.borCode.ldtrll,fonhuilhconply$ithrhosprcvisions.. <br />WARNINO F.ilurc to suc $0116 oipdaldn cor@sc it u.l,sful, md shrll subjcd m cnplorq lo siminal Fuhi6 dd <br />r. on. hundr.i thou$d doll&s ($l ion. d.trnBd 6 providdt fo, rh. <br />I hd.by alltrh undd pc.ahy ol pcrjury lh6l I m licos.d ondtr provision oichaprq 9 (connocins s,ilh Sdtion 7000) olDilhion l <br />ol th. a*i.6 ed PofeioN Cod., ed my licm. t in tull for.c md €lIdl <br />callralJcrlaNr[lDllslc[!.sr <br />I h6.hy .rrm onds Fnahy ol ptrjury lh.l th6. is . oisrruciior kndin8 ag6cy lor rhc p6fom&cc of lh. work for which thie pdmit is <br />i$ucd (Sd.1097. Civ. C.). <br />ATTLICANLDECI,A&IIIA! <br />I h.ant .Iim utuid poah, . t p€rju, on. of the followin8 delmrions: <br />Denohioo Pd'n s Asberos Nolifi.alion F.daal R.ru larions (rhl. ,r0, Pd6) <br />R.lluircd L.n$ ol Norificd ir. <br />-l <br />c61ity rhar th€ Ld6al rcsularioN Esedi.g 6b6los rnovd Ec .or epli.rbl. {o lhis polsr <br />I c€liry lhd I h.Erad rhis.pplicarion dd store that lhcabovc inlomarion t cotrd. ! alrd roconply*nh sllCilya Counly <br />ordinancs ed sbtc tjNs Rhtins ro ildins consrrud ion. ad hseby aulhortt rqr.shi6 of rhh Cn, da <br />,hvc m.lrioncd pror.n, aor <br />Aplli.ini or a[.nr Sif iru <br />z b-v c7.n <br />I <br />COMMENTS <br />Under Slab / Floor <br />Transformers <br />Lic6. Cl.s:-Licdc Nunbd: <br />- <br />D.t.: Co!tr..to.l <br />Lend.r ! Addr6