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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas. Pool. Fountains <br />Siqns (monument) <br />Life Safetv /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondinq / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factorv Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh <br />Service ]t/leter I 1 <br />,.t /tO a )4--u )FINAL z/t. <br />Notes, Remarks, Etc. 4 -tl <br />OWNER BUII,I)ER I)I]I-CARA'TI0N <br />Busiilcr\ and Profcsst)l Co(lc): Any City or C(rDly which rcquircs a prnril lo consltucl. allcr. rnrprovc. dcnmlish or rcpriillnl <br />structurc. prhr k) il\ issustrcc. rlso rcquircs lhc applicant lbr \!ch Frrnlil kr filc r signcd stalctrrtrl lhxl hc or shc is licctrscd fursuant <br />lo thc provisionN ol lhc Conlrilcbr's Liccnscd Lnw lChaptcr 9. Conrntcncing wilh Scction 7(Xil of Division 3 of lhc Busincss and <br />I)rofcs\iotr\Codc)orthathcorshciscxcnrilhcrcfromnndlhchisisforlhc{llcScdcxctrption. AnyviolilionofScctionT0-ll.5hyany <br />xpplicxiltlbrapcrnrit\ubjcdsrhc applicanlloilcivilpcnallyof0olnx)rclhanflvchundrcddollrrs(S5(X)). <br />_l.as owncrollhcpropcrty.ortrlycnrployccswilhwngesil\lhc'irsolcconrpcnsalioD.willdothcwolkrnrllheslruclureisnol <br />intcnddl or offcrcd li)r $lc (SN.7(}1.1. Ilu\incss aDd l'r)lcssi(ns Codc: l hc Conlraclor's Licen\c [-irw docs not apply k) nn owncr ol' <br />thc lrmtxry who huikls or irnprr*cs thcR\nt. and who d(ts such w()* hitrlsclfor hcrsclfor thnrugh his or hcr own cmpk)yccs. <br />provklcdlhatsuch inlprovctrEnlsarcnotintcndedorolLrcdt()rsalc ll.howcvcr.thchuil(lirrgorimfrovcrrtrlissoldwilhin(nrc)tilr <br />ofcornplclioD. thc Owncr Buiklcr will hrvc lhc hurdcn ol proving thrt hc or shc (lid not huild or itrrprovc thc pnrJuly for lhc IUfF)$ of <br />srlc). <br />_1. as owncr of thc p()perty. rnl cxclusivcly co0lrilcling wilh liccnsc(l c()nlractors lo conslruct lhc l)rojccl (Scc. 7044. llusincss <br />ilnd lh)lLassinCo(lc:'lhcConlrilctor'sLiccnscLrwdocslolrpllyk)nil()wncrolprol)erlyNh()huildsorintprovcslhcrcon. <br />ard cho contractsfirrsuchprojcclswilhflCorilrach(s)liccn\cdpursurnllothcCollraclor's[,iccn\cl;tw). <br />I ilol cxunrt)l urtrlcr Scclior B. & l'.('. Ior lhis lcason. <br />l)hle:()wner:_ <br />}\.OIIKI.:RS' CONIPUNSA'II0N <br />t)lt( l,ARA'l l()N <br />I hcrcby all irm undcr Fnally of pcrjury onc ol thc li)lk)winE dcclarali(nts: <br />_l have and will nuintair n Ccniflcnlc of Conscnl k) Sclilnsurc lirr rvorkcrs'corr1)cnsilk)n. rs frovidcd for hy Sccli(rn 37(X) of lhc <br />I-rhor (iilc. torthc pcrlbrnranct'oflhc work l'or whicl lhc pcrillil is issucd. <br />lhc w(nk lin which lhis permil is issucd. My workcrs' c()trlpctrsilli()D insurance crrricr and Policy nunrhcr rrcr <br />Policy Nunrber: Expires: <br />_l ccnily that irr lhc pcrlirrnrancc of lhc work li)r uhich thi\ pcrnlil is icsuc(I. I shrll not cnrpk)y any pcrson in nny manncr <br />so as k) hccotrrc suhicct to thc workers'c(,nrpcnsation laws of('rliforilin. iln(l rgrec lhill il l shoulcl hccortc subi:ct to thc <br />workcrs'compcnsrlionprovisirnsofScclirm.lTU)olthcLahrrCodc.lshrll.lonhwithcornplyrvithlho*pi)visio0s.. <br />\VARNIN(i: Frrlurc lo \(\'ure \\r'rlcr\'covcrrgc i\ unlawlirl. rnd shxll subjcct an cmpkrycr to criminill pcnrltic( and <br />civil lincs up t) onc hundrcd lhoustril(l (lolldrs in lo lhc c()sl ol conrpcnsnlion. drnHgcs n\ provklcd lbr lhc <br />Sccti()n <br />I)ole: <br />"b/?zY:fce\. <br />l)1..( t_.\lt,\ I l()\ <br />I hcreby illllrm undcr pcnalry ol pcrjury lhal I am liccn*d undcr provisioI of Chaptcr I (contrrencing wilh Scction 70(X)) of Division ] <br />of thc [rusircss rld Profcssirrns Cotlc, urd nry liccnsc is irt full lbrcc .utd clli]ct. <br />l-iccnsc <br />lhte:7 <br />I hcrchy sllirnr undcr frcnnlly ol pcrjury thll <br />issucd (Scc. .1097. Civ. C. ). <br />isa ion hndiilg agcncy lirr thc pcrlirrnrarrc ol'lhc work lbr which this lErnlil is <br />l.cn(lcr'\ Nrnrc: <br />Lcnder'\ A(ldrc\s: <br />- <br />APPLICAN DECLARATION <br />I tEL.hynlllnnundur pcnally ol fcrjury onc ol lhc lollowing dcclarnlionsi <br />l)cnmliti(,n Pcnnils-Asbcslo\ Nolificrtt,n Fcdcral Rcgulations (-l itlc.l0. l'iln6) <br />-Rcquircd <br />ktlcr of Nolilication <br />tlrc <br />I atne lo corlply with all City and Counly <br />I