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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />I ,nUnder Slab / Floor <br />Bondinq / Groundinq / UFER ll tt'N l\^lrtllt;1 1 ,r ) <br />Transformers <br />Torqueing <br />Air Conditioners I i\{ <br />Roof Top EquipmentT)j,16!/7 lt n/t lL'LNLIWA <br />Factory Wired Unit /I <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter l <br />FINAL t \AL\VIN^w <br />Notes, Remarks, Etc. <br />OWNER Bt]ILI'ER DI'I,CARATION <br />I h6eby amnn undn p€nahy oi psjurv lhal I o e\o.Fl &on rhe conktcros Lictre lrw for th. aollo\rin8 rcen (5(.?011.5 <br />Businds and Pmfsion Cod.) Any Ciry or Cou y which requiG a pmn ro conslrucl, ahd, nnpro!€. dci'olish or repn dy <br />srtuciu,., p.ior ro irs issuecc, also ..quL6 $c agpli.d aor such pson lo lil. t sis..{ $dmol th.t h. or sl'. s licdr! ,7Jfua, <br />ro rhe Fo siotu ol th. Conrodois Licorsd l2w (Charr6 9, ( onm..cins vith Sdtioo 7000 of Divcion I ot lhc Busins and <br />Profesions Codc) or lhar h€or snc is cxc,npr $d.arom dlhchsis lorlfic au.sed.x@piion Aryviolalionorsecr6.70.lI5hynny <br />appl&nr ror a p@i subjds rhc applic.nt lo a civil peMhy of n(n doe thm 6v€ hundred dqllds ($5CD) <br />l. 6 oNnd of rhe ltrol.ny, or n, onployd wilh wagB 6 lhct sle comp.@tio.. sill do rhe woII md ,]E slo.lN ie .ot <br />iardd.d or olr6.d ror .rl. {Sd 7044, Busif,s ud Prcf*io6 Codc ft. Co r0clois Lictrc Irw do6 noi .pplv lo e ownr ot <br />rh. proEdy who hrilds or iqrorB th6gn. dd who do6 such "!rt hims.lf or h6.laor rhough his or hd oM €dPloy.6. <br />Fovidcd rhar su.h imriovdrcnls e mt il1loded or ofr€Ed for sl. I r, h$'*.s. $e l,rildins o. i.prcv€mern is $ld wilhi. oru tq! <br />of compkion. rh€ Orqcr B!ik(, rill hr!. th. hlrda oaFovins lhal hc or ehc did d tlild ot inprow lh€ IIoFty lor $. OtrF* of <br />L es osro olrhc Fopdiy, m .r.l8ivel, conlr.c,ling s ith licm.d com@do6 Io consrdd th€ p.o.i.cl (Sd 7(x4. BEins <br />dd Pbft.sion cod.: Th. Conlmdois t,iccns.l.aw do6 nor.tpl, to d osnd of propsly { ho builds or nnpro!6lh66!. <br />and Nho conlmcrs for such proj.ds wnh a CofllEdo(, licc6cd pu*udm rothccodbaclois Liceac l-aw) <br />I aDeicmpt u.do sdtion <br />Drt.: oRrcrr- <br />wonxeis' contrgmsert<r i <br />DECIABAIION <br />I n6.by amm und6 rrnaliy of pdjury on. ofrfi. aolloNinr d..lsaliotu: <br />I hrve and sill'nlinrain a cdlifi.ar. ofconsl lo S.lf-lnsur. ror \rorkss compcBation. s previd.d iorbys(tion 1700 ofthc <br />L€bor Coda lor lhc Flomsc. of lh. *ort aor Ehich rh€ D€rnil 6 issu.d <br />and will nran aLn sorkcK trnc Labor Code. forrhe pdlo.tM.. oi <br />Y)n <br />Icdif}Ihalinthcp.rforma.ccollhcsorta.rrhi.hrhispomilisis.d.Ishdllnor..rllo,a.lP€6otrinanyidnd <br />s 6 to b€coric subjal ro lh. {0116 .onp.Nrio. lass ol CLlilom6. ed .sfe rh.l if I snould beomc subjd lo rhc <br />{okdl comp.nsilionplovistunsofSedionlT00ofrnehtrrCod€.lshall,ionh$ith.omflrwiihlho*provnhns. <br />\iARNINC: Ij.ihtr€ Io *cur€ sorkcF .onpdsartud .ovdr-!c is trnlarful. and shall tubjd d alPlots ro oidinal p@ahi6 md <br />.i!il lin6 $ to onc hundr.d lhoue.d doll s ($100,C$0), in addilion to lh..osr of co'npcNalioa <br />!!lI!l!:Dl!!I!I(]aa <br />I)E('LARAIIoN <br />I hd.by amrm und6 Fnally o I prjury Ihal I M li*.el undo pmvision ofchaplq 9 (coond.ins with S.ction ?0C{) ofDivisioo l <br />.i rh. 86i.6 ed Pol6ioN Codc, <br />'d <br />my lic€G is in full aora di.rd. <br />tD <br />,,* q <br />I hft4 affm unds FmIy o I D.rjury thal 6dc ir a @rcltudion kodins ascrcy for lhc poforlj1m. of lt€ work fot which tha Fnil b <br />isucd {S< 1097. Ci!. C.). <br />acddal r.8uhr io.s Esardnrs 6bdos rcooval d€ nor ltplicablc to lhis prcj€d <br />i&rhar I h.!€ red lhb dptlica(ion and srar. that $. abrc intomalio! is cotr.d I alrd ro o'nply snh all Cnyand Comly <br />.rdir.n.6 and srar€ l-a\s relal,n! l{, huild'nB constucr <br />ibo\c nrnrnnrd |mlt'1y irn <br />tPermilcctrrnrc(prinl): ( <br />i!6.lrhh( nr a.d Counrrro eni6uE,nth. <br />\ <br />Sub-Panels <br />I <br />.l| &r( lnrrhrsr.r$r <br />n <br />AIIIJ(hNLDICI.AAAIIA! <br />I ladry arnm lndd fdahyolp€rjuly o.e ollh. folto{ins ddlealnia: <br />Denrohion P@ns Asb6ln Nolifi.aiion redml Resuhl nrns {Tnt 40. Pan6)