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ELECTRICAL.INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underqround Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltaqe Fire Alarm / Dampers Communications Cable Building Under Slab / Floor I I a-4f/Bonding / Grounding / UFER I 7+T,U DIN) Transformers tt Torqueino Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouqh) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rouqh)I 19Meter Release I ,2r7.PTM 6L*E-l I Rough Service Meter I 41,X()DJ\^'6V +b1 Noteq, Remarks, Etp lr I t-t OlVNER BtU LDER DEL('ARATION I haq,* .frrm u8l6 ptult! of Fjurv lhll I d .rmF ton llr Codrl1ou' I icB ll* for rlE follori,s r6D (S< 70ll 5. B6in6! arn Protsio! &): Any Cn, or coudy shkn Equc a Fmr lo odtud. .ha. itrore &mlilh or lqin ey slrudu.. prFr ro it .l-,rko r.qutd rhc !p!li.dt for slch Fnn l. 6L a sisnol nalml lhd hc o. slE ii Iicmd I,Ml to rh. F\ilioN of llE Conrr*rd ! l-rokj ttt {(tuFd 9, (i'mnftins uni skhd 7mo of DivBion I of th. AGi,B ed Pnr6i'B Co&) r rh, lE or slE i dmF thscfom i.d rrE t 6s lor tlr .lkr.d .rdFion. A.y riohtbn of Sdbr 701 L5 b) Dl appli.rnr for a p6mn rubj(lslhc ipplicd to a .i!il p.n!k, ot nor 'rcr. th liv. hundr.d dollu. (1500) l.B osE6frLFnFry. m, mphyE rnh E.sd slh6t sic oaqxMior silldr llErql td dE rirtE ! ml trllrll or ofiocl for!L{56 7014. tu.iIB ud Pro&t!6N CGJ.: Itc CoiiE loi. t,tcet * &6,ot PPly lo d o"c of ihc In rEry who hil& or ir{&\6 rhd@ dl wh {h6 *h srt hih!.tf or h@lf or lhmush fin ot hs os @ploy6. pr.rlidi th.r s.h mF!\.ldr c ml irdi.d oroliild tor $t lr, bsd. rlE tlilli'B d itryoGEr a $ld rihn ffi F of onpldioa tlE o$E Builds sll t E llE bldd olrhnE ll. lE or JE dii mt hiU r irs!]G dE rftF, 6. dr F P* .a I.6.$€of rh. Fotay. mdclcn ly.ofln r,4 * h lic.ed codElc ro odM rh. FtF lSE. 7Ol{. &!:t6 $d hlEsioi ( od.: Ti. Cont.*loir Licd.l,!e &6.o1aDply lo o.*nd olprcFrly *ho build. or inproe6lh6on. ed who mntks for r!.h F!j.tl' vilh r (bnMo(r) licas.d pulsel to ln Cor(r.(oi. tj.ro L.w) I h.ro un&r Sclrcn- !aaf,E85:(AUr[!5AIlO! DECL4EArlA! I hs.t y smm unda pdllry of rojury on. of thc follo*in8 d.cl&!tioB: Ih.\cnd*illmi.ir!Cdiftlt.of(oisrros.lalM.f.rsort4codF8r6..6FDvi.Hforb,SEtirnl7molrlE Llbor Codc tor rh. pdaomMc. o t th. wnt for which rh. p6til a n!o.d. I h!\. rnd rrll hlinllr wott(d'.omFNrFn iEurmq c EquEd b.! s..lion lT0oolilE l$or Co<!. tur rlE FfM. of th. *nrt for *hi.h lhi! Fnil ! iq.d My qort6 comF.slion iNu@. dn( dl polk, nuhbd a. 6bLJ"t J 9el-s11t7 2-tr-)o I cdrfy rh.r o rh. Ftuffi. !t rh. * orl lor r trh rhis Fhn ! se!.d. Lrll ml qtplot ey F5. h rt ME $ N b haom.objel lo lh. porld' NmFtrraio. hs ! o f C.lifomia uld +G lhd if I 3tould tE(om. bi.tl lo'h. Nortd' c.nF.Mrio. FovnhN of scrion 1700 oaih. l,bor Crd.. I drll fonh{nh .omply wnh tfioE Innvilioa WARNINC, f_.'lurc ro GG. "$rk6'omrdurion.{ra!r. s unLsful. &d shlll sbjdr d dplord r. ainm.l F6h6 nd civ,l lln.! up ro on. hundr.d rhousd dolle (l in &idilion !o rhc con ol compcMrioc dlnrsd s rtorid.d aor lh. Srthn 1076.frh. titx, ( ode 'nt6c( lc- t9-t4 I hd.bt amm und6 p.n.ltt o{pq|lry I u.dd r.lirhn of(fiptd I (Nnma.i.s snh S.clion 7000).rDiYBhn ! ol 'h. Bdin6i Md Pblsio6 (i!dc. sd dy !c F-,c/ere4 ;jl]/q ( ,)C s I h6rb .trm undd Fuhy or Fiury rhi rlEC a! . isu.d (s6 l0s7.civ. c ) L6!r('r N.m hii.g 4trI ror lh. Ff(tll@. of rlr r I for*nahth6Fs. i! aftutAlllioJSa1lq! I h6dr !trm uidq pdlh y of pdtury orc of th. followrg &.l[.|i.ro: D.molnbn Pmir.-AshBro! NorifElrion F.dnrl R.guhnrN (1 hl. 40. Pin6) R.qut.n l.dr6 of td'lil'cdih stE!.r rmrrl e. rcr +r,lkabL u rht p.oi.d . rh6r rh.ahv. mlomation Li cotrcl Itgtcr..omply sd (oury ro dt6 uFin llE /c-aT1? n- !n h6@! rurbrn. r qrsndivd o f lhi3 Cny c/ FINAL