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ELECTRICAL.INSPECTOR RECORD DATE tD/stG.COMMENTS Site-Work Und erground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers To rquerng Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rouoh Ceilings (T-Bar Rouoh) Itleler Release Rough Service Meter WFINALq,IA ta'r?+ ) Notes, Remarks, Etc trlr-I OII|'NER BUILDER DEL( ARATION , hqcby amrm undd p.mlty of p.rjury ltul I aD .rempr frlm rh. cnnh.tnis' l.i..n!e lis lor rhe tnllosinr rwn (SG 7031 5 Bus'n6 aod Prolsion Cod.) Aoy Cily or Cou.ly whi.h Equt6 a pqnil lo .oBrtuc', ahc, iryrole &molisfi or !.ruir my sdclrc, rio. ro its isroc., .lso r.1ut6 lhc applicd for soch ,Enn to fiI. a sisncd stoImcnt lhal hc or sh. it li.dscd p@a to (hc prcviliotu ol thc Conklctois Lic.ns.d Ldw (Chaptn 9. Comm.ing $ith Sarion 7000 oa Division I oalhc Busin6s dd hoa.sioDs Cod.) or lhnl h. or sh€ is .xdpl ltd.iiom md ln. b.sis aor th. all.sed cxmplion. Any violalion of Sdlio. ?01 I 5 b, any applic$l lor a p€nnit subj*ls th. applicfi to a civil p€nahy o f nol mor€ thd l''ve hu.dr.d dolls ($500) I. a osad ofllE poFny. or my.'nploy6 vil h w.g6 c then sk compdsarion. s ill do lh. work erd thc nruclE i nor ilnad.d or olts.rl aor sl€ (Sd.70,1-J. a6ine &d &or6sioN Code: 'th. conkacror's Li.d* tlw doe n6t rpply b ow.d ol th.popaly who hrilds or nnp.ov6 th€en, erd who doB such *oi{ hins.lf or tcellor lhrcush his or hd oM.nployc6, provi'lcd rh.t such nIpmvdE s m nol intsd.d o! or6cd ior ek. lt ho$6q. rh! buiuios or lqro\onar is $d wnhin on. ya ot compl.tion. rh. ovnd Btrildd will hav. rh. hrkn oiFori.g thar h. or sh. did nor h d or impmv. th. FoFry tor lhe pu.loe of -I. d oM.r olrhc prorsry, d .xclBn!! .onradins Nith licda.n ..ilrados to coErflcl lhe pmjEl (Sc. 7044. t)Gin6 d l\ll6ion cod.: Th. Conlra€lo.s Lic..se Law do*.or appl, io eo$nd oiproFny who builG or nnprov6 lhd€on. and Nho.onhclsforsuchplojdrswnhsConr6cro(rlicds.dpursuurrorhc('onthdolsLic@Law) I rn crc undd Scdn) Drter Ornr: WOR(T:RS' COMPE,\SATION DECIAAAIIg! I hcrcty amrm und6 pmalty ol pajlry one ollhc fouo! in3 delsarionsl I h6r. anii will mai.rain 0 Cdificatc ol Co6nr to S€ltuErrc for sorksi @nip.neiridn, 6 provid.d lor by s.lion 1700 o f the kbo. ( odq lor rhc I,&fome.c of thc wolt fo! *hi.h thc pftnir is issu.d I hav.nnd$ill maint.in *orl.r' comp.Nation insu.aflcc.6 requircd bySdio! 1700 ofth. Labor Cod., for th. pcfommc ol thc qort for {hich rnis ptrnit is iscd My workds onp€Mion iNurme ffi6 and Fl,.y nufrbd a.: _l ccniay rhar in rh. paaorde.. of lh. $ort ror which fiis pemn is Gsued. I shallnol mploy 3ny p.e. in anynrMnd $ 6 ro beom€ subl€t to rhe ro ss conDaetiofl lawsofc.lifomh. aod arrc rhar ifl rhould b€ooc bjdt lorh€ sol{ss comp€Nlion provisioG ol Setion 3 700 of thc Lnbor Code , shall. lonhwirh comply $nh lho* ptolisioB. wAR ING: F.ilm b sN workm conp.Mion covasc is unlaslul. d shall subj4l an oplo)s lo odinal p.Elri6 ..d civil finca up ro on. hun&ed thousd dolltrs rhe cost ol comp.nerion. danus* a providcn for ih. Scdnrn 11076 orltu l-abor (idc. in1.J6r Drui3rL&t I hftby arnn udd pd,lry o t pEjury that I m lic€ns€d undq Fovision of Chapls I (comh@ins wirh sdion 7000) oa Division l of lhe BoshN dd Pmfsiod Cod.. od ny lic.s. Ls in aull forc. md drct. >4/7d/ I h6€by amrm und€r Dcnahy of pgjury $ar issucd (Sd. :1097. Ci!. (r ). ilclio. kndins aldcy aor lh. pcaommc. olnE rork for *hich this Fnil i.s AfIIICANLIIEqTAAAIION I hddry.Jrm und6 poalry of pdjury on. oath. follo*i.g d€kar ionsl D€nolirion Pdlnns-Asbdlos Notificarion icd6al RcsularioN (Tirl. 40, Pan6) -R€quned L.rrd ol Nofificahn abcros r.lnDv.l tre nor aDpli.able lo Ihis proist c lhar th€ abov. infomation is cortrl. I asr ro comtly$nh a[ Cilyed Counl, authornc rcpr6dr.ri!6 ofrhis Cnyrld couniy ro..16 up.tr tn. *..*f,.g",,/>4zr- fle944 APPROVALS Sub-Panels tindd ! ACrt*: _