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ELECTRICAL-INSPECTOR REGORD APPROVALS DATE ID/SIG.COMMENTS Site-Work Underground 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 Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rouoh Ceilings (T-Bar Rouah) Meter Release Rouoh Service Meter FINAL q Notes, Remarks, Etc U\I OWNER BUILDDR DEt.(ARAIION I hercby artr,n onds po.lry oa pajury lh.l I m .r.npr 6on fi. Contraclor' l-ic.nse LaLv fot lhc aollowi.s te$n (Ss 7011.5 ausinBs md Proa6sion Cod.) Any Cily o, County {hich r€'tuir6 a p€.mi to co6trucr all6, inp.o!t, dsnolish or rcpat My sloct@. prior ro ns issudc.. alsJ rcqun6 rh. applicer aor such p.ml lo nl. a sign.d stdmmt rhat hc or $e is lico*d pusudl ro rhc sovisioN ofrh. Cooradoa! Lien*d ljw (Chapl6 9. Comm.ncins *in sstion 7000 or Divisior I ofth€ tsusin€s ed Plof*ionsCodc)orrharheo.sh.i5.rehprthaeliomandth.bNisforrheall.scdcxmption.Anyviolalionoas(lionT0ll5bytf,y applicanl lor a panil subjdsthc applicaol lo a civilpcnallyofnol nrorc lhd fiv. hundr.d dollrs ($500). -1, 6 owod of rh. proFny. or m! optotB with wag6 s lh.ir $1. composalion, wiu do th. tro &d$. $nat@ i5 no' i.lad.d or ofq.d for el. {Se.?044, BuinB ed PmfBioN Cod.: Thc Conradol3 Licc@ LaN do6 oor apply to d oM.r of Ih. r,Dp6ly *ho b!il& or improvG th@a dd Rho do6 Nch *!ri( hiesclfor h6cllor drcuBt hi. ot ba om mplo)€€. provid.d rh srch inprorods e mr idarddl or olr6.d for elc lf. noudr. lhe bildins or inpro\mr b $ld {ithin on. )a ofcompkiotr $. Orffi Buik s will hrv. rhc Erdo of pmving lhd h. or st. did mt hoild or inF!( di. propary for th. purpo& oa l. 6 oM6 olrhc propsly. m qcluivcly conl,acrinr \rnh ltms€d .o'nr&ro6 ro codod ln. FDjct (Se 7044. B6i!B ard I|okM Codc: Thc co.lnctor s Lic@. Lre do6 nor .p9ly ro d o*nd of propdly sho builds or inpov6 lhdo.. md \lho onrds for ch Foj..rs wirh s ConlBcro(s) licm.d puBuad lo th. Cont clocs Lic.e lrw). I m cxanpt undd S{lion-, B &P.C aor$t r6on .ua8[E&r:co!!tE!s4l!oNll[ClAaaM! I hscby amm unds poalty olpqju.y on€ oflh. followinr dsbrarnrE: -l hav. dd *ill6ai.rain r Cdri6.ar. olco,Mr ro S.ll-lsur. aor rcrl(.c conrp4.rion, s provid.d for by S..lio.1700 oarh. tabor Cod.. lor $c p6lotre.. ofrh. *orl aor Nni.h th. tonn i! isu.d I hav.and$ill mai ,in *orke.i comp€nsalion insurance. as r.quiled bySclion llT00olrhcLrb.rcodc, aor rh€ polomance ot rlE *orl for lvhi.h rhis l-tmn is issB.l. My worhsi ompsation iNur c€ crir dd lolicy.udbd tu. l..nifylhat inthc pcrlormaoccorrh€Bo.k lor shich lhis p.mil is iisu.d.l shall not mplot aoy pdson in a.t Dun r $ aq lo bdom€ subjd ro th. {ork6 comp.Nd io6 las: of Califomia. dd olrs lbai if I slbuld bron€ sbjdr ro rh. *.r{da.onpnlqriontmvisiosofS.dionlT00oarhekborcodc,lshall,fonhwithcomplywiltthoep(vi3iori. WARNINC: P'allur. ro sure "orkcN conrpqsatiotr covcrare is unlawful.shall subjat d enployd ro qi,ninal pflahis and civil nncs np to onc htrndred Ihousand dollaB cosr oa conpNtion. danas€s 6 provid€d lor lhc SNrion 1076 o i rh. tib.r (ndc, irro 6r I h6eby ar@ unds p.nalry of pdjuiy rhar I m li.csdl und( poli.ion ofcl'apl6 I (connrtrins vith Selo. ?000) of Division l of thc ltsin* md Prcr*io6 Cod., &ij Ey lEcn* i. in tull rorc. dd elTd. I h@b, .ftm @dd Full, of pdjlry llln tn6c is a coldrudion k dilg .gtry for thc Frolr@c. of th. wort 6r which thit patnn 6 isu.d (Se. 1097. Civ. C.). AIfIISANI.DECI.ASAIIA! I tEd, rllm undd Fnony oa Fjury on. of thc follo*ing ddldarions: D.@l'rion PmnsAsbdro. Noiincarion F.{ml R.eohlioB flnk 40, Pon6] -Rcquircd lsl6naNorili..don and Counlylo ols uFn lhe //-/f -/3 Altq-^21 9) thl.r L.ndo'! AddrN: - acddal r.gohrioB e!trdi.g 6b6tus rmold trc .or .pplicablc lo lhis prcj€cl. red lhis application ed slal. lnalI -[--- -----]---- --t--