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ELECTRICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Condrtioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />l\,4eter Release
<br />Rough
<br />Service lvleter ri
<br />FINAL 'D0a tq
<br />Notes, Remarks , Etc.ll
<br />OWNER AUILDER DELCARATION
<br />I h$ch, ,,Inn un&r pcMlry of rcrjlr, rhll I m.xcnpt fmm Ihc C nrr&x,6 l-k.ns ljw ror rhc following rcNotr (S(.r031 5
<br />Busincrq dnd Protc*i{}d Cnde): Any Ciry or C.unry whi.h ftqut8 tr pdmir ro conslDcl. rll.r. improvc. dcmlhh o! Ep.n atry
<br />slruciurc. Frbr r. ih issnaft.. rho rcquircs rh..prli.ad lor sx.h Fmir to fika rigrcd sletcmnl thd hcorshc n liansed pur$anl
<br />io rh€ proririons ol rlf Co.rracrtr r Li.e.*d Lzw (Chaprc, 9, Conncn.ing wnh S.cttun 7000 of Division I of thc Business .nd
<br />PrcIcsions Codc) orlhal hc or shc iseicnDl rh.rcfon and lhc blsis lor rhc allcscd crcmprinn Any !n drio. orscdion T0rl 5 by.ny
<br />Ailrc0r f.r0trfr \uhJ(h rhc 0pnltrrnr rn acrv'lNntrlrynfnar nnnc rhon li!c hundnn dollor\,9100,
<br />Z[t-*,.,*
<br />".*r.
<br />n mycmnr.y(\ r h*aEc,.\r\ci, s. con'Fn\J,tr'n. v,,tdn,hr].rr d,h. {tr,m ^ tu,
<br />i[.,]& nr "r".a to, .t" (s* 7(x4 Bu\ms and Pr,tcssioB crdc] Th. contftr.r'r Lkdnsc Ilw des nor apply ro !n owrcr of
<br />rhc tmp.ny who hdild! or iny,ows trNn. dd who dos such rc& hinNclf or heMlf or thou8h hh or hcr own e'qloyces,
<br />pmvidcd (hor such i,rymrcmnrs m nor ir cndcd or oftcrcrl tu slc lf. ho*cv6. thc huilding or i'nprov.ftni is $kl wirhi. o.c Far
<br />ot m.Ul€rt tr lhc Owns Buildcr will haE tlE budcn of pmviry lh,l hc or shc di1 mr build or inlnok $c ptr,Fty ror rl* purF{ or
<br />LasowncrofrhcI'openy.!mcxclusivclrconrlaclin8riihliccnrd.ontrcr.rst,.on\trucrrh.pmp.rlscc7044.Busrrcs
<br />and PnniJsbn codc: Thc G,nha.ior's Liccnsc Law d.cs nol,Inly lo an owm. ofpropcny who builds o, imp(trcr rhercon.
<br />und who oniruch lor such nrcirts wirh a ConlEkr(\r lkcn*d nunumr ro rhc C.nr.a.ror'r l-i.cn* tjw).
<br />_l _.8
<br />I hcrcby 0fltDUnd& !.nih, orD.rjurtonc.f rhc lolhqi.S dcclarations
<br />_lhaveaBlwillm0inrlnr!Ccninclrc.IConscorroScllrlnsurcfor*orkcn conrpcnsrri{u. rs providcd nrbySccliotr]7m.frho
<br />L{hor Cqle.li,rlhc pcd'ornnncc olrhe wo lnr *hich thc n rnil h nsucd
<br />I havc nnd will minrrih work \' conln.nsrr ion inrutui... as rcqund hy Scct ion 17IX) of lhc Lahor atdc. lbr rhc lr.rLrro'trc ol
<br />rhd sork for*ii.hihh Fr.rir is nshd. Mywork.* co.rlrhsdri.i insur.i.c .dfticr r Folicy numher orc:
<br />lkyNlmb€r:Jxp@s
<br />ofthc w.rk for whi.hlhisltnnir is i$ucd.l shull trol cnI,loyonyl)cnotr in riynuincr
<br />c^ compcnsation luwsofCaliforni{- adrsrcc rhlr irl \hould h..onE subl..t !otlE
<br />)f scrio! :1700 ol rhc lih, codc, I lhnll, nflhRirh.onrdy wirh rh)s pm!ision\..cou!.osarion pDvNrnr(
<br />WARNIN(; t-Jilu.c x, {cu.. *orkc conrFnsxrbn covcrrgc i\ D ln*lu. md shnll sulrlr(r r cnll'loycr 1o (rimi
<br />:*.-',uffitl#
<br />llJ'\ (S100.(Ix)r. in rddiiirr
<br />I hcFbyaritalundcr D.n0llyol rcriurylhli I rn lienqlundcr n ol Chryrrr 9 (.ontrmmi'rg wirh
<br />of rh. Businc$ rnd Pofcssions Codc. dt my ltctrs n ir tull forcc.ndcthcr
<br />IAISIBICfl9NIENDIIGIC.EN(.I
<br />I hcrcby rrfirm Dndcr pcn,lryofFrjlry rhar rhrrc is r.onirucrion Lndins,Bcn.y for rhc Frrbirmncc ofihc uork for *hkh rhis Frmi n
<br />hrucd(S( 1097. Civ. C )
<br />AIILICANLDECLIAATON
<br />t tmfi, aninn hdcr p€nsllyofp€rjuryonc of lhe followii8 drcl{arionsi
<br />Dcnblition P.rmih-Ash.sros Notifi.alion a{dcrilRe8ulations(1irlc40. Pun6)
<br />R.quiEd L(.r or Ndiff, dbn
<br />n
<br />-lccnilr
<br />rhr rhc lcdcrJlrcsultrl,l----JLI ccn'ryrh. l hnlc rcrJ rh^Jmlv.^lrnrnr...trJ 5r, c tiw\ rlar,ng 'n
<br />rtuns E!rding asb. (o\ r.n,Hl J c norlpflic hlc t) rh'\ ttii)ic.r
<br />i.arioritrd{ lclhdrlErlivc irrfnnnllln hcotrccr. Ir$eioconrlywirhrllCiryand
<br />rhtriz.r sfirn!\ olihi\ Ciry atrJ C.
<br />I
<br />xtr,v.nrnri,rni p'on dyi(tri',\nrcri{n,
<br />/1poli.nnl or ]\grnl Siamturc U 6 H"
<br />I
<br />I,IAIYIZI
<br />APPROVALS DATE
<br />Under Slab / Floor
<br />Lic.nrc Cl.s:-Lic.nsc Numhcr:
<br />-
<br />t rle ( o,lmcro.
<br />trnJor ( AJdr.\
<br />I
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