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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Rough <br />Service Meter <br />FINAL t/'f/!1 1\8q <br />Notes, Remarks, Etc <br />OWNER BUII-DER DELCARATION <br />I hcrcby aflim undd poalry of Frluryrh3l I dn.xmpl 6orn lh. (.onk,croB Lic.nse Lnw for th. aonowins rcen (S6h3l5 <br />slsin.ss and Proieion Co&)r Any Cily or Counly which requt6 . pomn ro coNtod, ahs, improv€. &nolisn oi rcpan dry <br />slrudwe. pior ro its iss@cc. llso r€qui6 rhc applicd lor such pamn $ fi1. . sisn€d slaloncnt thal h. or 31l. ir licded pl^umi <br />ro lhc ,novisioft of lhc contactois Lic.nrd L.w (Chapl6 9. Conrm€nci.! Nnh s€tion 7000 ol Division I oflh. auin s ed <br />Prufsions Cod.) or rhat hc or she is crcmpl th6.lio,n ed th. b6is for lh. alLt.d .xmplion. Any viohlionofsetio. T0ll.5 by any <br />applicant lor a p€mit subjdB rhc rpplicdr lo a ci! il pmalr, ol not mrc lh fiv. hun&cddotlds {$s0o) <br />I. s own6 of the prop€rly. or my cmplo)6 rvilh s as6 as rhci, 3ol. .onp.nsalion. $ill do th€ ro* ad $c amdu. t not <br />inldrdcd or oatdcd lor elc (SE 7044, B6i.B &d B'oasio6 Cod.r 11. aonlr.dors t-icd€ hw do6 nor apply lo u oM.r oa <br />rh. pn'Ddy who builds or imp6v6 rh66n, md * h. dos such srk himsclf o. h.elf or llwush his dr hd om onplotc6, <br />providql th such impovdcnts e€ nol intadcd oro,I6cd forslc.lf. ho(66. rhc blildins or i'ntrovonc is $ld silhin on. td <br />ofcomplerion. tfic O*nd Builds q,jll hlE t hrdd olFoving rhd h. or shc did no! build or inproE thc FDFry for lhc puFoE ol <br />t. as o$n€rollhc ropdly, @.xclusivclycont6dins wnh liceGed conlracto6 lo onslod rh. Fojed (Se. ?0'14. R6io6t <br />a.d P66sion code: Th. Conlrdo. s License Law do6 nor apply Io m orn.r o f propsiy vho blilds or inprorts thdon, <br />and Nio contracrs for sucl Foj€ds *iih a Co hdo($ lic.Ncd luEuanl lo lhc ( ohhadois Li.@ ln*). <br />_l anclcnipr undB sdrion .I}.&PC lorrhnrcae. <br />.IIOBtrEBfl(A!UINTA1IA! <br />DlCt !Auo! <br />I heEby dmrm und.r pe.ah, olpdjurronc oatbc lolloLvios dsldalb6: <br />-l <br />hav€ ond will ,minlrin a Colificarc ol Consmr ro Scll-16urc lor pork.6 conrpensarion, 6 povid.d for by setion 1700 of the <br />libor codc for lh. p6lommc. o t lh. wolt for Nhich lhc pmil is istued <br />-l <br />halc a.d will nainrain woitdl comp.d.lion iNurancc. 6 r.quted by Scr io. 1700 .l rh. Ilbor Codc for thc pqfotr@c. oa <br />the wo lir *hi.h this pann n is.d. My workd! co'npdsion iNuece ctno ed qolicy numbd 6.: <br />E- c-cor <br />TSpae /tt'??6 /-4 <br />I.enifyrhd in lh€ pdformsnccoalhc *'orl for whict lhis p.rii h Gsu.d. I shallnol dlploy any p6oh i. an, nmno <br />so 6 ro b€com€ subjdt to thc wort6' conpGltion laws of Colifomia. tud a*c rha il I should b.Nnc srbjtrl lo lhe <br />sort6'compcNtionprovisiocofscdionST00ofthetitorCodelslBll,tonhslhcooplywihfio*provisiors <br />WARNING: Failur. ro sur. rvorke omposaion cov@sc E uila{lul, md shall subjd oplo)s ro oimintl ll<Ehi6 3nd <br />civil fin€s u! to onc hundr€d Ihosdd dollm ($100.000). i. addnio. lo the co$ ol compcNalion, ddn,8.s 6 providcd for lhc <br />sdion 1076ofrlE hu)r can( inr661ed arorEy's f6 <br />/LZz -/r <br />I hd.by amm undd p.nally of psjury lhal I d lic..!.d undd rolision olchapt6 9 (co,.nocins with Sdion 1000) of Divisio. l <br />oa rhe BusinN ed PrcfsioB Codc. od my li.€c it in lull lotc .nd .fldt <br />C -zo 2[/// <br />l/- 2t -7r <br />colsfaucu{lN-I.rlDllclcllcl <br />I hq.by amm lndd p.nalry of pdjury lhal th6e is a cotrnrucliotr lodiry ascocy for fic pdfomecc of the Nort for whi.h $n pdmn is <br />i$u€d {56.1097, Civ. C.). <br />APPLICANT DrCI {RA?IoN <br />I hGry amm undd paalry ol prjury on. ol th. lollowin8 d(l&arions: <br />D.molnion Pmirs-Asb6ros Norificatio. F.d6al R€guli ioN (Tn,. 40. Pan6) <br />-Rcquted <br />L.tt6 of Norifi cation <br />-l <br />.d ily rhal rhe f.doal rcgul,tioc r€8ddi,8 6b6los rcmoval r€ not atplicable lo this pbjd <br />I cditr rh.l I h.ve refld thb.ppli.alioo and slclcrhal ihc ah,vc inlonnariofl is corst. I as.a to co6lly *nh all city and Counly <br />ordinancB md Skte Lavs rclllins ro blildins co.nrudiotr dd h{.6},olhornc rcprslariv6 oflhir Ciryed cornryto 6td upon th. <br />on"' f/z7-/rabo!. frdrion d propcn, <br />Appli.rnl or Agen( SlSrt <br />Z-.er/ <br />I <br />Communications Cable <br />Air Conditioners <br />I eldc' ) AJ!L$ <br />- <br />lz <br />I <br />fT <br />I