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ELECTRICAL.INSPECTOR RECORD
<br />APPHOVALS DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Sollit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Rough gLitt('tW'ltt Y ,/uz)
<br />Service lVleter g/*tK ' >-l-9
<br />FINAL I .ilfr)
<br />Notes, Remarks, Etc.I 0/tII
<br />OWNER BUILDER DELCARATION
<br />I h.rcby afiirm und.r Fnllry ol pcrjury rhd I m cxcdpr rron rh. Con'Eror' Lk.r* b{ ror lhe rollowinS E sn (s(.7011.5
<br />Ausine$ and Proicsion Codc) Any City or Coutrry whi.h .cquiEs . p..ntr ro conslrucr. alts, nnprow. d.molhh or Eprt my
<br />(ruc1urc, nrior to ils nsuoncc, als rcqlircs rhc oppliconr lbr su.h llflrir lo lilc n siBncd nalemnl lhst heor shc is liensd |[6u.nt
<br />ro lhc E.visions ofitE Conr0cbas Liensd L.w {Chrtrcr S, Cdmmn.inB wirh Sccri.n 70OO ol Divhion I ofthc Busincsr rnd
<br />PmlcsionsCodc)orthlrlEorshchcxcmltthcrclmmlndrhcbasislorlhcrlhScncxcn{,tion.A.rviolationofSerionT0Sl5hrlny
<br />nppli.am ru a pcnnl iuhjeck rne Jlplicunt lo acililpcnalrrotnor nmrc rhu,ivc hundrcn dollatr {$500).
<br />ItZl. * .**, *r* **"y. o, my crylolRs wirh aas.s u. rh.n sh.omp.nsri,[ will do rh. wo* ad fi. stnrrE i mr
<br />irlcDded or oficrcd l'or $le (Se.?04,1. gusimss and ftolt$io s Codc Thc Cont.clols Lkense t w docs nol opdy to m owmr of
<br />rhcpmFny slxr hilds or itrrpn)vcs rltm( ad wtF d,rs slct wrk himscll or hcscla or lhmush hh or hcr o*n cnploy.cs.
<br />I,rolidcd ihar such imtmEmnN e mr intcndcd o.otr Ed foreL.ll bw.w. rhc boihin8 or in{lme,Ent is sld wirhin om Fd
<br />ofc.,r{i.rion, r Owncr Builtn wil how r 6udcn ofprovin8 rhd h. or shc Jid mr b{ilt.r inpmw rhc,rDlriy for rhc purro$ oa
<br />I. Aorncrorrhcrmpcfly, ilcx.lulivcly.ont,.rins*irhliccnrdconrrrx,^n,.on{tu.rrhcttuj..r(s..70r!l.Bu\i,'cs
<br />nnd Pmtssr CndcrlhcCotrnrtolsLiccnscL.wdo.snorilflyrodiowncrorfmpcrlywhobuildsoritr{'roveslncrcon.rnd *ho conrrr.h lor such proj.rls *irh a ConrBcb( 9 liccncd 0ur\unrro ihc Conrlacroi\ Licnr Ij*)
<br />-l
<br />Jmc\cmnl undcr Scci.*4o/r 81
<br />lllclAxAlltlN
<br />I hcrcby rllirmundn lc.olryoftdjuryo.c ofrhc folbBins d..le.liotrs
<br />Ihrv.$dw'lltrui'rn.C.difi.arcofCotrsctrrbSclf.ln\ur.ritrwork(.onDctrsrd).asprcvidcdlubySdion]T0Ootrhc
<br />Utxn Codc. fr rhc l.rtomncc or rh. woA for*hich rh. p.rnrir i\ hsocd.
<br />lhrlc rnd willmridrin so crlcoarpcns ir)ninsur0.c,rsrcqundh,Scclionl7(x)oirhcljhorCodc,forlhcFrlormanccoi
<br />rh. wo t)rwhi.hrhispcnnilisissucd.Myworkc(.omrns,rt,niNur0ncccrnicrardrnicynunrbcruc
<br />'fZ4.nn,t, -t.*U"rmrnc. rrhcs,trlr,trNh'.hrhisFrmirisisru.d.Ishallnotc,nployantpcsonironyntrnrer
<br />'s, uiro b.tun* subtc!rro rh. solkss s ncnsri.n hwsofcalifornia. ond lsNIhol itIshould lEcomc \!hj<t l.rtE
<br />wolksl cornp.nsolio. prclhions of Sccl ion 3?u) of lhc L{hor Code. I shall. fonhwilh comdy *irh rhoE pnvnionr
<br />WARNIN(i: Failuru ro *.rr. workc^ .omt n\dn,n.ovcra!. r\ unhstul. rnd shdl subicr an cndolcr lo criminrlrmlris otrd(i!il ftrc\ ut k' otu hundrcn rhousnd dollrs (Slfi,.(xx)). in rddiri( ro rhr.on ol .o y.nsrrion. d.trB8cs as providcd for thc
<br />inrcr.n and rrntrmy s f.c\
<br />181-no,u*,.{u"R€zk!*Ji*/zr4L2z
<br />DECI.{BAITON
<br />I hcrcby sl',tm undcr pcm,tyofFrjuiylhol I am licctrsn undcr prcvhion ofCMrtcr 9 (ommEins *irh S.crirn 7filo) orDilkioh l
<br />of thc Businesr and h.f.sion\ Cod.. md nry liccnse i. in full forc. Md .ffdr.
<br />CONEIAI]CIIONIENDINCII lII
<br />I h.Eh, rfirm undcr FnalryofFrjuryrnd rhcrc h o.oNrucriotr lcnding !8crcy lor lnc pcrformaN ofrhc sork fot whichrhis trnnit is
<br />ksucd(Scc. 1097.Civ. C ).
<br />ATTUIANIDfIIASAIION
<br />I lrrbt anm utrdcr pcnali] ol'pcrjury orc or rh. fdkrwins d(ktr r ion\:
<br />Dcnrlirion Pcann!Ashestos Norificalion lcdcrol Reglhlion\ Ont 40. Pda,
<br />R.dnird I.rrd.r Nnrifiorion
<br />-l
<br />ccniiy rhar th. fcdcE I rcg! lar io.s regdding dsb.io{icnn,valarc nor applic.hlc lo rhis tnjccl
<br />211anrry !h,r I hivc rc.d rhi\ lnplEarion and <nr. rhJr thc onovc inlb]dhn i!.orer.I alre lo conrp, wnt allCn,!"d Coury
<br />ordin.n cs and Storc Laws Errins ro brildins .oniru.rion, ud hcftby aurho.ih rcrr.e alircsofthisCnyandColnryroc.rruF,nrh€
<br />,bvc rfttrridrd tmpcny ior inrFccr
<br />Applienl orA*cnl SiAtultr )
<br />(2b-/-'1t=t/Pozl
<br />'idtalffilg'a
<br />Meter Release
<br />tJld.r'. Natr. _
<br />Lr.dci\ Addr\{
<br />II
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