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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARAIION
<br />t hcrchy alfifln undcr pcnally of terjury lnal I am cxcmpl frcm lhc Conrtfua l-iftns Liw for lhc followins rce$n ( Sa 703 1 5
<br />Busin.ss afld Prcfesio. C.dc): Any Cny or Coo y *hich rcqnncs a Frmir t. .onslDct. !hs. improvc. dcnElnh or rcrat any
<br />drudnrc, priq ro irs as ,.cc. llso nquircs rhc appli.ad lor sx.h lEnnjr lo fika siBncd shtcndnr rhti h.or shc n lic.nrcd Purua
<br />'. rhc [olisions of rne Contacroi 3 Li&nsd Law lchaprer 9. commrminr wirh Scclion 70(10 of Divhion.r orih. ausin.ss md
<br />Pmicrsions Codr) or rhar hc or sh. h crcmpr rhcrcnom und rlE b!si\ aor rhr allcscd ex.ryrb. Any viol.iionofSstkn?011.5 hyany
<br />Aryt*r ry
<br />" N,^r *brd.,k ,nnll anr ,o D c'vrl Nnbty,n n"E'a rhrn l,vc hu mddollest!5r()'
<br />!/lltl*/J*,t,**"n..rmy.mfr',rccsu h sas*.s ,hcn bk comrns ion. wiu do rhc wd* lnd ,hc *duc is nor
<br />' ,f,tnM ortso"a r,r *tc rs( ?Lla4, Bu.irc$ ind Prcf.$ions Codc: Thc Conrracn,l Liccn* bw docs nor omly ro 0n osrctof
<br />lh. pmrEny wtF buitls or inlx,ws lhc@n. od sL &trs sh *n k hi6\.llor h.sclior lhmueh his ot hcr oM cnDll)rc\,
<br />liovidcd rhrr su.lr inpmv.mn* rrc nor inr.frkn orolTmd for slh ll howw. rhc h{ilditrE or im0mumnl is sB *irhin om J.d
<br />ofcodpktkJn, rhc Owft' Buiki$ eill hdw rlr bdrdcn of prctin8 rhr tE or shc di, ml tdild or in{,mve rhc pmFn, for ih. PUrF,$ of
<br />L .\ owncr or rhc ln'pcny. rn cr.lusivcly conn Itr1ins wirh liccnsd conlrxcxnr t' .oNn.r rlr ltroitl (Scc 7044. Buiim\s
<br />und ttorssion C.dc: Thc Conkrcr.is I-i.cnsc tjs dMs noi lprly ro Mowncr olFn,pcrly *ho huilds or n.roves rh.'con,
<br />,nd who .onra.rs r.r snch 0mlccls silh rCo.nrcro(s) liccn€d puGurnr rorhcComlactr'sl-i.cnk Lrw).
<br />;:-",{[in"
<br />I hcrchj_allinnutrdcr pcnrltyolp!rjuryoncotrhc f(nbwinE dcclrr
<br />I hrlcrrd willnuintoinNorkcrl c.mrcnsalion inslrarcc- as rcquncd by S..rtun 1700 tf rhc tibor ( odc. lb. rhc lErtorrodc ol
<br />rhc work fnshichl[is ncanir is is{ed My,ortcF {nnpctrsain,n insurr^.^c .aricnnd Flic} numh.r arc]
<br />IlllOrrr,n, ,n,n. *r",run!r urrhc w,{k rn, uh'rh rhis r..lnt is issucd.I shslr mr.npro, anfirson trnynrnrcr
<br />ry {l/(q n, k ,,m 'uhF! ro rhc woac6' ompcnsrian hws olCalilomi!. r.d aem rhd if I shouk h$om subj(r ro rlx
<br />*orle^ onpd$rio. pmvnions olSstbn 3?(x)otthc Latrr Cde.Ishdl. todhsirh strrrly wirh thok nmvkions..
<br />:*I'['[15-f i'Z
<br />onllrnsurion .ovchBc k unli$lu
<br />d.llic (Slfil,(XI)), rn oddition ro
<br />shall srt'rc.r r. c'nplorrr rD dimiml t'.Miics
<br />Ihorchyrllir uDdcr |xtrtrlryoitcrltrryrhd Ir liccnql unJcr pn,!i\i{)ChnprLr 9lconnEncin3 sirfi Sccrn,n ?O0O) ofDivi\i.n:1
<br />of rhr Bx\ines\ Md Ptuf.ssiunsCodc. arxi nry lacns is ir lull lorcc u cf,ccr
<br />Conlmlor:
<br />COIEIAIJEUANIENI}INIiJI;INST
<br />I hcrhyrllirDundcrIicMllyorpcrJl'r- rhri rh.rctacointudk,n Indni3rlcncy lbtlhc,,c onrhnc.ofrl'.sorklirr Bhi.h lhis Pcnnir is
<br />i{\ucd(se 1097. civ c )
<br />AIILICANLI,IEII,ABAIIAN
<br />I h.r.by aninn undc.,rn0lty olncriury onc ot lhc folkNin! dL{lrnriois:
<br />D.rslirion P.rnirs^rh.sos Nor ificir ion tudcr!lRcgulori.ns fl i!le t0. Pan6)
<br />Rrqrtrd I.nrrol Norli.arhtr
<br />rwd;;hclcdcr.lrcBUl iotrs E8adinS rshc(or rcmovil!E nor applirablc b rhis ln'i.i
<br />vc Dd rhis!pnlicrrionard {urc rhd rhc,h)!c i',roi,ndn,n is corrccr lisrelo.onrpl
<br />trqr rcldiry h huildin! cotrdtucr "Jdh.rcbyaurtn zcrcprcsctrrorivcsolrhisCir
<br />ft.vc rmnri.Nd l]n)lf,n! ntr irstc.riotr Durpscs
<br />iU,li nt orAAcnl Si[n,lun
<br />y sirh atl Ciry rid Cou.ry
<br />'u;J;)--
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq i Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ir/eter Release
<br />Rough
<br />Service It4eter 1l
<br />FINAL hltt"lt0 '44^q
<br />Notes, Remarks, Elc.I
<br />ELECTRICAL-INSPECTOR RECORD
<br />?
<br />lhrvcnMwillminrain0Ccdific.lcolConscnlloScll.lnsurcr'or*ortcscotrFn\rbn,6rroridcdlorbyScclbn]T00.{rh.
<br />Latxr Codc.lor rhc psfortu ccofrhcw.* for whi.h rhcpcnnf h issucd.
<br />Cdf,r'-
<br />I nt,1'\ ,lJ,r..
<br />Communications Cable
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