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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS 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 Y
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER,,
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment x
<br />Factory Wired Unit
<br />Walls Conduit
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />lt4eter Release
<br />Rouqh
<br />w)-Service h,4eter t2.t/- tg .l/-/M
<br />ulnurttAFINALtlalm -T ?,
<br />Notes, Remarks, Etc U\
<br />OWNER BUILDER DELCARATION
<br />I h€.cby !flin! undd potlry of p6jury tbol I m cxcr.pi from Ihc Contrclon Liccns l,w forthc rollowin! l@n (56.?011.5
<br />Businss and Profsion Codc): Any Cty or Coudy which rcquir* a Frmn lo consltud. tlrd, improv.. danolish or r@.t my
<br />strucrue Drior lo ns issu&cc. also r.qund fi. spplkml lor soch pcmit lo lilc a sign.d slar.lmt fi.1 h. oi sn. i5 lic.Md pusuul
<br />to rh. trevisioE of ln Conrradois Licenicd Law (Chafld 9. Cof,nc.cibg silh S..tion ?000 of Division 3 ol lhc Busin€s &d
<br />PmfNions Code) or lhll hc or sh. n c\6pl lhaeEofr dd fi. bsis lor lhc all€s.d .xdpl6n. Any liol.lion ols*lion 701I ., try tny
<br />applic.nl aor a p€mit subjcrs th. appLimt to 0 civil pa.lly oi nol mor. thd ,ivc hundrcd dollds ($500).
<br />-1,
<br />ae oMd of lhe Fopcny, or my .nploy6 vath *as6 4 rh.t elc conp.nslion. *ill do lh. wqt md lhc snElrc i5 mr
<br />i ddcd or otrrcd for sslc {56.7044, BusinB md Prof6sioB ('ode -l1c Conrnclois LicG hw do6 ml a$ly ro d own6 of
<br />th. p,opdy *ho bnild! or imFtrv6 th@r ud {to d(6 such erk hiff.lf or h6s.lf or lhrcush his 6r hd os .mploy6,
<br />y ovid€n thal s!.h inFovtuls @ mr i di.d or ofiird ror el. ll ho\'4s, lh. hildins or idprclcrud i, $ld withio onc ,@
<br />olcompkiotr
<br />'h.
<br />O"n6 lruiks will hav. th. hrdd 6r pruyins rhd h. or shc did mt toild or inprov€ rh. poFr, lor rh. B,Fs oi
<br />6 o*,n6 oflfic propsrx d .iclBiv.l, codhdin! w n fic@d co rac,o6 to codd.l lh. Foj..l (S(. 7044. Bci,e
<br />dd Pofissnn Coda Tn Cotrl..clois Licdrc L.w do6 nol !p?ly ro d ow.d of a,opdly who builds ot imProv.s thdoa.
<br />and who o E.,ls aor such poj..rs wnh a Co.lraclo(s) licmd puEuat'l to $e Contoclois Lic.e L.E).
<br />ud6 Selion-, B. & P.C. fo.lhis rce(
<br />tol,4
<br />uteialr lllLl
<br />I hcreby afiinn undcr lf,Mlrl ol oncolrhe lollo*inr ddl&ari06
<br />I hdv. dd vill @inr&n a C.niarcstc of CoNol lo S.lf'lcu. for sorkoa mnrpentstion, 6 proliddl ao. by Sation 1700 o I lhc
<br />bb.r Cod., for th. p6Iolr]1!e ol$. sorl fot which fi. p@il is iseu.d.
<br />-l
<br />havc aod will mainiain m*.( cotrrp.Balion idurancc, 6 rcquircd by sel ion 1700 ol rh. t bor codq for lh. pqfolr@c. of
<br />rh. e* for whi.n rhi. D.mil is isu.d. My oorl6 @opoE tion icnrec. ceid &d policy .u6bd e:
<br />PolicyNumbq-Expircs:
<br />-
<br />I ccnifynE! in th. Faomrance oillrc *'ort lor which rhi !.mn is issucd.l shall nol onploy 6y pdv,. in an, nano{
<br />$ 6 ro b..ome subjar ro rhc wrt6 @npdation la*s of Calitomi& od asd Ihat if I should b€om. suhj.cl lo
<br />rvorls! comDNlionprevsn,ns olSdion 1700ofthc l-abor Codc.lshrll, fonhsirh conDly wilh lhoE PnvdtuG
<br />WARNING: F.iluc to Ku€ wortds conp4arion covd.g. is trnlawful, and slBllsubld drPloy6 lo cinin.l Fuhi6 afld
<br />civil lin6uptoon nun&cd lhousd dolld {Sl0o.0o0), in sddilion lo lhc cosl oa conpdalioo, dmas6 a provid.d aor ln.
<br />S(lion 10T6olrh.bborCod€. inr6r &d artorney s fG
<br />DECI4BAIION
<br />I h@by alfm undd poalry o f pdjury lnal I m liErs.d ud6 Fovi.io. ofchrplr 9 Gomodig Mlh S..liof, 7000) ol Divisioi l
<br />of rh. B6i,B md hoiBsions Cod.. ad my lic@ G in tull fore &'d.ffd
<br />coN:rBi,lclllN.L[lDldc.AcDlc]
<br />I h6€by amrm und6 Fnahy ot p.rjury thd lhft b a €otr( clbn lcndhs agd.,lot lh.Pstom c.oflhc\!orl aor which lhis pdnit i!
<br />issuo.j (Se 1097. Civ. C.)
<br />AIIIICANIDECI.AEAIIO!
<br />I hdltr afrm und.r pqahy ol pdjury ooe of th. followin8 d(la,.lions:
<br />Ddolnion Pmirs-Arberos Notilicalion F.da.l R.gularioN (Thl. 40, Par6)
<br />R.qdrcd htd of Noificalion
<br />crrily th.t rhe f.{cral rcsulrriotu rcgddin8 st€ros rdno\ al uc not appli.abl. ro this pojat
<br />I cdiry thal I h.v€.ead rhis,ppli..rion dd slalethd ti€ ah'v€ inronnali.n is.or.cl. I a-!!E to cootly vnh al Citv and Countv
<br />and SIal€ l,ws chring ro building coBtrudion. and hscby.ulhortc r.pr6at.tiv6 ofthis Cny md Cotrnlylo alq upotr lhc
<br />abov. mariofl.d pop€ny for iNp<rio.
<br />Pcmire nrnElpnnO:A
<br />DATE
<br />Communications Cable
<br />L€idcr ! Nlnre
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<br />L.nder's Ad&s'-
<br />x.,ruP*otS
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