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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER '42&-a nY)6L+E-
<br />Transformers Ir
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter / Ja 11 ,?-174 w DI t{fl<t1-$'5 /
<br />FINAL
<br />Notes, Remarks, Etc I U
<br />OWNER BUTLDER DI'I,CARATION
<br />I h6cb, amrd unda p.nalr! oa p.rlury thd I dn €r.mF from Ihc ContEcloB l-ic@ Law aor lh. tolloei!8 r@n (Sd.70l L5
<br />Busincs rnd Profsion Codc) Any City or Cotr. y Ehth ,cqut6 a tqnir to cod d, .nq, inprove dsrclnh or r.tsn &y
<br />srNclue pri.r to ns i$@cc, also r.q!i6 $c appli.d lor such Ff,nit lo filc a sisn.d stltddl that h. or slE b licosal pw&l
<br />ro th. povisioc oa dE Co ra.(ols Liccn*, tiw (Chapts 9, Com€lcins wilh Sclion 7000 oa Divilio. I of lh. BBins d
<br />Proa.sio Cod.) or tbat h. or shc G cxcmpt lhscftom dd rhc b66 for rh. allcg.d dmr(ion. Any violotion of S.(ion ?01L5 by &y
<br />rppl,Fr lor apm rubJRs'hc apphd ro.ctrilpmhyolnor mor.lhu ri\r hun&.d dollds(1r0ol
<br />V I, s omd of r h. pmpdy, or my .mplale oirh wa86 6 thcir sl€ comF6alion. vill do ft. voit md lhc siru.lE ir ml
<br />inrod.d or ofid.d aor el. (Se.7044. BNincs Md Pmlsions Cods Th€ Co raclor's Li.6( bw doB nol apply lo e ownd of
<br />rhcrrDpgry who h G or nnp6B rhmn, rnd who do6 su.h vo* himsclaor hm.llorlhmush hh or hd o*n cmploy6,
<br />provid.d thar such imFov@ls m nor mrddcd or o,Id.d roi ek. ll how6, thc blildins o, i'nrovo*.t B eld {nhn onc )@
<br />oaconpldion. th€ (nrnd Buildn wil h.vc th. bud.a ot pmvins lha hc or sh. did nol build or i,nF!rc thc pmFry for lhc purloF of
<br />-1.
<br />6 o*na otrhc propsly, @ .rclBiv.ly cont.cring with liccN.d collmclots lo con$tuc1 lh. prcjcd (sd ?o44, BGi,s
<br />ad P,oksbn cod.: Ttc co.tra.rols Li..ns. Ldw do6 nol apply lo e own6 ofpopdy vno bnildr ot inptovd thddf,,
<br />and who.ontmcrsforsuchproj.dsRnnaCo m.1o(s) lic.ns.d puc@r ro rh.conra.roas LicN L1u)
<br />l/.--I @ .r.mpl unddSation-. B
<br />I hmby afnm undd poalty oapaju.y on oflh. followinS daldalioB:
<br />I hav. d will maintain r Ccniarcarc olconml to Sclf'16u. lor sik6 @opa&liotr d prcvid.d aor by Sdion 3700 oflh.
<br />tnbor Code for lh. pafomdcc ollhc wort for which lhc p@ir a i!su.d.
<br />-l havc dd *ill mainlain wo*6 .omp.mlion hur.nc.. s r.quired by Sctio, 3700 oifi. bb.r Codc, for th. pqfotfucc ol
<br />fi. wort for snkh lhi. p.mil ir L$.d. My wort6 cotrrFs.iion i6urec @id ed Flicy .uftba E.:
<br />PolicyNuftb€r
<br />-
<br />!4cniry rhot in rl,. pdaonhanccoarhc wort ror whicn rhis p.nnii is issurd. I sh.ll.or dplo, trny p.6ofl in ymanns
<br />s s lo b€om€ subjat to the worlm c.,npftarion la$. of califomia, daercth.t ill should b6on. subj* loth.
<br />*o't6 comF.erion proviliom olSdion 1700oilhc Lab.r Code I shall. fonhwith conply wnh thospmvisioB..
<br />WARNTNC: Failurc lo s(@ Noik6 comp@rion .ov.raEc is unlawful, md shall subjd e onplord ro dinin.l pGEti6 ed
<br />.ri "1er ur '" nr 1r
<br />'nd'cJ rhou.d.l d.,lld rilu0.0u0r.
<br />Sdi6n.1076.irhc tibor Cbdc, ir d6lardaiiomcy s fecs.77u';. " Uw
<br />6 Pr'!'rcd r'r rh'
<br />t--?o {-
<br />r i'i iiiinXor r n,rr n--ffi-I hseby srm undd poalry olpajury $al I a li.oEal undd Fovisior of Ch.pt6 9 {conmdcins uilh s..tion 7mo) oa Division l
<br />ol rhc Ausins dd Prcf*ions Cod.. &d 6y lic@ is in alll ao.E ed .fla1.
<br />l-iccnsc( las: LiccnseNunrbd
<br />D.rc: Conrmlorl
<br />corsrf,lcllaxl.llDrNcacllcr
<br />I hd.by amrn ondd Fnalty oa pdjury lhd lh@ is s codru€lbn Lndins asac, lot th. prfomdc. oalh. worl tot which this Dsmn b
<br />issu.d (Sc.1097, Civ. C.).
<br />ATTLICANIDECIAEAIIAX
<br />I ndrry oflim unds paahy olp6ju,y orc ol th. foltoving ddldalioG:
<br />Ddolnion Pmns-Asb6tos Norifi€alion Fcdml R€sulalions (Tirlc d0, Pri6)
<br />R€qun.d Leller orNotificaion
<br />I csr if} lhal thc fcddal qularions esdrdi.s Nb.nos rdoval trc nol .gplicablc lo lhis proiel
<br />/**," ,nn , ** ,*o rno apelicsrion exi srar rhar $c rbovc infomdion n I0!rero complyNnh all Cny and County
<br />ordina..6.nd srarc bs r€ldine ro buildiru dion. ud hs.by adhoE City d Countyto ml6 uDonlh€
<br />abolc ,notioncd propdy lor imp€t-rion r',{pplicinr..Aq. rSign ure V*L*i -Qrt,r^*o "^,", l-2 l-7o
<br />z<ullfl$dErfGfl
<br />Rev.08"07-2015
<br />"". bal-7.o
<br />tad€is Addrs:
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