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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 />Communications Cable <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 />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rough <br />l.Service Meter .r,LWFINAL3/tv/14 .) <br />Notes, Remarks, Etc I <br />OWNER BUILDER DELCARA ION <br />I hn€by amfln uods ,€nahy ol p.rju.y thd ! an cx.mpr fto th€ Conatdos Liccns. tiw for lhc lollowi.g Msn (S.clo.ll.s <br />llsins and Profeion Cod.) A.y cily or counly whrch r.quir6 a pdmn ro codrucl. ahs. iDprov€, &molish ot r.pait srrv <br />ntudrc prio. ro ils isuucc. also rcqun6 $c applicd aor su.h pdmi ro filc a sis.cd sllrmml 'hd <br />hc or sic ir licdE d p@et <br />to rhe provisioE of lh. conxaclois t-iccn$d Law (Chapls 9. Comm.ncinS with Sdlioo 7000 or Divition I ollhc B6ins &d <br />Proacsions Code) or lhal hc or shc t excmfl thacftoft dd lhc bBis for 1fi. auqcd dd0ion. A.t violarion ors..rion 703 Ls by any <br />opplicant for a pmnn subjec8 th. applica.t to acivilpenahyofnot morcrhd 6t. hondr€d dollds($sctl. <br />l. s ownd ofr h. propsly, or fty enplot6 {nh wasd s rh.it elc cor.p.f,sar ion. *ill do tF *ott t d lhc slrul@ i! mr <br />inrdd.d or oro.d ao. eE (se.7041, DusinBs od PrcfsioN Cod.: Tn. Conlroclois LicN Lls do6 not @plv to u osM of <br />rh. pmpdy qho toilds o, inp.ov6lh@., ard who do6 such solt himscll or hNlt or rhmu8t his or hd oM colployd <br />rovid.d rhar such inprolanoB Nnot inldrdcd oro,t6.d aor sle lr, ho\66. (h. bui[ins or inplovcfu is$ld Rhhinonc yE <br />ofcompkio!.lhc OMd Buldd $ill tBv. th.l &n ofprclins lh, hcorshcdid ml build o! imFov€ lh. F$Fly aot tE purDosof <br />-l,6oscr <br />oarhc ptupdy. an crclsivclyconlrelins wilh hcs*d.ontadoulo co$rrucl lhc pr.len (Se. 70'14. Bcine <br />md PnltsionCod€'rh€contraclolsLiccns.LardoBnolapplytouo*ndolpropdywtobuild!orimploleth.rmn. <br />and *ho co Bcls for such F.ojds wilh a Contraclo{s) Ii.d*d Purumt to th€ cDnractoas Licmc l-3w) <br />-lan.r.nrfl <br />u.dd Sedion-. B &PC forrhis.eNoa <br />Drle: Orncr <br />]IOBTE8LCAMIENIAUqNpEcLaSAIIO! <br />I hd.ty affim u6dd F.I, of Fjury onc of lhc tolbwins &.Lr.tiore: <br />-l <br />havc and will <br />'Minlain <br />a C.nificale of Comdr b SdUBuc lor workcG ompcnlarion, 6 Folid.d for by Selio. 3700 oflh. <br />Lalor Cod.. lor rhc p6fotl@c. oalhc worl for which lh. Fdil ts Bu.d. <br />-l hayc dd will mainiain qoit.B comp.Galion iBurd.., 6 req&.d by S61ion 3700 otlh. t bor Code for th. Ffoll1@. oa <br />$c @rl for wlich lhi! pdm n isucd. My eorkdl onpotsaion iNurdcc @in &d policy .@bc a.: <br />lcolirythol inIhcpst Daocrdlrh.vork aar vnich lnis !.rmil is issued.l shallnor anploy my pq$n i. sny,nmner <br />s dr ro b.cotu. subjd ro $e vork6' comp..slion lsws or Caliaomi,. md .aE lhal ir I should berone subjsl to lhc <br />voIl6.ompdErio.povisiosolSction11700ollh.ljborCod..Islull.lonhrnhcohplyNirhrhosProvisio6 <br />\!ARNINC: Failuc ro *cuc rvork.re' compcmalion <br />civil fin€s up ro ooc hundr.d thousd dollaB ($100 <br />sarioo 1076 ofrhc Labor Codc, der6l Md lt'orNy s <br />covc'a!e 's unl^*lirl. and bid e dnpll,rcr ro oiniml psalliB d <br />dmrages 6 r,roridcd lor rhc <br />)[?) <br />!,!l(],,!alrc} <br />I hmby afilm u.d6 pd.lry of pdjury lhal I m liss.d undq provision of ChtPlg 9 (commding wirh S6rion 7000) ol Division l <br />of th. BNind ed PmfsioB Cod.. ard m, li..u is in aull lorcc dd cfldl <br />Q1o N <br />q v>7 <br />\\ /2a /tz <br />!a]lll1!(.lt!)\Lftu!La lcl^l-.r <br />I hmby ajrun undd p.ially of Frjury lhd thq. is a rcisrudion Lndin8 .gdc, for lhc psfotuc of rh. wolk for rnich lhis ponil i3 <br />isu.d (Sa 109?. Civ. C.). <br />ATIUCdNLDICIABAUA! <br />I ho€hv afiim unds p€nalry ol pajury on€ o I lh. aollosin3 dclralions: <br />D.nohion Pd,nirsAsb6toJ Nor ificltion Fdldal R.luld ions (Tnt 40. Psl6) <br />-Rc{ut.d <br />L.ud olNorifi dn. <br />-l <br />ceniry rhat the ledsal r.uular io ns l+dding Nbskrs rmoval dc nor applicable lo lhis prcjd. <br />I r.nilr:rhar lhd\.re.d lhisapp licalion dd star.rhar $. ah)r inlonnarion is cotrc! I asr€ro.omplywnhallCnysnd Counrv <br />ord'nancG Md srare liwsEldiu ro buildin3 hdely rolhoriz rc!.Mlaiv6 oarnis Cny Md Couilyto 016 upon $c <br />otFlc lnglion.d propcny f <br />A pt,licsnt or AEml Sian!(u 2) <br />\lb ''t-w 2 C4- <br />/8 <br />Air Conditioners <br />Lende,'s Addr6s <br />- <br />I <br />l <br />I