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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 / Groundinq / UFER I/?.4 //4 \a7 <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 />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />Meter Release r/L4/t1 <br />Rough <br />Service Meter I <br />FINAL 7m //0 4 <br />Notes, Remarks, Etc "L-/ <br />OlINER BUILDER DI]LCATATION <br />I h6ct, a,Itr,n unds Frally of psjury that I m €rcmfl fron the Conradorc' Liccnse L.w aor th. lollowiDs reen (S6,J0l I 5 <br />uusrnGs ud trolssion Code): Any Ciry or Cou.ry which r.qun6 r rdmit ro consl cl. ahd, improve donolish or r46t r <br />shcrure Fio, ro irs isrmcc. also E{ut6 rhc @plicur fo, such psnil lo filc a s(n.d stalnc.r <br />'lar <br />br or slE b lic.nsd p$uer <br />ro th. povisioc ofrh. ConL0cro.s Lic€ns.d hw (Chapta 9, Come.cinB Nith S6lion 7000 ol Divisio. I ofrll. Busidai ed <br />Proaesions Co!.) oi rhar he or slE is cr.'npt rheelioD md thc bsis for th€ all.r€d erchflion Anyviolaliooofsdlion 70ll 5 byany <br />applicanr lor a p.nDil subjds tlrc .pplica to acivilpeDllyornor hor.thd 6r. hon&.d doll-s($500). <br />L 6 ow,cr oflfi€ pmpsty. or my €mployG wilh vas6 6 Ihcn FE coDptudion, *ill do the wotk ed tlE iruclre is mt <br />iordd.d or oflscd aor slc (56.7044. BBinB ed Proa6io6 Cod. Th. Conir.ctoi s l-ic€M L.w do6 not apply !o d o\l@ ot <br />rhe pFpd, who hiilds or inpmr6 tls6n. md who do6 such Kdr hnnsclr o. hs*ll or lhoush his oi hd own .mplolt6. <br />providcd thar such inuroron6r3 a! nor inredql or or6ql ror sk Ir, hoRdd. rhe building or nn rovorcnl is $U wnhin one ,@ <br />oaco,npkirn. fi. OMr€r Builds will lEvc lh. hrda ofprorins th, ic or slE did tul hrild or iniFove &. pmFry for $. pur(F ol <br />l.6ownd ollhc prop.ny. m.xcluiv.lycontrsclins sith lics.d conlraclo6 lo codtuct th. projdt (S(. 1044. Bbins <br />dd Arisirn cod€: The contiacrois Lic.Bc La( do6 nor rpplr ro downer oaproocnysho builds or improv6 rhdon, <br />and *'fio conrEcrs for su.h p(je1s wirh a conrocro(, licc6.n ttr661rofic conr.clois Licmc LaN). <br />-l <br />m.xcr.pl undqsetion- B. & P.C toi rhi! r6on <br />D.r.: O*n6:.WORKERS' COMTTNSATION <br />Drc!4!4r!9! <br />I hqcby alfim uod6 p.naly ohojury onc olrhc aollovins d(la.rio6: <br />-l <br />n.vc {t will maintain a Cqlificste of Cosor ro Selr l6ure lor work.6 onrpeN0rion, $ povid€d lor by Sdio. I700 oalh. <br />Lator Code aor lhc psfomuc. o llhe {ort tor shich thc p@il is isu.d <br />Ihavcandwillnaimainsort.rscompcnsationinsranc.,6requir.dtrySdionlT00oalh.IjborQrde.lorthclsfomanceol <br />th. $orl for $hi.h this pcmil is Gued My Borters' comFnslion iNumncc cms ed poli.y nunbd 8rc <br />Policy Nunbd-Etptd <br />I csriry that inlh.pdaol@nccof lhc wort for trtich lhis psnn is iss!.d. l shall.or mploy my p6on in tny me.s <br />s 6 ro bdon€ subjd to rhc worl6 onpds,lion las ofcrlifomia. ed agrc tnal it I should br.oh. subjd to rh. <br />vorks @mpastion prcvisioN ol Stio. 3T00 ol$c tlbor Codc, I 3hall. fonhwith comply wilh thos provisioft. <br />WARNINGT l;ailorc ro Kure Nork6J compoelion covsaBc is unlaNrul. &d ddl subj€.r m sployd ro fiminal !6Ehi6 dd <br />ciril fin6 up to onc hundred tho6 d doll6 (t100 <br />sdion :1076 oarh. tjb.r Cod.. i.r6d md ono,.€y ! <br />11,1b <br />DECLAAAIION <br />I h6cby arDr undr pcnalry o apdjury thar t d licns.d und.r prcision of Chapld 9 (commcocioB { ilh Seclion 7000) ot oivisiofl 1 <br />of th. Busins d PrefsioN Cod.. ad ny lic.@ is in lull aor.c dd efidt <br />cao nt=e <br />I hscby amm undd p.nahy ol pcrtury fiar rha. b s codtuclion h.ding a8dcy for thc Ffomec oalh. worl aot \1'bich this Fnn b <br />issucd(Sc. 3097. CiY. C.) <br />AIeIICAII.DICJ.AEAIIOI <br />I hg.by afm undq paahy of pdjury on. olrhc lollovins decldarions <br />Dmohion Posits-A3b6tG Nolifical ion Fcdsal R€eulaliofls (Tnk 40. Pan6) <br />-R.{uted <br />L.ll€r ot Norifieio. <br />I c.nili thal I ha!. rqd rhis opplical i.n a <aicrharrhe$o\.infonnd nis.oEd I aSra to smtly Nnh oll C'tyrd Counry <br />ordi.an.6 d Srarc kws r€larin3 ro hildins conslructi.n, a .riv6 oalhis Cny Md Counry to 6ls uE i rhc <br />rli,!. nHrnined lrn)pL{} lor <br />Applic!tr1 or Apont Siqmnrre <br />wL^Luft c1 <br />(\/21l(b <br />...NKY <br />ruryr)o*.\!/r.r1l8 <br />L.ndd'r Ad&s <br />- <br />I cdiry ihd rhc f.ddal r.sulalioE resddins 6b6los rooval d. nol arDlicabl. (, rhis prcjd