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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />Site-Work <br />Unde rground <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 />Air Conditioners <br />Roof Top Equipment <br />Factgry Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh)tl rfl I ,' <br />I rl r!y107/'fX\ fl tt+llA-k?h) t <br />'*1t't t 0 - (l!-./,/y <br />Rough )\)\ <br />Service Meler ."I <br />FINAL ,L 't-20-t,'J lesDt Det) <br />Notes, Remarks, Etc. <br />OWNER BUILOEII DELCARATION <br />I hercby .mnn utrdd pdally of p..jury thal I m .x.np{ &on rh. ConlracloB Lic.nse tiw lorIh. aollowing r€Mn (Sd7011.5 <br />Busin6s d Prol6sioo Cod.): Any Cily or County nhich rcaut6 a p6nil to conslrucl, .llo. imprcv.. danolish or rqxir uy <br />srtu.tu., prior io il3 i$ud.., rbo rcqunG rhe applic&r for su.h pdful to nlc r 3igned rbrdor lhd h. or sh. i! li.dEd pcuet <br />to rhc Fovisio6 ofthc Conrrdcrors Licen$d Lsw (Ch.pld 9. Commcncins wilh SdFn ?000 of Division 3 ofrh. B6in.s ed <br />Proa.sqions Cod.) oi thar h. or sh. is .rcmp rho.from od thr bsts ror rhc allcgcd .xdprion Any liolarionoaserion ?O:11.5 by.ny <br />applicanlaoraFnnilsubje8thcapplicanlloacivilpc.rlryolnornor.thmfivchundrcddolles(!500). <br />l. a ow.d oflh. propdry, or ny cnploy6 virh q aB6 d then sn. conFsarion. *ill do lhc worl dd lhc shrodc i! nor <br />inlcrhl or ofid.d aor eL (Se.7044. Buins md PrufBioB Codc Tnc Conlroclois Licft. l,s do6 not apply to o ownd ol <br />rh. F.pdy Nl$ b!il& or inpov6lhsar.. ed *ho do6 s$h Ntl hins€llor h6ello. rhreugh his or hd oMrnployc, <br />plovidcd ltal such nnprov.lMts m ml hl6i.d or oltu.n for eL. lf, bowes. fi. hrildi4 or imprevoml is $ld wnhin .nc )@of.ontkio[ l1'. OMs Blildd Gll havc rhe hndd ofpmlins thd h. or $. drd ol buiH or iepo( th. FoFty aor Lt FrFeof <br />l. aopneotrh.Fopdy, &n.rcluiv.lyconkadi,S wnh c.r*l con(tro$ ro coNrud tbt pmjd (Sa.,0{4. Asin6 <br />and ftolBin Cod.: Ih.conr.cbr's Lic.orc Law doB nol arply ro do*nd oapropdry { ho buil& or improvd (ll66n. <br />and $ho conhcls aor such projdls with a Coihclo(s) licG.d pu6u,, lolt Co"lB.lor's LiceN La*). <br />I tun.rc,npr ondd serion_, B &PC for rhi! rce. <br />OrrF: <br />llaa(lSl.tauEENrall9! <br />DECLTAAIIOT <br />I hr.by arirm undcr F ahy ot pqjury onc ot th. aollovin8 &.lsatioN: <br />-l <br />hev€dds'U mmlain ! Cen i,icalc of Co6or ro S€l! lreurc for $orkda @.D€neridn,6 prolid€d iorbySdrionlT00 oflh. <br />L.bo, Codc. for lt. psfonnm.c ofthc volt for whicn th. pdmn ir isNd. <br />I h^.and \r,lln,ainrai. \$rk.6.ornpcnsarion iNuBnce.6 requirsl by S(r <br />'on <br />I700 orr hc l4or Cod.. lor rh. p6fonne.. of <br />rlt work tu whirh rht p@n t isudi My rortcn compqer ion iNurance c@{ dd policy numbs d. <br />PohcyNu'nbo Eipis: <br />lcdriaylhd inthcpdaofln.nccolrhc trork lor lhrh thipdmn is tsucd.I sh.ll nor mploy any F.Mn in anymMn6 <br />g, as lo b..otrE subjdl Io lhc N!,k6' compe.sal ion laws olcaliiomia, ud asre lhal il I should b.cor€ iubjd to <br />'he*0116 compqexon previsioN olScclion 1700 ollhe L,bor Code.l shall. fonh\ilh conply *irh rhospovisioro <br />WARNINC: Faihre lo sur. $0r[6 conpcnsarn)covdr!€ $ u.lawful, dd shrllslbler e mplord lo aimin.l penhiB od <br />clvil tincs u, to onc htrndrcd rhoNd dolla {$l n lo rhc coe oaconpensalion. dama86 6 provid€d aor th. <br />Sc.ri,r 1076rlrhr Lrlrtr (,x1., ducna d <br />!-[(! l!!U9! <br />! hcreLry aifi fln under rlnallyolperjtrryrhar prolision olChaptd 9 (com,nscins wilh Sation 7000) otDivisio! l <br />of thcBusinNdd P'ifsiodCoi., dd try licdk E in lullforca^leal€cr <br />I hreby 6mrh undr Dcnalty ol psjury $al I <br />issu.d (S( ]097. Civ. C ) <br />l€odins ascncy 6r th. p€rfomd.e ofrhc \ork aor \yhi.h rhis Frnir b <br />ATII,ICANLDECIAAAIIO! <br />I I'oriyltfmunds p.tuhy ofrdjury on of lh€ fol los ins d.c lral ions <br />Doolirioo Pmirs-AsbcsrG Notiic.tion F.d6al RcSoldiom (Tirl. 40. Pan6) <br />-R.quir.d <br />L.lt6 of Nolilicalion <br />ab6ros r6n \.1&€ nol apeli.abl.lo this proidt <br />r.d srat. rhar th. atFve infoft!.rion B coftst IaercrocomplysnhaUCityandCoxflry <br />io( and hcrcby aurhod. rcpi.sGrtc ofrhi Cny.nd Counryto 6t6 upon rhc <br />^Dplicitrl <br />or r0t SlEnrl'l <br />*-,r*-.",0);/ <br />APPROVALS <br />l\rleter Release ri <br />Lndea3 ad&s <br />/o.,1a,ru <br />t-