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APPROVALS DATE ID/SIG. <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />AS Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communicalions Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Facto ry Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouqh) <br />lvleter Release <br />Rough <br />Service Meter <br />FINAL t(L1 IB 4/4 L <br />Notes, Remarks, Etc. <br />ELECTRICAL-INSPECTOR RECORD <br />O\INEN BUILDER DELCARATION <br />I hd.b, amrn !nd6 p@lty ot pejury thar I m €xmpt 6orn rt€ Codracror' Licehlc Liw for lhc lollosins reen (S.c ,01 L5 <br />tsusinBs ed Prot6ion Coi.) Any Ciry or Couoty s,hich requt6 a peftir to conetuct, alrd, itrpro!., d.,nolish or r.pat ey <br />slruduq pru lo ik isudc.. rl$ r.qot6 nE .pplicd for such p.nnn to filc 3 si8nd statcmfll thal h. or sh€ is li.Gd pu.qur <br />lo lhc provnioN of lne contt.ctori Lic.ns.d h* (Cbafla 9, com.ncinS wnt Serion 700! of Division I ol$c Ausircs md <br />Proasions Co&) or thlt h. or she is er.mpr thocton Md rhe b6is ior rhe allqcd €xolll ion. Any viol.xon of s&1io6 701 I 5 by my <br />applicant aor a pmi subjdls lh. atplic&t ro a civil pc@lry of er m6r. rhan nv. htrndr.d doll&s (Ss00) <br />-1. <br />a{ o\nf olthc Fop.ny, or tuy chrlo}6 Bilh *as6 6 rh.t sL .onpdeion. will do tte rvort and lhc idm n nor <br />intodsl or olred lor el€ (Se.7o,14. Busins &d Prcf6io6 Cod. -r'hc ( onlmdor'. Lic.B tis do6 not apply lo e orqcr of <br />rlE !,bpdy who hilrk o, i,nprov6 rhcor dd who do6 sch "!* timsclf or hrsclaor lhrolsh his or hd oM cdployG, <br />providcd lhll such inpovoons e ml inlod.d or ofid.d for salc li how6 q. lbc hildins or impreEo@l 6 srd sthin on. ya <br />ol.onplsio., rlE ()"@ Blildc rill h6v. rh. hrdd olp.ovirs lhd hc or sh. dd (n build or Lryrolc rh€ rmpoly aor lh. plrpoe of <br />l. 6 owucr olrhc prop6ly. m erclusivelyconlra.linB rvirh lic€.sed contracroEro..nsrucr lh. por(r (se 7044, BcmB <br />dd Pr!tosih Cod.: Thc Contraclois Licds. Lr* do6 not applyro ano$nd ofprop.nt who builds o! improvd thaon. <br />and s,ho co racls forsuch projdis{nh a ConlDcto(s) licdscd puuuMt rorhc Conrracrois l-iceN L.u) <br />I aner.mpl unddsdion , R &PC lorlhis rce,n <br />Orndl <br />.uqatr!85:raurEN! raN <br />DECtAlArl}! <br />I hdchyam und6 p€,ahyolpojuryon.ollh€follosios dala.alnnE' <br />-l <br />hav. ard will ruintaio a Cedificat. of Cocdl ro Scll-lnsuc for sork.B onlp.nerion, a F6!id.d tor b, sdion I7Lr0 oirh. <br />Labor Code for th. pdlorucc of the vorl for which th. pnnil is isucd. <br />I har€ and will maintai. workera comp€maliotr iNurmce. s rcquned by S(rion ll?00 oa rh. tibor cod.. aor rhc psfomMc€ of <br />the $orl fo. rvhich rhis pmir is iased. N{, srls!' comp€Nario. imur&cc cmid dd policy number ftl <br />I cdily rhd i. tbc palormhcc of rhe*ork aor vhich rhis p€mil is isued. I shall rcl dploy any p@. in anynmnd <br />$r 6 to b€come subj€r !o Ihc wort6' codp.@lion l.ss ol Caliaomia. &d ale rhal if I should b.io'nc subj.cl to lh. <br />*0116.ohp.nerionpoviliodofSc.rionlT0Oofrh.lrbdrCo<L,lsnallaonhwnhcomplywilhlhosprovisioN. <br />WARNINCT F.i[r. lo Gurc Mrlas' conp.Bdion .ov6as. is udlaNful. md sh.ll subj(t e oploy€r to o'ninal Fnahis md <br />civ nn6 up lo on. hNilr.d rho@d doUe ($100.000). i. addnion b th. cosl ol comp.Nlion, dd.ss 6 providcd for fic <br />sdlion .1076 oarh. L.bor Code imdd &d aromey s fB <br /> pp!6nr: <br />I.ICTNITD-CANIBACIAtr <br />D!:ClASAlrO! <br />I hd€by arm und6 p€ndly of psjury lh3l I dn liosd undr provision ol Chapta I (co'nmdci.g wnh Seiion ?0o0) ot Division l <br />of the BusinN ed PmfsioB Cod., ed my lic.@ i! in aull lo.ce dd cffal. <br />carirBuqltalrENDldc-dc[rll <br />I hercby aiiri undd pcf,alty oa pdjury thlr lh@ is a ..{!lruclio. lcndi.s .s.Dcy aor rh. pd fomMc€ ot rhc Mrt fo, shich lhis pqnn is <br />issu.d (S(.1097. Civ C ). <br />APPLICANT DDCI-ARATION <br />I hedyormundd pcnalty ofFrjury on ollhc tollowif,S delealions <br />Dano lilio. Prnrn3-Asb.sios Notific.rion Fcnfial RcSular ions (Tnlc 40, Pd6) <br />-R.quned <br />t.ttd of Noi6cnion <br />, cenityrhat rhe Gdrdrclularions esed,nr asb6l$ rono\ala'e nor appli.ablc ro rhis pmjd <br />-l <br />cditi thd I hav. Md <br />'hi. <br />applic,rion ed s!ar. rhd lhc.bo!. idaomarion is cor( I arr€ lo comply s'ilh rllCnyand cou.iy <br />ordinan 6 ed suic Lrws r.l!lin* ro boildinB consdction. ed ho cby aurho.ize ,.p.Mlar iv6 otrhis Ciry dd Cou.ry lo mrd lp.n rh. <br />atb( nenriond prcpdy lor iEpdrion purpos <br />Arplic.n( or A!.nl Slgn.t!r.: Drtc: <br />COMMENTS <br />Lende' s Addres <br />Transformers