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APPROVALS DATE rD/srG.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 4D
<br />Bonding / Grounding / UFER I Irrlq "nt \^'t'eP
<br />Transformers I L ,,\
<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 Rough
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service lvleter a -a27
<br />A^/e"lFINAL1t 5l t41 I "v.
<br />Notes, Remarks, Etc t- ru l
<br />OWNIiR BTJILDl]R DELCAiA'TloN
<br />I hd.6y amrm undd pdaly of Fjury rhar I an .re,nfl 6orn rh. Conrraclors Licms. Law fot thc foUo{ins rc&n {sd r-03 I 5
<br />Blsin6s and Proa6io. Cod€): Any Cily or Couflly which rcqutB a p6nil lo conslod, alt6, inprov.. &nolish or r.lBt My
<br />srruclu.. rnn lo irs i$@c., abo r.qut6 rh. applicdt for luch Fnn ro 6L a sisnal sbrffil lhal he or st. b licss.d pueMl
<br />ro rlE pro\isioN ofrh. Conka.ror's Li..ns.d las'(Cfiaprq 9, Conndcing wnh sdion 70oo ofDivision I oflh. ABins ed
<br />Prolsions Codc) or lhal he or ih. is .ronfl ihd.ftom .nd rh. ha3is aor rh. .ll.g.d .xdnpriofl. Any riohlion ofSc.lion ?031.5 by.ny
<br />applica for ap.ftil subj{8tn aptlicamroa.ivilp.nrhyoanormorcrhefiv.hundrcddollffi($500)
<br />l. d ownd ofrh€ properly. or my cnployG vilh Nas6 6 lhct slc comFBdl ion. $ill do $. itit and the slru.l'rc is nol
<br />inroliql or ordcd for saL (Se 70,14, Busin6s md PmlBions Cod.r Tl'e Conlraclois Lic.6c LAv do6 nol aply lo e oMd o I
<br />lhc poFly qho tdil& o! inPlo6lhsaq od sho dc su.h w hnns€lr or h6.lf.r rltrooBh his or n r own cmploycB,
<br />providcd ihal strch i,nprcvm lsdcnor inldr& orolT6.d torel€.Ii howo6.lhr hlildins or iiprotrddr is $kl athin o.. yd
<br />ol.odplaion, rhc Omd Blildd wiu lsve rnc hudd olp$vin* lh,r fi. or sl1. did nol buiid or nqro\€ th€ prcpdy for t tlrrb*of
<br />_I, aomo ollhc FoDdy, @.rdun lycotudins wnh lictr.d cooradoBro o6tNd ri. projccl (SE.7044, BGrs
<br />trd Pn frsion Codc: 'rh. Cont..ror s Li..6c lj* do6 ,ot arply ro e ownd ofprord, who buildr or impro\'6 thd@&
<br />and who comBds fo. so.h pmj.ds wnh a ConiBcro(s) lic..s.d pruuar tolhc Conracroas LiceN Lav).
<br />_ldr.r., trndd SNriotr ,B &P( lor rhis r€aso.
<br />yQS6EECI.AUIE|S rO!
<br />DECIA.BAIIQN
<br />I her€by amfln undq pqahy olpsjury onc ollh€ follosins dclaalioG:
<br />I havc od sill mainrain a Ccnificare of Co.Ndt to Selt'lsurc fo. w.rk.6' onDmMtiotr, a Fovid.d aor tr Satioa 1700 o I thc
<br />libor Code lor rh. p6fom c€otIhcwork for*hichlh.p6nil is issu.d.
<br />I h"vc and $ill msinlain woi(er! coBp.c.rioo ituurarcc. as r.quirdl by S<rion l70o of ln. tabor Code for lhe p6lomdc. ot
<br />rhc work lor which lhL pfln t iscd My sokda NnFstion iG!tucc @i6 d:d policy numbd E.:
<br />S+.f= Cj'..qezrs^1,-- /4.*,..r.."F--.r
<br />1113 )+t5'l?4/2-/4, I
<br />_l ccniryrhar ii rhe pnfoman .ol$.work aor$hi.hrhis pdnn is issNJ.l shall not Enployanyp6oo inayme.d
<br />e a ro l{o,nc subj(L to
<br />'nc
<br />wortds ompmar ion l.\s ofcalifomia. dd ase thal il I should l,B:ohc sobj.d lo thc
<br />workm comF@rion provisioN oas(tion 1700 of thc Labor Codc I shall. ft'nhwith conDly wiln lhr* pslbions..
<br />WARNIN(;: Failur. ro sre workss' comtdlalion ov*aB. is unhwf!1, ud shau subjd a dployr lo oi6ln0l pdBllia ed
<br />ci!i! nnB up ro o.c hundrcd lhousd dol ). in addition lo lhe cost ofcomperealion, dmascs 6 piovidcd for lh€
<br />sftrtr)n 10&.rrh. tlh.rcod.. mrdar dd
<br />",,", t\ lz6/2-B k;n ,$,,t
<br />DEqIdAAIIO!
<br />I ha.by altm udd p.nrhy o aFjury thd I m li@5.d uDdd Forisio. of Cha$6 9 (oanocinE with Sdtian 7000) oa Division I
<br />of rhc Busins ed PrcasioN Cod€, &d ny lic@ is in lull lo..c a.d cft6l
<br />'c41,
<br />/., o ?M,
<br />D.o: ll 2-l ,9 L. avcl()S-hc -(-.4 1, -
<br />colutrucllQarElDllc-ac[Ncr
<br />I h.Eby ,Irm uidd ,rulty oapdjury lha Oe i! ! con rruobn lmding a8mcy aor lh€ psfom c. ollhc wrl fo. wh{b fiir Fini k
<br />issucd (Sd. 1097, Civ. C.).
<br />ATIIIIAILDECI.AAAUQ
<br />I hdtbyatrriundd p€nalty ofprju.y on of rh. folbwins d*llor iom:
<br />Dcmolilion P6mitFAsb6los Noli,icalion Fcd@l Rcsulations (Tnb 40. Pan6)
<br />Rcquir.d l-end of Nodncaio.
<br />I cdilythd ln. a.ddal rc8ulaliors reSeding 6llslos rmoval rc not apphcablc ro rhis rrojdl
<br />-l
<br />cdifythot I hovcrad this applicarion d starcrhar rtu ah.ve inlomarion i{ coftsr I agre t) comply Nith rll City and Counry
<br />ordi,.nc6 and Sl.te t \rs rclnti4 to ins consrruclion. e1d hs€by aulhort. 'c!,6arari!6 o f rhi ( iry md Counly lo ots upotr tnc
<br />.bovc,ndion.d propd, for
<br />ltfzef>-R,\ptrlicfltrl or A(enl Sisnrture sJ^r T-c4.lt"'avelt ft(.
<br />ELECTRICAL-INSPECTOR RECORD
<br />Meter Release
<br />l..n'ld s Addrs:
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