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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground n J^^
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains 5l (zo\r$,(Ufia))N- L"*,lh A p..L ",,.l,,l
<br />Signs (monument)
<br />) 1 b,1 a"A-"t - /""1c, ** f,^1i6 Aust beE"G,l Rcu q.l
<br />Lile Sale ty /Low Voltage 4. k<- rtl *'Peol lu-
<br />Fire Alarm / Dampers ut$ O9' De-L *url ^Communications Cable &, aor- b,4l-1,.,,,/ o,rt 1;
<br />cotrco+ @ol .L-,( Co",ll^rt
<br />Building t
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER l0llA/,.1 q\(x
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rough fbd aWloq 6t
<br />Service [/eter
<br />FINAL ll/Al,K 1\q(
<br />N otes, Remarks, Etc.
<br />OWNER BUILDEII DELCARATION
<br />I hcrcby Bfirm undo p.mky of pcrlury rhd I nm cxcnfl rn,o lh. C.nracros Licnsc tia ior lh. rbllowinS rclen (Scc.?0.]1.5
<br />Busincs rM Pn'icssion Codc) Any Ciry or Counry shich rutuiEs { Fnnil lo condrucl. rllcr. inDrovc. dmlhh or Epln any
<br />srrucxrc. prior ro ils nsuarc. rho rcqutcs rhc atplica tu such p.flnir ro 6lc r siBmd srarcmnl rhar hc or rh. b li..n{d puNm'
<br />lo rhc rovisioN.rlh. Coolrncrols Liccnscd tiw ichiprfi L G,m.rn.nr8 with Sc.rion 7fix) ol Divhion 3 ollhe Bo 6\und
<br />Prcfc$ion\ Codc) or rhd hc or sh. is ex.nDr thcr.fm,h and rhc basir ln r alLlL{ excflrption. Anyviolulion.fSccri,nT0.ll5 by aiy
<br />at!1iconr ior atcnnit sublcctslhc amlicanl lo rcivilpcn,llyoinot nrrc lhan nvc hundrcd dollars (S5fi)).
<br />L as ownf of rhc pDFdy. or ny cntl.)sr *irh {ascs ss rhcn nh .o,Vrns ion. *ill do rh. wdt oJld fic $nriurc k mr
<br />irrcndcd or oltiEd lnr slo (Ss.?044, Busincs and Pmlcssions Codq Thc Conrrucrol s Liccns. L,* docs tur appl, to on own$ or
<br />rhc pmpcdy *h. brilds or inpmws lhmn. lld sts des ixh rc* himscll or hc^clf or rhrcueh hh o, tfr ow. cmlloyc*.
<br />fovidcd rhar sfth iopmcftnk m ft inrcnd.d orof.r.d for sab li how*.i rh. tdildinS or ii{mwr is $ld *ithin one jtar
<br />o,omtlcl6n.lnc Owmr Builds willhlvc lhc bud.n oflmvins lh.l n orshedidml t{ild or iq&\c lhe pNl.nr lor tlt purpos ol
<br />oyt'
<br />fuJ. * ".*, "r,r," p-p.a). Jm cx.lL$vcly conrrs.rin-s *irh liccn*d co.rEr.x ro c,.srdcr rrr p6jd (se 7014. Busims
<br />, arn PDtr.lbn Codc' Thc Conrrc(tni \ Liccnsc Lrw des flor .!'J,ly ro on owflcr or pmpcn y {lx, builds or improrc h.rmn
<br />rflrJ qho odL.cl'{urh|rojd,rih!Cndm.rons)l(.n{JruFuunrrorhcCnrro(krsl.trcn{li*r
<br />lrn,.r.n,Dr trndcrs..r'o. a &PC ro.rhx'c,\.n
<br />Dsle ()*ner
<br />rvr tnxn qs' r r tit paNs,tn( lN
<br />DE.(:I,A.BAIION
<br />I hcr.hyrlfnmutrd.rt rrhyol!.rjrr!otuorrhclnlk,wi',AdNlrrnnnx
<br />-l
<br />havc ud*illminruin a Ccn ifrarc of Con*nr ro Sclr lnsur. tu sorkcra.onVrns,rion. ns nn,vidcd lirr byScclion l?m.flhe
<br />Labor Codc, for rh. I'dfornums oI thc sork for whi.h lhc psni n nsucd
<br />I hrvc rnJ sillnuinrtrir workcri .onip.nrdri()n insuranc., rs rcquncd hySc.rtun:lr(X)ofrhc LahorC,nlc. for lhe p.rlorron.cof
<br />rh. so for whichrhkFrnrir i\ ir\u.d My work.i\' (,hlrnsat ion insorri.c.mif &d policyflunrbcr rcl
<br />s74iE J o
<br />o+5 3
<br />-l.cniiyrllat
<br />rtrihc t'crlnirnrncc ol thc work ior which rhhrcnnn h nsucd.l shrllDor cnrpl,)y!.y pc oninriynrdimr
<br />v' r\iohccom subjd rorhc sorkc r' .o n{.n\nr ion law\ o r Califunir. aid a!r.r rhrr il I dhuld lr.otrf, suhjccrlo thr
<br />qorlc^ omr.n\rrionpn,lisn,h orSc.rtun l7(x)ofrhc l-rtxr Codr.I Arll. tunhwirh.on]ply wirh rhos trovisi.ns
<br />WARNINC: Irailurc to scu.c vtrkcs compcn(rion corcrasc i\ unl!*l!l- d \hrll \ohjccr rn rmrk,y.r b d,niml I'cE ic\ Md
<br />civil iincs xp ro otrc hundrcd rhousand dolhn (Sll)o.o(x))ol oq)ctr\rrn,n. th gc\ s ln.vid.d l(tr rlt,:;,,:.,;
<br />Y,V
<br />DEIIdTAIIQN
<br />I hcEby affim lndcr r.nolrroap.rjuly rhlr I ao lienrd lodcr flovhion olChaprdt 9 (6mftfti.8 sith SNrio. ?000) ofDivision 3
<br />of ihe Busirc$ und Pofcsio.s Cod.. atu my li€cnr t in tull lucc orn cficcr
<br />5?Llp
<br />1Y
<br />laXiIf,ICIAll.liNDINGJ
<br />I h@by rmrn un<lcr pcnulry of F.jury rhd ihm k a snsrdc''.n Lnding rgcmy lor ihc lErlornma of th. work lor which rhh p.mir k
<br />nslcd (Scc.1097, Civ. C.)
<br />AfILICANLDEIIAAAIII}N
<br />I k iby allim undcr pcnrhy of perJury onc .a rhe Llloeing dsldalions:
<br />tlcmolirion Pc.rnirs-Ash.sros Notificrtion ltdcralRcgul iotrs (Tirl.40. Pon6)
<br />-Rcquircd
<br />Llrcr oa No1iff,rliotr
<br />-l
<br />ccnilirh0l thc fqtcGl rc8lhrionr rcgddin8 hcno!EnDvalarc nolanplicahlc ro rhislmjc.i
<br />l..nily rhrr I hr\. rc rhi.mli.inrurnn iotr (corcd I.ENroconldywirhrllCiryandC.unry
<br />byaurhdzr icpr.scnlarivcs ofrhis Citl rnd Counly lo cnlcr uFn rh.ordinrn.rs Srrr.lf,*arc
<br />alx)vc mnri(nrcd p&Dcny
<br />.i\E-
<br />**1/) 1.d
<br />Translormers
<br />a J e, ar
<br />t-.
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