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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Lile Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Translormers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouoh) <br />lt/eter Release <br />Rouqh <br />Service I\4eter <br />t-lrr,t &'/2>)FINAL TIID II?'T <br />Notes, Remarks Etc <br />OWNER BUILDER DEI,CARATION <br />I h$cby afirm und$ p.Mlty of pcrjury lhal I am cxempi fmn rhc C.nke.ro^ Li.cns Lar lor ln€ follo*ing ten (s*.70r1 5 <br />Ausiness und ftofeasion Codc): Any Ciry o. Coumy ahth rcauncs ! pcmn to con(ocr, rllo, improv.. dcmlish or rcplir .ny <br />srtucr!,c, r.i, ro ni hsumc. .ho (iuircs thc arplicd lor such pcmir ro lih { signcd sr,r.m thot hc or sh. is liansd pusuanl <br />lo rhc pmvtions ofrtr ConrEcrrtr \ Liccr{d ttr{ (Chaprcr L Conrmcmins with Ssdion 7000 of Divtion I of'h! Busincs and <br />Pmfc$ions Codc) or thar he o h. h.x.mfr lhcrclronand lhctasir n lhc alLscd cx.nfrion Antvid ionofSdhn?011.5bylny <br />aptlic{r r(r n pcrnril subFctslhc rrpli.anllorcivilpcnolryoanor,tutcrhtrniiv.hundrcddollm(S5Ct)) <br />l. d own( or thc pmlrny. or nry c'n hFcs sil h sryes or rhci. q,lc m p.nslion. will do llE wo.k and rhc nBk i\ *n <br />inrorlcd or oficrcd for slc (Sa ?O14. Busimss snd Eofe$ions Cdit: Th Conlmctor's Lian* Las thcs .or ,pP,y ro on nwrcr of <br />rhc Imp..ry vi. Irilds tr inpms rh.6n, ond whr &B such *\rI him{ll o. hcr*lfor rhtuu8h hi\ or h.r ow! .mployccs. <br />p.ovid.d rhil such lfllroEmnrs e mr inred.n o, ofl('d fo' qL. Il hlwlvci rlE tnikiry or iqmvcrnr k tld si$h .rc )ts <br />ofcoq,lcrion. rlt Oqn.r auiud wrll hrtc r hud.tr oflmrin8 rhd,rorsne dil et i{iU o. inpovc thc pNtEl} ior the pu4n*.r <br />l.rsoqNrolrhcpmfcny.!r,cxch\iv.lyconkrcrin!wnhliccDscd..nr roNlocon{tucr rhd nmr.d (scc.7014.3u $s <br />and hni$i,i Codc: l hc Cortd.(tr s Liccnrc Lrw docs norrpply b di.wncr ofprolcrty who hnildx or imFovcs rhcrcon, <br />nnd sh..otriMhiorsuchpmFcl\wirIuConknrodnL..iscdNNudnrk'rhcConrractr'sl-ircn\ctrw) <br />I rm.xrnrnr u.d.r S(rnn .B &PC lorrhFr$on <br />Orn.r: <br />u!)85EBLC0!I8ENS Il0! <br />PE(.LAXAIII)N <br />I h$chy.inr trkrcr pctrilry oi pcrjuy onc oirhc nnbwins dccltrri{r's: <br />-l <br />hrvc ud will@inrain rCcnillcrlcolaonrcnl to SelflnsuN lor *o,kc^ .ompctr$tion. N Pmvidcd rb!l'ySccri.n llTtxjorrh. <br />ljhor c(dc. aor rhe pc,ror@c. orrhc "ork lor qhich lhc ptnnit is ts!.d <br />I h.r. and willnuinlrin workcrr conrrcn\ali{rn in\utun c. r rcqxnLtl h,Salion ]700olrhe litltrCuJc, tar rhc Pe.foirnrnccof <br />Hr!'ti rrmi' <br />is i\$cd n insur.rcc clricr ond F'licy nu $.r (. <br />l,t-L.1- <br />i.y Nunbcr:-ErPircs <br />-l <br />ccnili rhar in <br />'hc <br />pcdoi,mncc ofr[c pork lor whi.h thn rcnnir i\ is\ucd. I shrll nor cnrfloy ony pcnon in trhy trhnmr <br />s r(h tE om subr.d h rhc workcrs .onqrcnerion lnws orcnlir(rni{ rnd lgr Ihlll il'I slouLl hco r {hjcd rolh. <br />"orkd( comp.nsorion provnion\ ol s(rn,n ]7{D uf rhc ubr codc. I shrll. iodn*irh mrply sirh rho$ fovhions <br />IVARNINC frilur. n, su( uork.( .onDcnurion mrcmAc is unhwlul. rnd \hrll srbJttr in cmPloycr lo cnlinrl FMllics and <br />civil ljnc\ up nr om hundrcd rhou\n d dollf\ (S|(D.OX)). i irion ro rh. corr ot..n'rxn€r <br />U(}:NlL(]]rr3 ctA3 <br />Dllru-&\uaN <br />I lErh, uafim u.d.r p.Mlly or lcrJury thol I anr lien*d undcr fmvision olChrprd 9 (com'ftRin8 wilh Sccltr 7000) orDivii.n 3 <br />ol lhc Busircss and Prcfesions Cod.. !i ny liccns h in full tuc d cttul <br />C.o-g-I <br />!.:oBsralcuaNrENDllliacExcr <br />I hcrchy ufimundcr F.,xrorpcljuryrhd rhcrc is r onslactiofl lcndin! ngcncr aoi rh. Frlornunrcc ofrh. w.rr lirr which rhh lEnnil h <br />nsucd (Scc.1097. Civ C ) <br />-l <br />cdily rhlr $c rcdcmlr.Sulolions Essdins asbcsros ,.nbv!l m .or appli.,blc ro thk pmirr <br />l.cnifyrharl h{!c rcad lhhaptlic n,nullnnrcrh rh. rhrvc infoirndn,n is corer l arftt k,.o <br />ordirdEcs an(l Slllc ljss rchiing h bui y and Counly lo clrcr uF,n rtc <br />ah.vc mnrnrrcd pmt dy foi insrsl <br />.o ntucrnrurl hcrchyrurh.rizcr.prclcnrari!c\ <br />S- <br />'iqZ <br />APPLICANTDEd ANATIoN <br />I nolSy offrm unds p6na[y ol ttrjlrr 6n. o(rhc following dcclamtions, <br />Dcnblitiotr P$mih-Asbcsros Norificarion Fcd.rd Rcgulario.s (Tillc 40. P0n6) <br />-RequiG.l <br />Lcrrc, of N.riferion <br />I <br />I