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ELECTRICAL-INSPECTOB RECORD
<br />APPROVALS DATE tD/stG.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 />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rough 6/''/,'7
<br />Service Meter
<br />Lt r<,<t'z\FINAL 67 >t{c., t. W
<br />Notes, Remarks, Etc
<br />OWNER AUII-DI]R DILCARATION
<br />I hcrchy aftnn undrycnolry of pcrjury tht I m crc.!, ltunr lhc C.trrrrcton Li.rns hv tix rhc toll.sint i.,on (sc..70.11.5
<br />Bd\inc\{ ! l,ror.s\n,n Codc): Any Cny or C.x ry slicn rcquncs s ltnnir ro .on$fl.r. alr.r. iq,ovc. dcnn,lhn ,tr rcPln !,y
<br />srrudur. lrirr to irs ksuancc. ols lcquncsrhc amli.o for such pcmir ro ,llc a sisn.i (arcm.r rhar horshc i.l1.cbs.d ,u^aier
<br />r. lh. Fr.vht,n\.rrlr contra.tor's Liccnscd L.w (Ch,tr.r 9. Comncn.nrS Rilh Sccriotr 7000 ol Division I ol rhc Btrsincs rnd
<br />Pmtusn,ns codc) o. th,r lEorshc ncrcnDr thcrcfron.nd rh. bnsis |orthcrllcscdcrcmprion AnylidrrionotScdiotrT0ll5hyant
<br />nprlic!rt thr ! pcilnil subj(lslhc ipplicanl k' acivil!ctr.llyolnol nrcrclh!n fivc h!ndrcd dollar{($500).
<br />l. N ownn or rh. pn,Fdy. ur mt crnplo)r.s Nirh erg.s is rh.n $b .onFns$ ion. sill do lhc $ork m<l rhe nture is nor
<br />irlnkn or orkrcd ln srlc (5(.?044. Busincs and Profcsions Code l hc Conrru.loiF t,iccns€ tjw d..s nor rpplyro anowncr.l
<br />rhcpmFny who htrild\ or iipmvc\ tlrtu( md wlrl dm sch turl hins.lf orh.r{lf orrhn,u8h hir or hcr own cn{'loycc\.
<br />pnliLdlh such impovcm scmr inrcnd.d or olTcEl forslc.Il howc$r rhc tflitlinA iqx)wEd t {kl wirhin.rc iur
<br />ol.onrldion. th. owr.r auitF will ho{ l,r bordm ol pmting Ittrl hc or lhc dil trol huiH or nnrmrc rhc OTF{y ror rr* pur'I$ or
<br />-1.
<br />aso*rcroIrhc tmncdy- trmcx.lusiEly.onrr!.rins *irh liccnsd c.nlra.roFro L-oidtucr rh. pn,F.r lscc.7Or4. 3u\i'f,s
<br />rnd Ih,f6\lr Codc: ThcConkr.t s Li.cns. Lru dds nor rpplyb an.s.cr of!tur'enywho huildsor iDffovc\ rhcrdon,
<br />ool sho conrrlcl\ lor \u(hrnjrcr\wirhu o)nrDcr{(n liccn\cd prnu,ir h r hc conlfurr's Li.c sc Lrw).
<br />-lanrqcnrnl
<br />undcr SNI
<br />D,le Or..r
<br />wttnxl tsrottprls,rutttt
<br />Dfctaxrna!
<br />I hcrcby nffirm undcr p.nrlryofpcrluryonc ofrhc folk,*irg d(lnarnnrs
<br />I hrk anJ *ill nEinrdn ! Ccdir*ar. .r G,n*nt ft, S.lf I nsr. r(r *orr.( .o.rn nsal ion. .s t'ovidcd lor b, Scd b. :17(xl of rlE
<br />Llbor Conc. fur lhe pcrformne of rhc $ork tu rhich thc pcrmil h i!\!cd
<br />IhIcsnd*ill rinrrin work.rf.onrt tr\rrnr in\rrun.c, rl rcquircdbyS.cri 37(Xrolrhcl-rh.rConc.torrhcllerlornuncc.t
<br />rh. work f(tr Nhich rhistemrir is i\sxcd My workcA' .oml)tn\rr i.n i'rur .c.rni$udplic, Nn$cr {!
<br />L 1 S.Zk \%
<br />l.cniry rhar in th. pcrfonnDncc.lrhc work li,r $[i.h rhis lcnnn is nsucd. I sh!ll mr crrloy any p.rson in ri],DdrEr
<br />$ as ro lEs,m suticr ro rhc +o!kc6 comp(nsarion lxx orCal ornir. r.d ls rhrr ir l {$uld tr.om subjccr n, rhc
<br />*orlurs conrpcnsnrion F)visions ofSccrnrn.lT00ofrhc trhtr Codc.l shdl, n)dhwirh.omply qith rhosc J)lnvGiinn
<br />sc.riotr :1076 ofrhc trtn (hdc. n crc( and a orrcy s f !.s.2.{.t<
<br />DICIAXAIION
<br />I rE6hy amrm u.d.r p.nrxy or lcrjury rhar I ss nenarl u.dc. povision of Ch+tcr 9 lomrmins wnh Serion 7m0) or Divkion l
<br />of thc tsusircss and Prcfc$ions Cod€. and m, liccnrc n in full firc lnd efie.
<br />?>to t'lq 36
<br />,"," 5 zq.\q AGC
<br />COISIBIIjIANI.INDINj.&CENCI
<br />I hcEby rflim undcr rcn(hy of pcrury lhal rhcrc n ! consrrucrhn lendins +dtr.r ror rhc Frfonrumc oilhe work l'or which lhn pcrnir t
<br />i*rucd (sc. 1097.civ. c ).
<br />APII.ICAIIDECIAAAIII}N
<br />I h.a'by anim under lcnalty of pcrju.y onc ol'lhe lt'llowing dcclulbns:
<br />D.!mhion Pc.nniA$cslos N.ifi..lion Fen r.l Rcauhliotrs (Tnh4{, Pan6)
<br />-R.guncd
<br />t.i'cr of Norincation
<br />l-lccn'[ thd lhc lcdcm.rcsullrnn\ rcBUdins o.bclnircnnral!,c nor trp'rrhlc !' rhhnm,cd
<br />K!r*.n, ,t, , t* *,0 *,( unnlrrri.n dJil d c rhrr !h. trh)vc inrnmrion h .oF.ci Io8rerocomply* h arl c'rr ad (i,unry
<br />y rtx,t! rctrcsctrl3hvcs ofrIis City Md Counryro r.rcr u,i,n rrt
<br />len7\^&6
<br />,"," S-Ltl \(
<br />trndfl \ Addrus
<br />ordi'Inrcs rnd Srur. l,rss rclrring
<br />ahove Nntiorcd prop.ny lor
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