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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough
<br />Service Meter
<br />FINAL '.19tAl))l
<br />Notes Remarks, Etc
<br />OWNER BUILDER DELCARATION
<br />I hcBh, afinn n.dd ,.n.lry of li.rjury r hor I m cxcmpr lmm rhc Conrrlcr.F Ltcn{ l !o ir, lhc f.lbwine rcasi (Sa ?01 1 .5
<br />Bu\inc$ .nd Prorcsion Codc): Any Cily or Counly which reluircs r pcr6ir l. coniru.r, rlrtr, improvc, dcnFlhh or rcPan 8try
<br />ntudurc, tlhrlo irs nsuanc.- aho Equncs rh€ applicanr lor such pcrm r. fih i silncd slarc.rnr lhol lf,or shc n licc"se{l psu.trr
<br />ro rhc F)visions ofth. Contnctols t.iccn*d Low (Chaprcr 9. Commcrcing wirh Sccrin 7(ID of Diviri(,n 3 olthc Busi.cs otrd
<br />Prulc$ions Codc) o! rhar hcorsh. icrcdpr rhercfromlnJ rh.lBrh lor rhs,ll+.d cx.q)rion Any vnrl iotroIsdhn70:]I5 hy trny
<br />aftli.,nr r.r, p.rnrir subj(ts thc a!tlic!nt lo a civil pcn,ltyoinor mrc th0n fivc hundrcd d.llas ($5tx)).
<br />l. N ownf or rh. proFdy. or ny cnrrloyccs wnh srgts ,\ rhcr lrc .o,npc.sal ion. r'ill do rh€ rhrl $d rh. fidm n n.r
<br />inr.dcd or offcrcd f.r slc (S(.?O14. Busirc$ and Protssions Codc: Ihc Contrrois Liccns trw dous nor ,,rrly ro 0! owtrq o,
<br />rhc pn,F-ny whl builds or inprovcs lhcmtr Nd who das shh so* himsclior hcfclfor rhmugh hh or h.r oai cmPloyccs.
<br />proridcd rhar such irnFotemnls arc mr inrc'xhd or oficrct tor elc lt h.$tvd, rht hildin8 or iml'lorcEtrl is sld lirhin onc ,t
<br />or s pLrir.. rh. Owncr auildcr will havc llr bur.,cn of !6lire lhd tr or \hc di:l mr huitl or i'nrret rhe pDpcny n, rhc rurF{ ol
<br />-r.
<br />$.$croIrhc ampcny..r.cxclusircl, conlradins *irh liccnrd coftr.ron b con{tu.r rh.,n'i.r (ss.. 70,1,1. llu\i'rcs
<br />arxl lh,f.sinrCuder'IhcCont.kr'rLi.ctrs.Lnwdocinorlprlyloinowrcroipn,pcrlyshobuild\ornntr.vcsrhcr..r.
<br />ud $ho (,nrmcrslhr chlroFcr\wirhaConrracio(9lic.n*dpur\rfl t,rh.Coitrc(trsl-iccnruw)
<br />-l
<br />!mcxcnrpl undcr Sccr
<br />Orner
<br />lll)f,tr!f,r]r!)MtExs]tl0N
<br />I}]CIAIAJION
<br />I [crch! dilir undcr lcDrlr, ol Nrjuryonc ol rhc follo*in-s dcclmriotrr
<br />I hrvc and w rll rnirlanr a ccn rlicrrc oi cotrsni ro Sull'ln\urc f(r wor[cE co rptisdri{nt.as pmvidcd lor hysccrion 37(lJolrhc
<br />btln C(x[. ror rhc ,.ffomB c .r rh. *ork for shih rhc Pcmn i\ ksucd.
<br />I hirc ind will,nri ain $orkc r( .o nu.nsal ion in\lrarcc- !\ rcquircd bystcri(nr.lTmorrhc tjhor codc.lorlhc pcrr'ormncc of
<br />lhc work t{trwhichrhh pcnnir is isslel. M,workc^ compcnsrrion i'FuBmc caricr drrli.y nunlb.r c:
<br />I..ni,i ihrr h rhc p.rfo,'mn.c.frhc work n)r Nhi.h rhis lfnir is tsucd.l s[trll tror cmDloy rny pc6on in lny nunicr
<br />s 0s to h(conrc subF:r ro rhcsorkcc'.omrcn\alion lNrofcalifornir ! l asrccrhar ifl sk,old h..o,B suhir.r b rl.
<br />qorkc6' compctrsal ion novkions of Scclion l7(xj of rditnr Codc. I shnl tunh*irh condy wirh rho* ,r.visions
<br />s('nn ltT6nrF L$ol
<br />,*".4J!]11
<br />.1,*
<br />,
<br />0!!lz!ll.l]..U!
<br />I h.rchy rfl rnn undcr Dcnrlry orrrjMy undcr pmvninn olCh,picr 9lcomnrkin! snh Sc.riJ.7000) olDivisi,r 3
<br />o, rh. ansi'r.s r d Pdassi(rtrCudc. d nry li...rc ir ir tullntr.c d cl'lt.r
<br />n"." elE lt\7
<br />I hcrcb, flir'n rdcr lttrrllyorNrjury rh
<br />i\sucd (Sc. -1097, Civ C )
<br />rhclc n n onsru.riotr lcndins sscncy ior ihc pcri..@ncc orrh. work rur shth lhn Frnil i!
<br />AISLICANLIEII,AAAIIA!
<br />I ltrcny afimr u.dcr pctralr, orpcrj!ry onc orihd rolIiwins dcchturnnrs:
<br />Dcnrlirnn Pe nic'Asbcnos Notlncarn,n ltdcral Rc8ul ions (Iirb r0. Pd6)
<br />-R.quiEd
<br />t.rr.i ol Norili(ri,i
<br />l.cdifyrhd rhc fcdcral rcguhriotrs rcg&lin8 $t{(osrcn$ulrre nor lJ)t'lictrblc ro rhislrroJc.r
<br />aF6ro.omply wnh allCiryand Counry
<br />iecs ofrhis Cny ond Counly l. ctrlcr ur.n tls
<br />^,,!Lrl,a
<br />Pole Bases
<br />llzsltgr lz>)
<br />t
<br />i
<br />Policy Nuntcr
<br />-ErpiEsl
<br />r,.u' $-19 2 z 1
<br />/-a:,d+
<br />{^^€
<br />--t--
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