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ELECTRICAL.INSPECTOR RECOBD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit l@rrtWalls (Conduit).l6llq1r.44 /
<br />Walls (Rouqh)L rt\--
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rouqh
<br />Service IVleter
<br />Ehln td.o*e*4;,A)FINAL
<br />Notes, Remarks, Etc ul
<br />OWNI]R BUILDAN DELCARAIION
<br />I h.rchy ar6nn under t nshy of pciury lh l mcxcmll 6om rhc C,'nxsci{tra Li.cnse tjw ror rhc rbllowins rcasn (s< 70.115
<br />Busincss rd Proicsion Code) An, Ciry or Colnry $hich rcq!n.\ d pcnnl lo con(ruc|. rllcr. inrprcvc, dcn!,li\h tJr rcpdn ,ny
<br />(rudurc- !,in ro irs issoae! sho rcqun i rhc,rnlic, ror su.h Fnnil lo nlc r sisrcdsr cmir rh lroi sh. ii liccnsd ,usLEtr'
<br />ro rhc Dbvisions oflh. Co.lmdois t,iccnsd La* (Ctut'lcr 9. Conrtuftin! wirh Sccrion ?uD.f Divhion 3.f rhd B8inc$,.d
<br />Pmlt$ions Codc) or rhal hc or rhc t cicnpr rh.!.Imm,.d rh.lhsir ror rh.,lkecd cxcrplion An, violari{}n.fs.cisfl70:11.5 by.ny
<br />rrrtlicu fo.aperdn sobjc.( rhc amliclnr h d.ivilpcnnl't.l not mrclhotr fivc hundrcddolla* (S5tn)
<br />I.$owncroflhcpn,pcnr,ornycnDlorcs,ilttrnscs0rrl-4i!vrL.o'np.ns,tnnr.willdottEtro.k drhcntod!(hfr
<br />idcnlcd o.o{rcr.d lor $lc (S( ?04.,r, Br{inc*md Prorc*ionr Cod.r Th. co ra.tolsLicc.scLlwdoesnoraPplyroanorfttof
<br />th. lsp.ny who boildsor h]|)mvcs thcs)n. ftlwho d6 s'ch wlt iimsclfor hcNlf or rlk,xSh hi{ or hoown cnrnk,ycc!.
<br />provntd rhol slch inpr.rcm s @ mr i.rcndcd or olIcBJ for qlc lt k,wclti th hnihi8 .t inrtmvcmnl t $ld sirhin on. y.s
<br />ofconI,icrtun-lhcOwncrauikjcr will fiarr rhc hnrdcn ot pmyinA rhd hcorshc did nor I ildor inlii,h tnc tmFrly lor llE pu4n$.f
<br />-1.
<br />isowmrofrhc ptrlPcny. drcr.lusivcly.ofta.lir8 rirh li.cnscd conrr.cloF h conslocr rhc pr+.! lSc.. ?(}1,4. Busim$
<br />rnd hrtu\hn Codc: Thc Conlra.lols Liccnsc Law d.cs nor alpl] lo an osncr otprorcdy who huilds or inprotcs thcrcnn.
<br />ond who conlmcls for such pmFk sirfi ! ConrEcb(n lccn\cdruAUMr k,rhccontrucl(tr s Liccnsc La*)
<br />I am cxcnrfl undn Sdion
<br />I!OITE&::!AUTE!!AI!Nll&cl aanoN
<br />I Irrchyrfiirnu cr pcmlryol trrjury ncof rnc t'llosins dcclarari(rN:
<br />-l
<br />hrrc ! uillminrain0CcnlficlicorConscnrroS.lalns!rcrorworkcs.omF.nstion.as rmvidcd fitr by sc.thr lrTtn ol lhc
<br />tibo. Codc. rbr lhc plrtornue ot lhc 'or* {o Nhich rh€ penir n hsucd.
<br />I hav.,trd*illnrirl0in Nor*cri compcnsarn,n imunnce.6 rquitul b!sc.rionlTtDoilhc tnhot Codc. turhc P.rfornrtnccof
<br />rhc rork lbr shrh rhis D.anil is tsucd My *ukcr' ompcnsarnnr in\urm.d .Jnid ,nd lolicy n!.rbcr m:
<br />l'(,licyNunnrr-
<br />-l
<br />ccnilrrhar i.rhc pcrl.!@n.c orrhcworkro. $hi.h rhili. nir n i\sucd,I shlllnor enrrloy riy ndiso. h oy amnncr
<br />$ N b bccom sobi{r r. rhr sork.6' .omFtrs.rnnr hqs ol Crlifonri!, Md trgrc. rhrr il I ch.uld b.corft {rhid to lhc
<br />workdf compcnsdion ptuvi{iotrs ol S€r n ]?m nf rhc tihor C.de. I \trll. finnwir h .o llly wirh rho* [ovhion\
<br />WAININC |.ihtrc ro Ecurc *orl(cn .ofrpcisrrion corrrlc i\ unhtrtul. r shtll \uhjccr rn cDrpk,ycr ro ditr1im! |fnr]lics.nd
<br />n,Jusxri,n,. drnrac\ r\ fr.vtrl.d k{ lh.
<br />Ihrrubydltnn!
<br />'lcr
<br />prtr.lry.l l)crlurylh lanr ni\i, ol(l,dfrd91.. nncrcirAwirhSccrion7(xxDol Di\i\nn,:l
<br />oi rh. Busi',c\\ rtrJ llolis\nn*Codc. aid rylircrsc is i'r tull forcc irl.liccr
<br />t L7 E +/D
<br />I hcrby rmrn uM.r Fnrlly ol pcijury ih l $ r.onsrrudim Lfrling rgcnc! litr rhc Nr,nnnrmc ofrhc *on( nn *hich rhis |r(nnn i\
<br />hsucdrscc :lllg7.Civ C)
<br />L.trdcls Nnrnc:
<br />-APILICAILDECIASAIIAN
<br />I hcEby ltfmr undcr pcnahy ol p.rury otu ofrhc nnhwins d.cle,rk,ns:
<br />Dctrmliri.n P.rmi's-Ash.slos Noriticirion lcncral Rc8uldiotrs (Tirl. 14- Pm6)
<br />Rcqrtcd t llcr ol fiorifrcarion
<br />rhc fcddfu l 0SuhrtnF rcBddi,r!,\lr!o( rcnri!rl dr. ml x0pli.rhlc n)
<br />rhrr rh. trh,vc i',r(nN i,n, i\conrcrh.vc rc.d lhh oppliclrt,nud d!rc
<br />Storc ttrws rchrin8 lo i,uildinE coinru.!
<br />\(DrL
<br />I aSre roomfly lirh sllC y.nd Cnunry
<br />oitrcsnf rhkC vandCqunrvto.nr6ufF.rh.
<br />"," 1f 'tf a
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