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DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs 0nonqnent)/a{E ( 17 )t?4 a( 4D lxhr\
<br />L i le Safety)E-ow Vo lta ge I
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondinq / Groundino / UFER IL I lLt r,q
<br />Transformers
<br />Torqueing
<br />Sub-Panels I
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soflit Flouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release ro \(l t4 .,'41 @ hLloWU@b !-r"11
<br />Rough ,l ,ni ft'l
<br />Service lvleter A
<br />FINAL a-7-lY N.\W1(,\
<br />Notes, Remarks, Etc
<br />I
<br />I
<br />OWNER BUILDOR DELCARATION
<br />I hcrcby anrfl u.dd ,.nrlry of pcrjury lhar I m cxcnpi fom rh. Conkrlors Licensc l.aq for rhc following rcN,n (sN 70J l 5
<br />Businc$ arxl Proicshn Codc): An, Ciry o, Counr, which rcqtircs I pennir b .dnir!.r, rkc., improvc. dcnrlGh or EPat my
<br />slrucrurc. rirb ns i\su ... rko tuquirc\ lhc appli.MI tu \u.h Frmir ro ik. si8rcd satnrcnl th.l lEor shc n liccnscd, rursuunr
<br />lo lhc prcvisions ofltr Conhcrols Liccnrcd Liw (Chaprcr 9. Conrnrrcins wirh Sccrhi 7{xx) or Divkiotr.l o{ lhc Busincs flid
<br />lmtu$hns Code) or rhrl hcorshc ncrcopr lhcrcfromllld lhchs\i\ tt rhc rll.gcd cx.n/iotr. Any riolnti.n olSslion 7o:l I 5bylny
<br />dprlicanr lara pcrnir rul,jf( rh. aptlicdd tu acivilFnahyor6.r frtrcrh0n fiv! hundE'd dollan {$500)
<br />-1.
<br />rs owncr ol rhc pioFnr. or my cntloyecs ,irh sagc\ !\ lhcir $lc conrP3n\rrion, sill do rhc work drxl rhe {Mrc ( nor '
<br />inrcndcd or oftcrcd for sld ( Sr 7(}il]l, Bulift\s and fi,fcssions G'dc: Th cln mcrin \ l-iccDs. t.aw di{* ior rtlny r. !. owNr .l
<br />rlE Im[.ny who huilds or inDrcvcs rhcturnr. od who &ts such s.rk hirnsclror hccclfor rhmuah his or h.r o\n cnrPloyccs.
<br />polidcd rhar {i.h inltlm{mm orc nol irlcnL\l or oftEn for sb. l,: ho!$rr. rbc huikling or idpm{fttrr i $U wilhin .rf, ,t,tr
<br />otcomplclim.rh€OwncrBuildq*illh,verhehu.nott'(,vinslhdhcorshcdidnorbuillu'inrprovcrhcnftJFiyforlhcpulrseol
<br />L xsosioofrhc ptupdd!, rnur.lusivcly.onrrNrin8 wirh liccnrd conrrldor t, onntud rh. fnic.r (se. 7044, Businc$
<br />Pnltssion Codc: lhc Conlracir'r l-ic.trsc l,a* docs nor rprly ro nn osrcr olpropcny who $uilds or nnprolcs ih.rcoi.
<br />*ho .onra.kr.r cuch pn&ch wilhtrConlracr(s)li.cnqcd pursu.nt k,rhcConrructols ljccn* lju)
<br />lrnrcrrarlu .' Sccri,rn .B &l)( turr[i{rc.<rr
<br />lhlc Orner:
<br />]lABtrE8E.lOUfIi SrIIl()!
<br />DIII^AAIIUN
<br />I hcrchy xrfirn undrr lrmhyorprruryonc olrh.foll(,win! do.h[nN
<br />lhrvc tu *ill uinrinrCtnili.drcolConscdroSclf.l,rtrrcf(tr$.rtc^ comEtrsari(n,. rs nmvntuJ fd hySNriotr.l7ll()ol lhc
<br />hhor Codc. ntrlhcDcrloraumc ofrhc turk itr wlrich rh.Irrmir i\ i$u.d
<br />rhc trork lar whth rhis lcnnir is anrcn My tr.rkch .onl,]ctr\ i in{ru,Ec.3tricra rnliry iun,h.r dc:
<br />Carrcr
<br />Ertn.s:
<br />-l
<br />.cnily rhlr in rhc pcrr'orencc ofrhc w.rk fn which rhis pcnnir il issrrcd. I shall nol cnrploy.n, Pcts.n in rny rrnnrr
<br />$ is ro b..onf, subi.rt ro rhc wo*c6 comp€n\ot ion hw\ of Califonri.. Md agrcc rhal if I sbuld h..onE subFll ro lh!
<br />workcn conrEtrsrlion povisionsofScdnnr:lTtroollhc ljtin Codc.lshall, ronhunh.omdy tnh rln,* [ovisions
<br />WARNINC: Friture lo {.ud workcn co lrnr i.n .ovcngc is xnhsfr!|. d shrll subr.cl !" cnlllLycr ro oininnl Fnrxi$ and
<br />civil finc\ up ro one hhdrd rhoulsnd dolldc ($100,0fi)). io addirnn b rhc c.s olconqrcnetion. damscs r\ rroYidcd rd rhe
<br />Sccrion 1076 olrhc l-Ihr C.dc. iircrc{ dnd,norNr\ t.cr
<br />Dor.r - applldnt:
<br />LICEIIEILCONIf,ACrcA
<br />Dg:Irlf,AIIO!
<br />I h.nbyrltlrm undcr FnallyolFrjlrylhal I 0m liensd unds 0mvhion otChaprs9 (onmncing wirh Scciion 7(x)0l otDivision l
<br />.f rhe Brsinc$ md Pnfc*ioos Codc. lrd mv lkcn\. is in rull rore dd cflcr.
<br />l-i.ctr\c (-ln\!
<br />raNsraltcurNrENuNclc[ltr
<br />I hcreby !fltn !frlcr Fnalty of pcrjlry rhar rbcE ir a co.rflcrhn knding oecmy for lhc pcrfonmncc oirhc work for Rhi.hrhis Fmn Lt
<br />issncd (s.c.lm7. Civ C.,.
<br />L{ndrr'\ Nrm
<br />AIIIIIANfDII;LIaAIIO!
<br />I ILE$y afinm undcr lenalry o, lErjury onc ofrhc aollosnr8 dcclararions:
<br />Dcndirn Pc'nirl^sbcslos Noli6c ion ltdcral Rceulllions ( lirlc 10. Pan6)
<br />l{crtrirrd txrc' rl Norili.rrior
<br />l..nilyrhd rhc lcdcril rgulitioDs (e:din8 r\bc{.srcn}trtllrc trot onrli.iblclo lhis pmrccr
<br />_l.enlfrrhdlluvcrcadrhisrpplicrrion d irr. rhar rhc ah,vc iiformarn isconccr lrBrNlocomDlrwilhillCiryridCounry
<br />ordi'uncc\ md Siarc liws rcl,ring tr huildirg .on(d.tnnr, and h.i.h, aurhorD. rcfcscd0iivcs ol lhh Ciry ond Counrrro c d op.i thc
<br />$ovc nE tu.cd lmp.ny for insr.crion pllpors
<br />ApDlicnnl or getrl silnntrrc
<br />ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS
<br />1V /,1-a{0
<br />Under Slab / Floor
<br />,1
<br />uL
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<br />lrndcas Addr.{
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