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ELECTRICAL-INSPECTOR RECORD <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 Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />To rq ue rng <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service lrileter <br />FINAL llMln"t Vlu//r?ttua tJ, <br />Notes, Remarks, Etc ur <br />OWNER BUILDER DEITARA ION <br />I h€reby amrm rnd6 paalry oa pdjury lhar I @ crmfl 6_o,n rh. Co.tr.clo Lic.ns. Las for th. aollowin3 llmn (Sd?011.5 <br />Bsin6s and Prclsion Codcl: Ant Cily o, Coutrry whi.h requtd a Ff,nn ro connrucr, ahs. inprcvc. danolnh or repst anr ' <br />srrudu€. p,ior ro its issu c€. ale r€qut6 Ih. opDlic i for such p.mi lo filc a sisn€d slarocnr that hc o! sh. is li(ns.d plrsua <br />ro lh. provisioN o f lh Conlractoi s l,ic.nEd tjw (Ch,pr6 9, comnE.ci.S *ilh Scrion 7000 of Oivision I of lhc Busincs sd , <br />Ptofdsions Codr) orlhat hc or shc a.rcopl rhqcfro!. dd th. bdis for lfi€ allcx.d qolplion. Any liolarhn oas.rio.70.ll 5 bv ul <br />apprKanr tirr a pmril sulrdr! th. opplic&( lo a cilil pcnalty of nor nore rhd livc hundred douds l$500) a <br />-1, <br />d oM€r olthc prcFny. or dy cdl'lq6 silh va-g6 6 thei! $lc conpnsalion, wiU & lhc ryorl dd lb. ttnar@ is nor <br />intmded or oraql for el. (56.7014, Busin* af,d Prcf6sio6 Coda Thc Conrracrois Lice6e Las do6 nor apply lo an oMcr ol <br />th. poryit sh. builrk or inlrov6 rhdo( ddvho dod e.h \w* hi6s.lIor hdclror rhrcu8h hi5 o.hr own mploy.e <br />rmvid.d rhol such isprcvErcnls e ml inlq'{H oroffsrd lor slc ll hoN-.6.1h. iDildins or imprcr@an i. sld sithin on. }a <br />ofcompletiorL fie otrns Build€ wil hsle the brn6 orFovins Od h. or shc did nor build or npreve fie propdy for th. pulDoe ol <br />_1, s owns olrhc prcp€ny. an eiclusivcly conrlacr ins \virn licmsed conrrachN to cotr(Dcr rhc lmjd (Se 7044, Bs'n6 <br />nnd PNfsion Codcr 'rh. Corlrrctols Licms. Law do6 noi aptlyro u osnd ofpropaly wno builds or imprclB thcreo0. <br />and sho.dnlracrsfo.su.hFoj<lswirhaContatu'1s)licsMdputr@rrorh.Conrm.rorst-i(ceLzw) <br />-l <br />m cx.mpl undr Sccl h",-.t- <br />I hscby ailnn undcr pcdly o I pgjury <br />-lhav.andwillnaintainaCcnificarcdfcooscirloSell-lnsurcforrvorl.cconrpen3 <br />ion,6Drorid.dforbysetionlT00ofth. <br />tibor Code ior thc prlomuc€ of lhc wo* for vhich thc ponn is istr€d. <br />_l havcdds,ill namlain work.E- conp.6arn,n insu cc.s r€qurcd by Sdr i.n 1700 orrhc Lab.r Codc. for thc pdaommcc of <br />lh. worl L, which rhis tnnit is issrdl. MyworkeA compoerion irourmce..ri6 md polic, numlEr a.: <br />PolicyNlnrb.r: !xpn6 <br />_l.fiifytlErinrhcpslonnanceofrh.workforshichrhGp6n is issued, I .hall .or .mlloy ddy ,.6on in rnym.nnB <br />s 6lob..omc bjEl lo lh€ wo*el compaslion laNs ofc.lifornio. andarreth.l ial should b.comc subjdl to th. <br />$(*6'comp.NlionprcvisioBolsdion3T00oflheLabo!Codelshall.fonhrvilhcomplrvithlhospovisiotu <br />WARNINC Faihrc kr sDre \orkr6'co'.p€Nelion covcrale is unla*ful. rnd shall strhjd s onfl.)d to dinin.LFxlri6 and <br />ci\il fincs up ro om huidrcd thosand dollds ($ <br />Se..li.n 1076 ofrhe ljbr ('.d. inrrar a.d <br />I her.6vainruidc, B alrtolFrl,tryihr Ianrli <br />ol rhe Businss and Pofsn.NCodc. ud mylic <br />provGio. olchapld 9 (com,nmcinB wilh Sstion ?000) of Di(ision l <br />Licsc Nuohq <br />CONSIBUCITONIEN'TNCJ(iINCI <br />I hcEby arfirm utrds p€oahy of r{rjury rhar lh6e is a conslruclion lodins alencv ror lhc pri'mdce orrhe$ork lot "tich tbis pmnil is <br />$su€d lSN.1097. Civ C.) <br />attllcaNf![cta&trl9! <br />I hr.by afllm unds poahy oapsJury onc ofthc follosins d(lsalions: <br />D.Dolilion Pdmils-Asb6los Notilicalion ljcddal R.eularions (Tnlc 40. P[16) <br />-Requircd <br />Lcnd olNotifi ..tion <br />- <br />I rdrfyrhar rh.rl6al rcEulalioN r8ardins sbcro' r.rnovale. nor spplEablc ro this Dmid <br />& ,^'r, tfi , *{*^ ,n6 appl'c.uon tud satc rhd rhc abolc inrom.rion t cod.n. t asrc 16 conpl, wirh .ll ci) and county <br />ord anc6 Md St{ratrs r r€bl'n€ ro bu 'ld'nr coGrru.lion, ed hseby adhoE. rcF.Flaliv6 o l$ir Cit, dd Cou.ly lo ol€ up.n th. <br />abo!. md'mnY,to-k, ior rlrfr'on purl{s <br />\nr (!nr m.\p r \ienrrfe r,'rc <br />pcmr,(mnc(p-Enq/,-$.cJc- eft) F ows <br />ot conp.@rio.. danr!6 a prolidcn aor rh. <br />)uu, <br />I cndd s Addrs <br />-------T------ <br />--------T------ <br />= <br />=