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ELECTBICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab i Floor
<br />Bondinq / 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 (Rouoh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release
<br />Rough
<br />Service lvleter /1
<br />FINAL 7-26-lY tx,Plil\
<br />Notes, Remarks, Etc.\./
<br />OWNClr BUILDIR DELCAR,{TION
<br />I h.rcby,fi.n rndr !.d,hy ol p.rjury rhar I an cxeDfl 6orn lhc Contracros Liccnse Law torrlt rolb*in8 rc,son (scc 70rl5
<br />Busi.c$ !D.l Prolcsiotr Codc) Any Ciry or County *hich requircs a Fmir b ..nitucr, {lrd. inDrow. dc'relhh nr Enon rny
<br />sltucrurc. prk r k, ir\ nsua(r. al$ rquird rhe ,pdica.r f( iu.h Frnf lo filc i sigrcd {alcN th0t h. or shc n liccn*d pu^udnr
<br />lo lh. Fovhiotrs olrtE Contmcrols Liccnred bw lcfintrer 9. Conftncins {irh Se.tioo 7fi10 or Divisio.I of dc Businc$ und
<br />PmfesnrnsCodc)o!thalhcorshcncichprrhcr.annandrhctasisrorrh.alLgcdcxc,npriotr.AnyviolalionofScclion?03l5byany
<br />aptli.rnr tu d p.mir subtc.k rhc applicanl lo a civil Fnany ol not morc lh five hundrcd dollan (5500)
<br />!. N owncr of rhc pmFny- or ny cmni,rcs wirh uscs os rh.n s)h .nhpcnrnrn,n, will d. rh. wor* md rtu slnrturc h rer
<br />inrcrncn or .rcrcd i{n s0lc (Se ?0.1.4, atr\itus dd Pordsions C.dr Thc C.ntaclofs Li.cnsc ljR docs nol lmly Io u .*ncr of
<br />rhclmlxny who huildsor inpmEs rhcmr lnd wln dos such $o* hinNclfor hc^cltor lh,otch his oi hfr own.mrk)yc!s.
<br />prutidcd rhdr su.h nn rchft.rs 6 mr i.rcftIi or otrcdl ror srJd ll hosew. rhe Soilding or irymycmnr k sold *irhin .tu ,tr
<br />ol canlrllcri,n. rhc O*ncr Buiud will hrw rlr bur&n of tr.vinB rhd hc ., shc did ml hdrld or iqmr rhc pmllgly ior rlE plrlbs oI
<br />_1. $ o*ncr ol rhe pmpcny, sm crciu\ivcly .ontrring siih licdn*d c.ntrcioN ro s.(dcr rlE tmjd (Scc 704,,1. Buucs
<br />inl P$lk\b Cod. Th.Conra.roasLiccnscLnwdocsmrqrplyroatrosncrof!rcp€nywhotuild\orimproYcsrhcrcon,
<br />and $ho contrach tu such prcje.rs enh a ConrrNronn lken{d plrsknrb lhr c.nk(roi s Liccnsc Lawr.
<br />I Jmcrnrtruntl.. S..ri,n, .A &PC ntrrhArcn\ur
<br />}YABf,E8SI;OIIEENIA.IJQN
<br />DECLANAIIAN
<br />I h.rchy rfnflrundcr Enahy ofp.riutyo.c orrh.lnlk,sing dftlr,rn,ns
<br />_l huvc md o ill roinrrin , Cdniftarc or Con*ni ro S.lf-Imur nr workcB com0cnsal ion. r pevidcd lor b, S..rion 1700 of rh.
<br />tib.r Codc, for thc Dcrfommc of lhc *ork fttr ehth lh. pcrmil h i\socd
<br />-lhrvca
<br />sill mrn'hh sor[cn' con,Fns rn,n in\ornrc. ns r.qondd ht sc.r rn ]7(r) of rhc Lrh.r Codc. for rhc Frrorruncc or
<br />qork rbr which rht pcrnrir , *orkrs' coorensarioo insunn.c.rifi dt policy ounrbcr {c:
<br />)L
<br />-lc.nilylhnr
<br />in lhe I]trtornEet of rh.wo LrwhkhrhkFrnir is iisucd.I shlll mrcmPloy anyner$n in3nymdftr
<br />$ .\ r. h(o'r sxbrc.r ro rhc wo*qc conrrcnsar io, hws ol Calilbmi!. and asr rhar if I sh,xld h.conE subj.c o tlE
<br />*ork.6 snD.nsnrbn pmrisions olSdion l?mof rhc LdD. Codc- I dull.,odhwirh NnPl! wirh rk)s pmvisions.
<br />WARNINC Fuilurc h sxrc *orkcs'comp.nsrtion ovcBBc is unlawtul. and shnll \ubjd an.mpk,rtr tu dmind lruhics ond
<br />.i!il fiN\ trp k, or hundr.d rhousand dollrs (Sl0O.UlO). in ddnirn to lhc cosr oa.ompcnrorion. ddtug.s !s pmvid.d lbr thc
<br />S..ri{n, 1076olrhc lrhtr /tt1/ l?
<br />l!!rL!!t^lla-\
<br />I h.rhy rmrmntul$ p.nalryofpcrjury rh l ar liccnkd lndcr pmvGion ot Chrprc, 9 ( conftnci4 *irh Sc.r ir l(xD) ol Divisiotr :]
<br />ol rhc Ausincs and Prnfc$iors Codc- ,Jd my liccns
<br />O
<br />I h.rby aflnm undcr p.nally ol pcrjury Ihal lhcrc h 0 on(rucrion lcndins dgcfty ror lhc pcrlonMncc of Inc sor[ for shi.h rhi\ Fmir ir
<br />hsu..l (sdc :1097. Civ C)
<br />AITUCAILDIICLAf,AIION
<br />I trn*'y lmnn undci pcna ky of pcrjury orc of lhc followinB dalar.t ionsl
<br />Ocmliriotr Pcflnirs Aslrcstos Norificarion Fcd.rrl R.aularions (Tnlc40, Pd6)
<br />-Rcquircd
<br />krrer of fioriarcarion
<br />I .cn,fy rhd thc Ldcrrl rcSuhlions rcgrding asticslos rcnmEl $c Dol q,plicrhlc t, rhivroJ({r.
<br />-lccniiyrhar
<br />lhrvcrc lrhhapplicrrionud nlrcrhr rhcrb\c inrorm n,n is.otrccr IiexaloLlmplywilhlllCny, C.un(y
<br />odiunrcs rnn Srarc ljss rclariry ro hlil.lir! con{tucri(ni, rnl herchy adho'izc rcprcscmil nllht Ciry lnd Counryio cnrcr xrn rtr
<br />nk'vc nrnrioncd !i(,0.n! for irslJcciiotr purposcs.
<br />Applirrrt {r AB.nl SiAnaltrtu thle
<br />Communications Cable
<br />7X8//t
<br />Lendci.\om
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