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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE rD/slG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Floof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />[/eter Release
<br />Rouqh
<br />Service Meter I
<br />FINAL {12,//, &1 f
<br />Notes, Remarks, Etc. (-I -
<br />OWNET BUILDER DELCARATION
<br />I hcrcby aflim !nd.r Fnahy or p.rjury rh.l I nm cx!m/ fmm lhc ConlracroF Liccn.. tjw rot rh.lolbsin8 rcab. (Scc70315
<br />Bushrss und Pmacssiotr Code) Any City or Counry *tich requn s r Frnir ro con(d.t. oltcr, inrpmlc. dcmolhh nr rcNn ony .
<br />struclurc. prio. ro irs irru*e, rls r.quircsrhc dmlartrr rd suchpci,nilto 6lea sigmd nrrcntht rhrr hcorshc is licenrcd pur$anr
<br />lo rh. pnrvisioN ofltE Conlrclols l-iccned lj{ (Chlprcr 9. C.6mn. rB *ilh Sccrion ntr) ol Division:l orrhc Axsincss ind
<br />Pofesions Codc) or thor hcor \hc ircxc'rrr rhcrcrr.m rnd rhe hrsk Lr thcallcBcdcxcmplion. Aiy violart,n ol Sdhn 7011.5 byan,
<br />ryplicrnt for a pcnnit subj(k rhe lppli.am ro rcivilpnrhyofrcr nnrdh,n fir. nond,cd dolldr($500).
<br />l. ,r owE of rhc pnpcny. or my cmplo)(cs *irh wascs !s lhen y,b .om,'cnsarion. will do llrc work xlrhc{mrmismr
<br />i cndsl or oalcrcd for slc (S( 70.14. Burin.s Md Piorc\ri,nr cui. Thc Conlrrlois l"iccn* kw dmr not 0pply h an on ncr oa
<br />rh. rmFny rk, boild! 6. inpov.s ltrm.. aln who des skh $o'l him..lfor heMlror rhn'u8h hn or hcroun cnPloyccs-
<br />providcd rhur snch iq,rokmnh d nor inrcnddl or oflcr.d t r slc.ll howcE- rhc huildins or itrpmrctu i{$ldsirninom }qu
<br />ofcorylclion, ltr Ouner Buildcr willhnellt budctr orprovi.s an hc or sh. did nol tuikl .. impmt rhc ,nFny ror rhc Nqn$ oi
<br />-l-
<br />as owm, ol rhc pn,r.ny, nm.r.lusiv.ly cofta.r ira wirh licc.sLal conlrldo^ ro .onntud r h pmrcd (Scc. ll]44- Blnncs
<br />,kl Pbr.srbn Codc: Thc Conkadn! l,iccosc t wdocsnorapplyi(,a.*trctofpn)F(ywhobuild\otimpmlc\rhcr.on.
<br />dnd *ho .utrh trr skh pmleck wirh 0 Co mciorls) li.cnscd prsuanr ro rh. C.nk!.ttr s Liccn* tjel
<br />_l ure\cnrpr trhdrr s rtn .B & PC.l'orlhhrcav,n
<br />D c:-- O*n.r:*,t**r'is' corlptns,rroli
<br />DECLAAA.IIAN
<br />Iiercbyaffirmundcrpcnrlryorpcriuryo collhclollowirBd(larotn,is
<br />-l
<br />havr orl will tuinrdin , C.nilRdc ol Cone.l ro Sclf'lnsurc for workcrs coopcnsnr ion. N lmvidcd lor by S6rion l?(n or rhc
<br />Lahor Codc. fo! rhe pcrlom(t orrh. wurk ror *hkh rh.IBrmn h ksucd.
<br />-l
<br />hrv. llrd will.rinrrin workcs .onrDctrsarion imurancc. as rcquircdhys.crnnr.lT00ofthcLrborCodc.turrh.pcrt.rnLi.cof
<br />rhc work lnrshich rhn |J{rnrir is itruL\l. MrworNtrs conlErsaiion irsuran( catrio rrt lx,licy numhcr ffc:
<br />1 o i,?c1?)
<br />-l
<br />ccnilyrhor inrhc perto flnanc. of r hc {",^,.. rhisl)cfluit h issucd.l shall oor cnDloyanytcsotr itr onymanne,
<br />s 6 ro lE om snbjNr ro rh. *orkdc conFnsalion l0{s ofcaiiti,rnia. snd ssm rh.r if I stFuld tEom subjccr rh rrt
<br />worlcG cor{rtrsdn,n phvisionsofSetion 3?morIh. L{no. Codc. t rh,ll- ronhwirh.omply wiih thosl,nvtidnr
<br />WAI.NING fiiluE r,, sc .c sorkori $nr|rnqridr .ovcfu8c t xDl.wir.\h ll suhJ.cr rtr cnlloycr k oininrl
<br />.i!il ftrs np r) onc 1,trtr,1'.d rhou\rdd
<br />?o
<br />I hrfthy rfilnn uMcr pcn.llyofp.rjur, rhlr I !m licc rrolnn or ChU$ 9 lconnNrcin8 *nhSc.rion70(n) ol l)ivr\ion l
<br />my liccns is i,r rul iqEeJrlfL{r
<br />-r L/
<br />I hcchy nfirnrund.r rEmhy.tprriory rhd rhcr i r.oNrucri
<br />issrcd lScc :109?, Civ C.)
<br />l.trdirl u.r.y i,r rltr |lrnn t']c ol ih. Btrk lir rl,i.hrhir ncrm s
<br />ATIIIIANLIIES.AEAIION
<br />I hcnhy,fllm u.d$ pctr,lry oipcrjury one ollhc rbll,,*in8 dc{hdridn\l
<br />Dcmolirn,n Pcrn rs A\r.no\Norili.arionFcdcr.l RcBuhiionsIlirle.l0, Prn6)
<br />R.qunrd I-.(Lr ol Norfi .arion
<br />l.cnily rhar I havc rcad rhnspplicrrt erl{arcth.rthc li)nndion i\.orNi I r!a!r
<br />ordirrnces ond Slarc l,*s rclnrif,s
<br />lhovc nrtrlhncd pr'0cny br
<br />lpplirnnl or AEenl Si!nalurc
<br />a
<br />l)ly wnh lll Cnrand Cotdy
<br />t
<br />V
<br />r
<br />1
<br />L,nJd . Addlrq
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<br />I ccniryth.t rhc radcml rcslhrioDs rcsrdins a\h.nor rc'fr,vd drc noi {llicahlc k, rhh n!,J..r
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