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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS <br />Site-Work <br />Unde rground <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 />Qgnding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Rqof Top Equipment <br />Faclo ry Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Rough <br />Service lvleter <br />FINAL /2-f'/s.J/tilz fi,1) <br />OWNER AUILDER DEL(]AR{TION <br />I hdcby ,iftd undd paally oi Fjury lhn I M crempt 6onr lhc Conrra.los l-i.cns. Law for lhc aollowins r€en (56 701 I 5 <br />Busin6s and Proadion Cod.) ,^., Cily or Counry which nqut6 a lrnn to coanru.r, alt6, improvc. <tdnolish or r.pat dy <br />srructuc. pnor lo its iasu c€. lls rqun6 th. opplicd aor such pdmn io fiI. . .ign d edmd thd h. or sll. b lico$d pusmr <br />ro lhc Fovisioc oftE conl.lctois Lic.n$d t:w (Chafls'). ComEc.ciry wirh S*ro. 7000 of Divtion I oflh. Blsin6 6d <br />ProGsions Codc) or lfiat he or sh€ is dmpl lh6.from Md lh. b6is for ih. rll.gaj .rdFion Any viobtion oas.dion 701 L5 by .ny <br />applicsl ior a Fm iubjel3th..pplicanlroscivilpc..hyofnormor.rhMfiv.hu.dr.ddolles(t500) <br />l, 6 ownd of rh. FoFny. or ny .mplo!6 knh $a*6 6lhcir sl. conpoMion. will d. t *ork and $. rd6. b mr <br />idodcd or o fs.d ior slc (Sc.7044, Bsins od Pmfsio6 aod.: Inc Conlracrois Lics. ks (t)6 nor aDply to o oBrs of <br />th.polEny who toil& or ihproGlhm.. ed who d(E suhuo hxns.lrorhd.lr6. rhmugh ht or ha o*n mployc. <br />provid.d rhar n'.h mprdrddts ft rtn i dd.d oarqcd lor eL. l( h.rvdr. lhc buiuine or inprcvo.d 6 Fkj wilh,n dn. )d <br />ot co,nplctirn, lhc Owr A!iU6 will hav€ thc hrd6 of Fovins lhd h. or sh. did ml hlild or improrc lh. propory ao, rh. FrFs ol <br />I. 6 o$nd 6i rhc Fop.ny, d.xclusiv.lyconrraclin! sirh licscd contradoslo (Nrruct rh. projdr iS6 7014. BGme <br />and r\irtusi, Codc lhe aofu,cr.a s l,ic.nsc Law do6 nor apply ro e own6 ol DrorEny sho builds or imDrov6 th6on. <br />and vho contmds aor such proj..ls $ith a Coilhdo(r l'ctudl tuRudr rorlE (ontraclois Li.d* tiw) <br />I m .x.mpi mdd Salion_, B. & P.C. for thi5 rcen <br />]llrA|Lt-lrllll]lrrlllAlDt( t_AR,\t l()N <br />I h(.br amnn und.r p.nahyoaFjoryon.oath. aollo{i.s ddla@tio6: <br />_l harc ad $ll mamrsin a Cqrilicate of CoNmr ro S.la- lBUr. for rvorkst conll,.nsrnn a proridcd tor by S..lion 1700 of th€ <br />bbor Codc. for lh. pdaomec. of Lh. Mrt lor which lh. p6nil b isu.d <br />_l havc and ull m.inlain work.d comr,.Eslion i6uBncc. 6 rcqoircd by S(tion I700 oalhc tabor Cod.. aor lhc psfolMcc of <br />rh. work lor wh,ch rhis pmir i. isu.<L My *ort6 comFMion iNurmc. catrid ud policy nunbq tu€ <br />"*,* ' *o".{- lJ r-L^l 5a 3,."..-<<- Ce <br />2-r:l Z <br />I c.nifylhot in rhe pdaonMm. ofrh. Bork ior $hi.h rhi trmn is irsu.d. I shall nor mploy any p.Mn in rny marn r <br />$ 4i lo bdon. subJd to lhc {ork6' comp<NI ion laNs ofCalifomi.. md qrc. ihal ill should b.conE subjal lo lh. <br />qod(d. codp.nerion pruvnioN ofS.dion 3?C{ofrh€ trhor Cod..ldEll. ionhsirh comply rilhlhos prcvi.io6.. <br />WARNIN(;: Failut r. s@ Rort6 conptuation covoa8c is unlastul. and shzllrublct an @ploy6 ro ominrl Fuhis Md <br />ciil lin.s up to oh. hundr.d ihou@d doll6 (1100-000). in add ion to thc cosr or co,nFNalion. &iascs a provid.d for lhc <br />s&rio 1076 ofrh.l.alx)r codq inls51uddfrotuy't fB <br />!ECI,A8AI]A! <br />I hmby rtttrn u6do p@.ly o f p.rjurt lhat I o ltaa.d uidd Fovsion ofchapr6 9 (@maci.g * irh Sc.lion 7000) oa Divtion l <br />ol lh. BBiIB dd Prot6ions Co& &d ny licGc G in tull aorc. ed crdl. <br />c-t(2 I 528 ar ,/ S- <br />t2 ->I 5 <br />coltllltcrurlrDlDrlcIc[lIjt <br />I h*by arm und6 Fn6ny o f pdju.y rhal fiq. b a cotdtu lio. hndi.g aldcy aor rl& pofol)@c. oalh. mrt for $tkh lhis Fnil ie <br />issu.d (S(.1097, Civ C ) <br />AITI,TCANLDEO.dAAIIO! <br />I h6!byrlrmr.dd paaliy ofpdjury on oIthc followins dc.l&arionsl <br />Ddolirion Pmns-Ash6ros Notificalion Fcddal R.suLlions (Till. 40. Pan6) <br />R.qun.d Ldld of Non6.aion <br />I.fiiayrhar the leddal qularions rcrdd,ns db€stosBnoral e nol apflicable ro lhis prcj4l <br />-l <br />cd ify lhar I halc Bd rhi. applic.rion md $ar. ihd $. al!\. inlonnarnrn is .odd I as@ ro .onpl, wnh rll cny and aouhry <br />odmancB and Slaic k*s r.Ltiialo bu <br />!bov. morio..d lropd, lor inspfttion <br />( ald hd.by adhona r.F.frrdir6 o lrhis Cit, d c.u.rt ro ni6 uFn lh. <br />Applic.trl or Aaml silnrlure <br />eermiree nrme I panD, K t*\d>, cJ. G", ({, 4 <br />IIIIIIIII <br />APPROVALS <br />,,,",.1a-3-/, <br />Ldd.r 3 Ad6< <br />- <br />Meter Release <br />Notes, Remarks, Etc.