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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 />,9pas, Pool, Fountains <br />€igns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor /A <br />Bonding / Grounding / UFER t1 v.\4]u <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilin gs (Hard & Soffit Rough <br />Ceilings (T-Bar Rough)A\ <br />Meler Release -Jc'Wrud 6'511 t€-r4.rp)cf F <br />Rough /A <br />Service Meter \'21'1 tr_ul/t[J <br />FINAL {.'>(,"1 t\X'lU{n <br />Noles Remarks, Etc. <br />---t <br />OWNER AUILDER I)ELCARATION <br />I h6eby arrm und.r Fnany oa psjury th8t I an .x.mfl tum lh. (o. raclotr Lic.oe Ljw for lhc folloving r.en (Sa 701 I 5 <br />B6i.ss od Prf*ioi Cdc): Any Cny or Cou.ty which rcqutB . p6dit ro consrrucr. alls. ioprcvq d@olish oi E an e, <br />sltudoe, prior b ns isudce. also rcquiB th. rppli.d aor such pdil r 6le a siBn.d sraldsl ihat h. or sllc is licds€d pum&' . <br />lo rhe previlioE or $€ Conra.roi! Lic.ns.d Law (Chapt6 9. ComDcocins \ ith Sclion 7090 of Diviiod I of rh. Brin* Md . <br />Pmt6sionsCod.)orlh.lfi.o.sh.is.x.mptlhcciommdth.basislorrh.alL8.d.r.mflion An, violalionols.clion 70]15 by y <br />appli.anl foraDmit subjtlsth. applicanl lo scivilp.nallyofnot morcth fiv€ hund.€d doll s($500). <br />_1, a o*nsoath.proFny. or my.nplot6 s,ilh tr.s6 6 rhcir $1. @np.Bdrion, $ill & the Mrl oddEn lmis tur <br />ints ed orofcrcd lor s.lc 1se 7044, Blsind md ftoaeioN Codq Thc (ontra.lois Licm Law do6 not .pply to u own< or <br />lhc popsly who builds or i'qror6th6sc d who do6 sch ss* hins.lt or h@lf or rhroush his or hs own cmploy.6. <br />provid.d fiat sucn impovonors @ mt idad.d or ofi6.d for sl€ lt ho$'6s. lhc h{ildins or ioFov.em i! ed s nhr on. ,a <br />olcoDplaio., rhc Omd Buildd will ha!. lh. hrdo oaFovins dld h. or she did @l hiild or impm!. lh. pmpGly for thc pupos ol <br />I. a own.r olih. Flpdy. m dclBi!.ly conlraclinB {ih li.dE d ..ntB.to6 to coNlruct th€ roj.cl (S€c. 7044. B6'n< <br />,nd Pofissnr. Cod€: l hc Contturor3 t.icds. Law do6 no! applyro eo$n- ofpiopdr, $ho builds or inprovd lh6on. <br />and qho comm* fo. sch prcjds witn r Co.rdo(s) lic6E n puFomr io rh. Conrrrclois Lic.M L.w). <br />l.nr.xempr umld Sc.ri.D .B &PC itn this rc8on <br />Drl€ osner <br />]EaatsDgiiau!f,rsafiqB <br />DECIABAIIII! <br />I hqeby amnn uoda pdrltyolpdjuryotr€ oflhe followinS dcclualioNl <br />I har. ed will mainlain . Cgrificdc oaco.mr ro SdtuNr. aor wrk6i conrp.nsarion. 6 pmvid.d tor by S<rion :1700 of Ihc <br />Labor Codc. lor th. pdfommc. o a$c worl foi whi.h rhc penit is hsu.d. <br />I have and will mainlain $ork.G comFmalio. iNuffncc. N r.qut€d by S€cl ion ]700 of thc Labor Code for lh. Ffom@cc or <br />\ hich I his p.nn ir i! irsu.tl My wdrkrsAd..p v,*d co,np@rion iBurm.c.rid and polict numbd ffe: <br />-l <br />ccrliiy lhal in lnc p€.for manc. ollhc wort lor which 6h pmril is ks!€d. I shau oor chploy 6ny N6on in any mmd <br />e d ro bdomc suhjd ro rhc {.116 compdsalion la{s otcalifodia, dd arc rhd ia l shorld tB.on. subj{l to lhc <br />woikds conpssarion |,olisiotu ol s..tio. ] 700 ol ihc tlbor Cod( I shnll. lonhvirh .onplt $nh rhos pruvisioE.. <br />IVARNINC: Failu.e Io sue worke6'comp€nsfllion co fui. !!d shall subj-i d opbyd ro aininal p.mhi6 md <br />ro rh€ ton of conpcnehon. drmar* a prorid.n ior rh.to on. hundrcd lhoGod dollds ($100.000). in <br />inr66r drnorEy'r lB. <br />1b <br />I hmby amm undd po,rry o f p<jury th,t I @ licdsd @d6 povilio. ofch.pl€ 9 (mmnmcin8 \vilh Srlion 7000) of Division l <br />ol lllc BBin* sd PrclesioE Cod.. and ny licft. is in tuU lorce ald .llcr <br />. tDl44'zlqTlr[n .^,"*,1 <br />(AXSBUSIIANIINDITC-ACE!(I <br />I h@by amm undo p.oahy of !sju, thar $qc is 6 coBltuclion LndhB aeocy for $c p6foil@c. of th. $o.k for shicn thie p6,nn is <br />issu.d (SE.109?, Civ C.). <br />IIIUCANLDECIAAAIIA! <br />I tElty atrm undd Doahy oap€riury onc ofthe follositrs d(lmrioas: <br />Donoliion Pdmts-tubcln Norifi.arion r'.ddal R.SulalioN flnlc40. Pd6) <br />-R.qtrncd <br />l-clrd of Nolifimt6. <br />-l <br />ccnily r hal the acdEal .{ulalions rc8ddio3 db€sros rmoval a,e nol applicable ro lhit projdr <br />N":*'x;. rh.l fic ,bo!c infom.lion G .odd I a8rfr io omply Nirh sll Ciry and County <br />Il. dd hdcbyaulnort rcpr6drrdilB o l ihh cn <br />aboE motioncd prop€.ly lor iNFcrion Iru,i" <br />APPROVALS <br />pott"tNuu,*,,M*pnn <br />v <br />Lcnd.r s AddrK <br />I