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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monumenl)
<br />Lale Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<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 />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />lvleter Release
<br />Rouoh
<br />Service ltrleter I
<br />FINAL ?/tq,/1V 4 *9) )
<br />Notes, Remarks, Elc.
<br />-t
<br />ELECTRICAL.INSPECTOR RECORD
<br />OWNER BUILDER DELCARAIION
<br />I hercby rfftrm uftdcr penalry ol pcrjnry rhlr I m €xcdnr fD,n rh. Conrrct c Liccns. bw lor $c foilowin8 rca$n (S(.7e3 I 5
<br />Brsindcs ,tu1 Ptutcsion Cod.)r A.t Ciry oi C.unly which rcquiEs a lxrmn Io con(rucr- alts. imt'rovc, dcmlish ot tiBt fit
<br />srfl.ruE, l,rior ro irs t$mcc. rl$ rcquncs rhc ottltlnr for sucn lElmir to 6h a siBed (alcm rhrr lE or .hc i\ li.cn*d pumlnl
<br />ro rhc lbvisioos ot rhc Conracrol\ Liccn*d Llw {Chlplr 9, Conftftin! wirh s.clion ?ux) of Divnion 3 of$e Buiinesc and
<br />Prci.sn,ns Cdde) or fiat lt or sb. i\ cr.rpr rh.rcrommd rh. basis lor rh. allcScn ex.,nplion An, viohtion.tSccrion?0]1.5 by lny
<br />applionr lor , pcrnir subjech lhc 0pplicant lo a civil pcflally or not mE lhan fiE hundtn dollas (S5m).
<br />lLLl J\ owncr or ih. r,oFny. or m) cn'rlnyrcs w h *a3cs .s thcn sh .omp€n$lion, *ill do rh *.rk and Lhc slMluE h mr
<br />itrrcndd or offcrcd lor qk lS(.7044. Buws and ltofc$ions C.ds Th. Cont&kv s Li.c.s. h* docs ool q,ply to u osM 6f
<br />the pmpol, *ho blilds or impn,Es rh.mn. atul uli) dfts iuch blk himscll o. hercll or lnmueh fih or hfr osn cmplryces.
<br />Iovidcd lhat such impowmnk m @r inrcn&d ororlcrcd forsah.ll howcvr. rh.t ihirao! inVmwm.r t $ld wirhin onc r.u
<br />of.onpLtio.. lhc ow.cr auitcr sill hoE rhe brdcfl of Imvins rhot hc o, sh. did n, bxild or irymw lnc pmFny for lhe purFs or
<br />-1.
<br />N .wncr .f rhc lopdy- am cxclusivcly conrndins wirh liccrsd .onr,.trs ro c.nnfld rlt Pn'rtt ( Scc ?O1-,1. Busi'x\\
<br />n'rl I\$fssin C.xlcr Thc Cotrtacror's Liccn\. Lla docs nor npply to anoqncr olpopcdy wtu' hrilds or imtovcs rhcrsn-
<br />Md $ho contB.ls r'or such pmich wirh ! C.nrrucron sr licenyd fl*urnr ro rltr Co.trodoi s Liccnsc tiw )
<br />I rmcrcmpr undcr Scclion-.BAl'C-rtrrhi.rc}'r, ",,'-.*,M,#Mu," . V'lq- lt
<br />DIiELSAI!9N
<br />I h.rchy ilinnrundcr Fnrll, of Fjury onc ofrlf fi,lk,s'n! drchnrion\:
<br />IhrvcandsilltuinlrinaCcnificdcolConscflr'sclilnsurclorworkcr\.anll|rtrdn,n,asFrvidcdf.rbySNti.n:l70Ootrh.
<br />Irtxn Codc. forrhcFrformri..of thr wod rorwhichih. p.nnir i\ hsucd.
<br />-l
<br />hrvc rnd willmrinrai. worlcri conpcnsrrnrn insu8ncc. !s Eqrircd bys(tion l?molrhc tihor Codc, for rhc pcrforddk.or
<br />rhc wo,k fo.whichlhh ncmir i\ hsu.d. Myworkcn coDFnerbn insutanecnntr md policy nunrh.r arc
<br />Policy Nunrb.r:-
<br />Y4t{.nirr rhar ir rhc pc orntrrcc of tu work hr which rhn pcrmil is hrucd. l shJll nor . floy dny li^on nr any mlnncr
<br />so $ r. bccoflE suhtcd ro rhe s orlcn co'nFtrsdnrn h*s ol Crlifumia. Md neN th{ if I nnut hcconE \thrc.r t, rlf,
<br />qorlcr conrpcnerion trovision\ otSccrbn.lT{nofrh. tjl$r Cr)dc,I shdl. fonhwilh.onrlly wirh llt,* !rcvi\ions
<br />!VARNIN(;: Failurc ro ccurc wo*cr $nDcnsrion covcn-lc is uolo*{ul, and \hrll \uhj..r m.nfluyc. ro rnnrinrl IEDki\ and
<br />civil nncs np ro onc hundrcd lhous0nd dollln tsloo.(xD)- in.ddnion ro
<br />'hc
<br />co{ orconp.nsrtui. danE8cs as rmrid.d tn rhc
<br />S.cri( :1076of rhc LitnrCodc, inrcre(nndrliorrcy \ Ic$
<br />,,.^- . iiq ty ^***fufufo3a"1s.t
<br />DECIdAAIUN
<br />I hcrby rmrm und.r r.ualry oi llrjury rhll l0m liccn*n undcr [ovhion otCh4rc! s (..miEmin8 wilh Sdbn ?(x)O)o{Dirnion:]
<br />ot rhc Busi.ess and Pdf€$ions Cddc. aJld my li.cnrc is in rull ror.c d cltel
<br />Li..nscCllss:-
<br />-Liccnsc
<br />Numltr
<br />CQUIIBU':IXTNJNNDING.{GENCI
<br />Ihcrcby,flirmund.r lInllry olFiury rhlt ltuc n B oNrrudinn lcndins ascmy for rh. p.rr.int..c olltu worl aor *hich rhia Fcrn n
<br />isstcd (scc. 1097. Civ C )
<br />AIEUCANLDECLAB^.I]ON
<br />I hjrc$y antm under pcnalry otrc(ury.ic ol rhc ft,lk,win8 delnrarion\l
<br />Dc,xriti({ PcflDirsAsbcnos Nolilic(ri(r ljcdcral Rcsuhlions Il ilt,r0, Prn6)
<br />RcquiBl tr(cr ol NorillcarioD
<br />-l
<br />ccnit lh0l $c i€dcral rcsublions esdjins a\bc\ros removll!.c n.r,pdiablc ro rhh pmi.tl.
<br />14..diry rh{ I haw rcd rhis dnllicalion tuld ({lc lh ihc.bvc inr.ilrErion h.or$r.l agrebcomd,*irhlllc ymdC.unry
<br />onlimnccs r.d Srarc ljws El,rins ro hlildins con(rudion- od h.rcby Nrhorizc rqmsn6riv.s orthis ciryand Counryro cnr.r u[x,n rhc
<br />xt!trr nrctrrn)i.d prutrdy r(r ,N
<br />Apdi.lnl or,\*e I Sirhalorc o,, ./:l!ilL
<br />*, l/tc t4*
<br />Pole Bases
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