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APPROVALS DATE ID/SIG.COMMENTS OWNER DUTLDER DELCARATION
<br />I hcr.hy .flinn undd l.nrlry of pcrjury rhol I m cxempr fmm lhc Conlracrod Lic.n* hw iot thc lollowin8 rcusn {Scc 70ll 5
<br />Businc$ lrd l,rof.ssion Codc): A., Ciry o. Coldy *hth equtc\ a lEmn to c.trsrru.l. allcr. improlc, dcmlkh or Epon .n,
<br />{tucror. p trro ns issuM..,,ho mquies th..pplicn.r forsuch lEnnir ro fi,c, liEn.d arc.tnr rh0l hcot shc n hcnscn l)ursont
<br />ro rhc pmvisions ofrh. Conrrocroas Liccnsd l-aw (chapr.r 9. commcrcirs wirh Secrjon 7000 or Divhion 3 ollhc Busnrs .rd
<br />P(risnnrsCodc)orrh,th.orshchcxcmplrhcrcriomandltcba\isforlhclllcgcdcxcll)rn,n.AnyvioLtionolSarionT0llth,any
<br />.lflicrnr lbr a ncmrit subjsts Ihc ryplicoor r. acililpcnalryoloor 'mnrh,n fivc hundr{ dollnm ($500)
<br />-l-
<br />rs owmr.f rhc pioFn y. .r nry cnploy.rs wr h wrScs I rlrct src omFtrsrrnrn. *ill do rh. work dd rhc sl imnnor
<br />inrcnlsl or otT.r.d ror sdc ( SR.7044. BusinNs and Enlt$ions Code l hc Gn racroi { l-ic. s be docs nor rlply ro rn o$ncr of
<br />rhc rm|Eny *hi boildsor in{r,vcs rhcn)n, il sh di* $.h k,* hinN.lf o. h.teli or rhrrgh hh or h.i ow. cnDk'yc.s.
<br />ptuvn,cd rh.r $rh n{mrnrnh m mr inrcnd.i or olTcrcd ftr sk ll h*.\tr. rhc lNiklir8 or in{'r,sr*nr is $h *nhin nm !{r
<br />.r.onDhri.n, trr o*nn auilAr wi! hrvc rhc hurdcn or [ovins thor,tr.r \hc did mi b{ild or improlc lhc polcny aq rhc tuF,s ur
<br />L r\ orvturorrhc flo ny. nm cx.lulivc ly .onttucr i.r $ith li.cn\.d conrracn'^ n, ..Nn(r Ihc tdL{ (Scc 7M- BNrres
<br />indt'$ti\sdrCodclhcConlrldoisLiccnscI-!*doc\Dorrtpltbatroqcroflm|crlyuhobuiklsorimpruv.srhfc..
<br />and *ho..drr.r\li'rsrchtmjNrssirhrCbtu.r*(9li.crsdrDruunllorhcContacrr'\Li.rischw).
<br />ll!8llQllrrJt nlrN
<br />DE( t,,rkAl1()N
<br />ol |trjulnN.lrhc l;lLotr trg {1..lxRrtrrr\
<br />I hrvcondwill nui.lair trCenifiqtcol Conscnr roscll lnslrc nr*o (s corpcns0rn,r. rs providcdtorbysccrionl?molrhc
<br />Lahtr Cqlc- r',,r lne Frt .nun..ofrh. woA tuwhich(hc psnrir n hsucd
<br />ll Di ain *orkcis conl,cD{tion insufincc. rs rcqutedhySccrk,n]7(DofrhcltrborCodc.tbrlhtrFnnnrunctot
<br />"+4"'"* ""*' "',d e'ttr *'*' '"
<br />I Itt-l I
<br />_lccniltrhsr inihd p.rfoi,rutucofrhc work for *hich rhk t.irnir h nsucd.l shallnor cntk,! an! tfso. inanynunncr
<br />s N n, tiromc subjer lo tnc workss mmpcn\arion llws orCalirornir. dd.8m thar iil dmuld tdonE slt'jml rortr
<br />workcA comFtrsriionpmvisiorsofSccrion:lT0oofrhcLatxrCodc,Isl'"1.ro hwith .onDly wilh lln,€ prcrisn,nl
<br />WAININC railurc t, $.ord w.rkc cotrrp.trsdinf cortngc h unla$iul.
<br />ci!ll li',.s uf ii otrc lrnl'c{l rhousi d do!lr'! lXllX),rX)(r). ilr rd,liri.n n, I
<br />Scdnn' .1076.frlt htxtr r-,,1., i'n.rr{ trrl r.'tr.v'\
<br />( \rprimnr:
<br />"a
<br />Y:3-t a
<br />t2f!!!!-tstllQr
<br />pcnrlryotpcrjuryrharlrnlici{lund.rlRriuinolChnrcr9i.oNrsn.n,!*iihStcrionl(XX))oiDivi{oil
<br />ol rhr Rusi',cs rd,l Prcfcs\n!tr Codc. rnd ny li..flr. i\ ir lirlllnr.c x'trl.ll..r
<br />C(tLo zD 7r/€fq)-
<br />CANjiIBIJqIIONITNDIIG.AAENCI
<br />I hcrhy ainn uM.r Fn0lryoipcrjurylhal lhcrc h aconsrruclion hding as...y fot rhc pdlorromc olrhc work 16r shi.hrhis Frnrir k
<br />hsrd (Scc. :1097. Ci!. C ).
<br />ATTLICANLDEIIJMII!]N
<br />I hodry dJIm und.r F.axt ol p.rjury orc of lhc lblk,sinB d(lnrat tuns:
<br />I)eRnirbn Pcrmih Astr(o* N.ri,l..rion F.d.r,l R.Suhrions lTrllc 40. Pon6)
<br />-Rcqut
<br />d knf orNorificdhn
<br />I ccdilyrhd rh. Ldcri l rcSu lal ions
<br />I ccnilyrhd I hnr rcnd rhn I rSre ro conr!ly *ith.ll Ciryand Counry
<br />olrht Ciryand Coury k,.nrcr rFn rhc
<br />,,,,"8- jaJ
<br />{,"^*"(Cl4a'c<-)
<br />Sile-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Air Conditioners
<br />Rool Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinos (T-Bar Rouqh)l
<br />Nileter Release g/?qhd )&un
<br />7
<br />Rough
<br />Service ltrleter I
<br />FINAL n Y rll( t Alqtb tr ;>/
<br />Notes, Remarks, Etc.vL - l-
<br />ELECTRICAL.INSPECTOR RECORD
<br />Sub-Panels
<br />u'ilcr Sd.rn,n-, B. & P.C. rdrhis rc!\on
<br />1K
<br />a3
<br />trndo " Nunc
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<br />.dnnNcs dnd Srrrc tiws
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