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APPROVALS DATE ID/SIG.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 />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service lvleter
<br />FINAL *l)nlt\Itufil*€{aa)
<br />Notes, Remarks, Etc I U\)
<br />OWI!ER AUTLDEN DELCARATION
<br />I hcrcby lffinn u.do pcMlry of Fljury riar I am cxcnrpt rion rhc Conrrocron Ltcn\e Lns ro, rhc rollowin8 E.$n (Scc?oll5
<br />B$in8s and Prorcssiod Codc): An! Cily or G,utrry whi.h rcqxir.s . llcr.tl lo condrucr, all.r. nq,mvc. dcmlhh "r rcIr3n oiy
<br />ed.rm, pii$ ro ir! issurtu.. de rcquircs thc q,tlhanr ror sn h Frn ro filc a si8trcd srarcmnl rhar hcor shc is li.cn€d pu^unnl
<br />ro rh! pnvtiotrs oI rhc Conlractoas l,ich{d l,w lchrpr.r 9. Co $rfti.g wirh Scc'ion ?ux) ol Divnion 3 ofltc Bucincss 8nd
<br />Pnfcss nsCod.).rrhartEorrhchcx.mpllhcrcftorond'hrh€sislorrh.,llcBcdcxcq'tiotr.AnyviolarinnofS*rirn70ll5by,ny
<br />omli.!tr| lb! a pcirnil subjcch rhc amlicant ro a civil l)cnrlry oI nor mrc rhan filc hundrd dollds ($50o).
<br />-1.
<br />us oqrcr of lh. pmtEny. or nry cnDloyccs iith ruBcs !s Ihc ir $lc ompcnssri('n. will do rh. eolk ud rtr stdurc h mt
<br />inrcndsl or oflc.cd lbr qle (Sq 7(X-,1, Bxsiftss snd E r..\nrns c(d.: Th. C.nta.k, s Ltcnsc ljw dms nol alply ro an o*t, of
<br />thc pmlEny Bho hoilds or in{,mrs rlENn, ard who drs uh m himsrlf or &rclf or rhrurgh hk or h.r ow. cmnb)ec\,
<br />ptuvidcd rhat such impmrnrnrs d tul int lcd n ofrcNl lor srk Il hows. th. tDilding or irymwnrnl is vrld wirhin om ,!U
<br />of coDplclion, th. Owncr Buildcr will hovc ltE buracn of F)vins lhll hc .r shc did n.r t'uild or nr$rorc rhc tmFiy for llE IUID9 of
<br />_1,,so$rcrolrhcnmFny.ahcr.lulivclycont&rintswi'hliccn*d.onr t s tr con\dd lhc lmicl lsa 7(N4, Bu\im'1
<br />,M t\iLs$n Codc ThcConlmcrols Liccnsc Ltrwdes.ot aptlyto anowncrolptr,pcnyrho build\or impmvcs thcrmtr.
<br />rnd who contfts ior sucn nmjds wnh a 6nrr!.r.(9 liccn*d plruor rorhc Grir*.r.r's Liftn{ hw).
<br />I m cxctrrrr utrds Sdio
<br />Dorc O*ner:
<br />wotxers colnPrnsariorv
<br />DECLAAA.IIIIN
<br />I hcrchy rilifln undc. p.nnltyolpojuryom ollhc tuln,qins dcclurnnr\l
<br />-l
<br />h,vc dwillNinrainiCcrriararco,G,n*orroSclalosurcfffuortcB.oqxns,,'o6.ns pmvidcd for bySNtion 1700orrfie
<br />trrbr Codc. for th. tdrormkc or thc *olk for whth lhc nom is nsucd
<br />llman,rai', sorkch co rp.trrrrion iNunicc. r\ rrquir.d hySc.tmtr:17(x)olihc liho! Codc. for lhc Icrfortun.c ul
<br />ichthispcrnn i\ i\su.d. My workrs onrpcnrdnrn rnsu$nccca .ru.d,xnicynumtc.uc
<br />l.cnitirhar i', rhc p.rrormtuc ol thc work for *hich rh( pcnnn h issucd. I sholl nor cmpk,, !n, pcron in rny numt
<br />$ ns b bc.om \ubiit io lhc wodcrs comlcnelion la*s oiCllifo.nia- lnd lsEc rhrr if I \h,nld bc.om sub.j..l lo th.
<br />wo*cn comr.nsari.r povhionsofSarion 3?drofrhe L n Codc. l shrll. fonhwirh .onply wirh rh.s lrovisio s..
<br />WA|ININC: Failurc t,, rcurc workc*
<br />civil ntrc\ !p k, one huodEd rhou\a d
<br />Sccrnrn .llr?6 ol lhc Llhr Crxic. inr.dr
<br />.omp.nsdion covcrnlc is unlawrul. .nd sholl slbj.rt cmploycr lo qi6id p.roltid md
<br />dotle. (lll)o.Ux)). i. dnion r. lh..ost ofcompcnsolion. drmaes ar Piovid.d ror lh.
<br />,id hmy . r.f /,
<br />'' , fiFrsen<wrnrtrui-ft". 7fi ulrE
<br />DECIAaAIII}N
<br />I h.rby dfllrn lnder F.sli, or p.qury thd I am li.cnsd undcrymvision oichlt s 9 (.omRftins oirh s6thn 7m0) ol Division l
<br />ol lne Busirc$ ad Pmf.srions Cod., md ny li.€n* ir i. tull tnr.. ,rd cff.cl.
<br />c) ()gDY 7 I
<br />7/ro [tt
<br />CONIiIB]JI]IIONIEIDING.AIiINII
<br />I hcnhy 0lltrn unil.r FnahyolNrjuryrhd rnqc h B c-ndrucli,n hndiry fla.n.y r(r rhc t'.rionmno oithc wort tor whth rhh Flnir G
<br />i*ucd rS.. ltl97.Civ C ).
<br />AITIICANIIEQAAAIITN
<br />I hdrtly ,flmr undn p.n,lry oI t rju.y om of lhc followins d(loEt ions:
<br />Demrirnrn P.rdirs Asbcdos Nori6c.rion Fcd$rl RcSul.li.ns (Tnh 40, Pd6)
<br />RcquiEd lx (.f Norill.nlion
<br />I ccnifyrhar rh. f.dcral rcBulrl i()ns rcEsdin8 ashc(o\ rcflDul rrc frn atplicrhlc t, rhi\ pt,i.r
<br />!lcrdifyrhrr lhJlc rcal rhis urltrrn rrtrd!{rcihn hc nh,vc hrnx iotr i\ conc.r lrlreiocomply*irhrllCiryrtrd Counly
<br />ordi'rnrc\ xnd sirrc u$!'rl,iingn, huildrnS.on(rucli(,r. dhcrchy0urhorizcrcprcscnrllivcsolrhi\Ciiyrndc(,utrrytuctrrcrullnrthc
<br />abovc m iomd ftupcny hr ,"rr*'
<br />lk\ ,{ppliconl or AAEnr SiAnrrurc
<br />ff"-n**.",0n,',I hl S,tctlr'n ^"ty'rufe
<br />II
<br />ELECTRICAL-INSPECTOR RECORD
<br />Under Slab / Floor
<br />lr & P.C. r'orrhn rc on
<br />ta:=
<br />t nJ.r'l Adtte{q.
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