|
APPROVALS 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 / Dam pers
<br />Communications Cable
<br />Buildinq
<br />Bondinq / Groundinq / UFEB
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilin gs (T-Bar Rough)
<br />Meter Release
<br />^\\Rouqh 2-t1lr x\+)d
<br />llLTlotn 4fweL/?\)
<br />Notes, Remarks, Etc.
<br />OWNER BUILDER DELCARATION
<br />I hcrchy rffi.nr undcr pcn!]ryof IrjuD thar I on cxcnrl lmn rhc Conrhclos l-ken* ljw for rhc follo*ins Ensn (Scc 70115
<br />BulnEss rnl Piofcsn,n Codc): Any Cny or Counry $hich Elltcs r p€mir b c.ndtucr. alrs. inprolc, ddmol,sh ,{ RNt r ,
<br />(rucrurc. Fiorto ns hsu!n.e. dl$ r.quncs rhc.prltdnr rd sxch Fmi' b fiL r si8trcd s,rc,rc lhr h.orrhc is liccnrd lu6nMr
<br />Io rh pmvnnns.f rhc Conh.rors l-ic.oscd ljw (Chutrcr 9, Connncncin8 sirh Secrion 7rx)O ol Divnion I orlhc Bu\iids rnd
<br />PR,fcssians Codc).r rhar tr.r\ho i\.x.'upr rhcrcrr.mMd rhc hiis lbrrhc allcscd cr.mpriq' Antvn,hrn,norsc.rbiT0.rl5hyr y
<br />rpt'licnm fo.atlcrnir sxhj.rrsth. rttlic0trl r. rcivilpciallyofNrnlkrh,n fiv. hundr.ddollr^ is5fi))
<br />UOBXEBS:TOUIENSAIIAN
<br />DEIIA.IAUAN
<br />I h!rcbyrlinmundern n{hyolpcriurynmolthclollowirxderldarir rs
<br />_lhavcandvillnuxtrlni,Ccni,ilar.ofCotr*nrroSclflnsurcnnworkcA conlrDsr!bn.N provid.dlorbySccrion3?UroIIhc
<br />tjhor Codc, for rh. rcrfonm colrhcw.lkforwhi.hrhcpqrni h issucd
<br />_l h3lc and rillmrinhin *orkcr' comr.nsalion insur.Dcc. 0s rcqun d by Sccriotr ST(x) ofrhc tihor Codc.lorlhe rErtorronc. of
<br />suqlM! {,trtcF (ornncns0rinn irFuhncc curicr
<br />&r'-w. rtl<-
<br />40 Y.-r"\ \g
<br />I ccniry rhrr in rhc p.rfornumc orrhe *ork nn whici rhis pcmn n i\!ucd- I \hrll nor cardoy any r.^on in any nBnncr
<br />$ 0\tohNnrc subjcl lorltc sorkcr{con{.trsrtnJn hssofCalifonri{ rnd rerc rhd ifllh.uld hc.om subjrrr ti'lhc
<br />solkol conrt^*nsarioD Frvisiofls ol Scdiotr ]Tm of rhd Lrhtr Codc.l \hall. tunlNith.umfly wirh rlxxc frovisiotrs
<br />S.dion 3076olrhc tjtnr Codc- ir crcstatrd alrorrcyt
<br />,r.,",-\'l['\g
<br />I hcrb,afti. hdcr pcnalty ol pcrjlry rhar I n ljencd undcr tmri{iotr ofchoutcr9lconrftacins rilh s.cii.i 7ffx)) orDiviri,n l
<br />of lhc Busirc$ and Pn,fcssions Codc. arn my liccns. is in lullfoe! ud cficcl
<br />\ozt(o\
<br />IONSIBI]qIIQNIINIJIN1;-E{jIjI.CI
<br />kiucd (Sec 1097. Civ C.).
<br />l,ndeis Nam:
<br />-
<br />AIIlJQlNLllEll,/laAIlON
<br />I l*rcbyaffinnrndd lcn lly.f rcrlurtuncof rhc Llbwirgdcclarali{nN:
<br />Dcnrn ioo Pcrnits Ashcnos Nolificarion rcdclrl RcEuhrnnr (lnt t0, Pan6)
<br />Rcqunc l.rr$olNorillcrrin,
<br />lcdirrrhrrlhavcr.odrh(rpplicrrn,nandnar.rhlllhcih)lcinlban,ionirc.rcdl]sreroconrdy$irhtrllciryadCoutrry
<br />ordi"rnc.s !n,l Srnrc I-x\rr'.ldirg lding cotr!rurrion. ml hcrcby!r'rluizc rc|nC\.rhrivcs ol rhi\ ( iry rtrd C.unry b cnrd utin rlf,
<br />trh,vc nrnrhnc,l tr.p.ny inr inlnccl
<br />4npli(nnt o. Ae lSiAMlu
<br />Vl1v,v\
<br />,rr.1\\a
<br />ELECTHICAL-INSPECTOR RECORD
<br />Under Slab / Floor
<br />Service lVleter
<br />FINAL
<br />l. $ osic. .f rh. pmpcny, 6r my enllolces *irh wr8cs as rhct solc sry."$rion- will do rh. srl ud rh. rrntl@ iq tur
<br />n cnd or ofi.rcd ror ele (S(.7o14, Busin.s Md Proresions Cdc Th. Co.r,.!o. s Likn* tle &rs nor 0prly ro r. owncr ol
<br />lhc lmlEny who boildr or nrtMs rhc6n. .rd wh. docs {ch wo* hinNcla or hc.slf or rhtuugh hh or hfi o*n cnDloyces. '
<br />F,vid.d rhlr such inlmttu.G m nor inrendcn oficEd lor slc. ll howcvtr, ltr t{ildiry o, inr0mwn nl n $U *nhin om Ftr
<br />of collphlion, tlE o*mr Buiher will haE ll[ hrfltcn ol pi6ving llrr1 lt or she dil Dl hrild or idq,bve ln. pEldy for tr tu.FN ol
<br />-1,
<br />asowncroflheF,Icny. amcxclusivclyco ructing wilh liccns.d contaclon lo snnfld ttE !rojecl (Scc.70,14. Bunnc$
<br />snd hDrcssi,r Cod.: Thc C.nta.rors Lic..r L,e does to,r applyro uno*ner 6aDrorcny wtxl builds or imnrovc! rhcr6n,
<br />!trd who conrmrsfor such pmjccrs wnh a q,nrdo( 9 li.enrcd p!6u,nr r. rhcCotu&rofq Lhcn* Liw).
<br />-l
<br />omcrc'npi utrd.r Scclion-. B &PC t rrhis6r$n
<br />Dale: Oer..
<br />Exftcsl
<br />W,{RNIN(;: Fiiluid r, $.urc *orkc6 .onfriN ion covcr gc i\ rtrlatrtul. itrd \hall su$J.cr ,n cnDb)u ro dnniral Farkis nnd
<br />cNil ,incs np h onc hundrcd thousrnd doll0B ($loo.mo). in addirion ro rhc co\t ofcom|Dnsatio., dnruecs rs pnridcd lor rhc
<br />-l-\L lr
<br />L.frl.r'c Addrc's _
<br />-l
<br />ccrlifylhd th. ri\lcral rcBU lnl io ns re8rt i n8 lsrEn.src r,valarc nor lprlkrhhlo lhc pmjcci.
<br />--------T------
|