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ELECTRICAL.INSPECTOR RECORD
<br />APPHOVALS IDiSIG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinos (T-Bar Rouqh)
<br />Rouqh
<br />Service lvleter
<br />Notes, Remarks, Etc
<br />OWNER BUIII.,tJR DI'T,CARATION
<br />I hcEhy alfirm und.r p.tulr, of p.rju., rhd I m .r.mpr fDm ih. ContrrNr' !t.nc Li! f.r rll. folk'wing rBen (S.c 7011.5
<br />Bosin.ss and PNr.ssio. Cod.) Any Ciry or Counry which a{un s a p.mi to con{tud, .lr.r, inptuE, d.mlih ot Ep.n dy
<br />nruduB. t ior r. iis hsum.. al{ Equir.r th. appli. r fir such Frmit to fiL a sisxd irai.Enr rh.! h. or sh. it lt.n*d Pu$ad
<br />n, lh. pbvisbrs of irE Conkaror's Lr.ns.d L.w (Chlprs 9. Comcnci.g rirh S(rion ?0OO of Divi\Dn I ofrh. ausit.s rnd
<br />Ptuf.siDn\Cod.)oriharh.drsh.is.x.morrh.r.fommdrlEblsisforri.alh3al.r.ryiion.AnyviobrnnorS.dbnT0ll5byrny
<br />ipplici for a pcrmir ubj.ch tlE applicalrro acivilD.ml(yofnor mn.thdn fiv. hundrJ ddllrs(t500)
<br />-1.
<br />!s own.r.frh. pmFny, or my.'npk'y..s *nh $q.s n rh.n sk comp.n\arion, eill&) tlE wo* ind rh. cBlN n nn
<br />i .ndcd d ofi.r.d nr eh (S(.7O14. BusiN$ ond Pr.f.ssidns Cd.: Th. Cronki.ror's Lic.nr Il* des nor atrrly b anowmr of
<br />ih. F,l.ny *h. tlilds or impmEs 6oun, snd wln diEs sch *,k hinr.lfor h.6.lfDr rhtuu8h hh .r h.r o*n cmploy.cs.
<br />pruvid.d ihar \och im!rcwmds e mr i . al or otr r.d nx sE I I h)EEr, dE rriklina or itrptuv.dni h $Li wtni, on. J€.r
<br />oI compLrion. ft. oqncr auildd rill luE r ttrrd.n of Imviu lh1h.or:Jf, did n, tri[ or imptk uF,n,p.iy lor $. FllF{{of
<br />l, rsowmrotrh. prcp.ny, m.xcluiiv.ly contmrDs with lic.iFd contlcrou tD con{rucr rh. nmjed (S.c 7044. Busi,Es
<br />sd fir'f.ssirCod.: Th. Cont (n\La.ns. La*d..s nuraflrlyro an.w!.roflnp.nywtn htrildsor inprov.s th.r.ot,
<br />and *ho otudts lur such ptuj.c* rirh r comEdoi, lr.nkd ousunr to tlE Conrrctor's Lt.n€ hs).
<br />I rn.x.mpr uftl.r Sdion ,B &P.C forrhsrcasoi
<br />_ OrRri_
<br />IXlA[I&ttoutEdtiarra!
<br />DIiC].AXAIIOE
<br />I h.r.hyrlfirmun,l.rp.nrlryofFrjuryoncofrhtn,lk,einxd..h rn)n\
<br />-lh!v.MtsillmnrainaC.nrfEai.DfCons.nriDSclf-ln{r.Lr$o.r'.tmFnsarbn,,'!tuvid.JftrbyS..ibtJ7mollh.i%*
<br />for rh. pc.for'rtrc. of th. *olt fo. whkh rh. pdmn G issu.d
<br />villmintain wo*.6 conD.nerbn irsBr., as EquiEd by Serion 17(xJ ot rh. hbot CdL. for rh. p. omc.of
<br />c.'nn€nsr i.n in\unnc. catrier Md gnicy num6.r ar.:
<br />-l
<br />c.nifyrhai in rht p.rfortun.. nfih. p.d ntr rhich rhis p.rnn s issu.d, I shalln r.'ntby any p.^o.
<br />s as ro b.srr suhler ro rh. woiGs comF.n\dion laws of Califomia, md agt. dd if I rbutl h.com suhj..t ro ill
<br />work..s comp.nerionprovisi.ns oiS.dion lTlxl ol rh. L3tnrCod.,I dBll tunh*irh ohtly enh thds povniois.
<br />WAIiNING: Failurc m scure urkch c.ry)enerion mv..rg. n unbw{ul aJxl shdl suhj..( m.mpkry.t ro dimin.l lEmlras and
<br />on. hundr.d rhou*md dollrs ($lgl.({x)), in iddiri',n 'h. o{ In.nf.n.r'nn. J"m4.r i. Fx'vil.J f.' rh. \
<br />r,.( r.\{.r llr,\
<br />Ih.Ehyltlimuid.rI).nalryofli.rjuryrhdIrmlicn\edund.rpmvnionofChrnrd9(conmftin3wnhS.crnf,?0U))ofDivis.l
<br />.l rhc ausir.r\ md Prcf.sDns Cod.. md mylic.ns N intullforc.rrxl.Ifd.
<br />(1)[sl3u.Lua]r].Nill]ri-a.ri!!l}
<br />I h.Eby amrm un{d Fmlry of FrJu.y thd rhr. h a .odocti,n Lndin8 |3.Ny fo. th. p.riDmoN .f rhe mrk tor uhich lllis IE mit is
<br />n\o.d (Sec. l1x)7,Civ.C.)
<br />arB,lcatlItct tIBAIlo!
<br />I dry .trm und.r n nalry oi p.rjury onc oI rh. folhwh8 d..Earions:
<br />D.mlib! P.mits-Ash.(o\ Notilicatidn F.d.ril R+!lrtions (Tirl. 40, Pd6)
<br />-R.quftd
<br />t u.r.il&iifrrihn
<br />,
<br />-lrcn'b
<br />rha 'h. fed.,Jlr.suh
<br />#*L,lr*nr,""'rx,t
<br />rbns rtarding a\h.{os r.'mval rc nor qlplic$l? o ihis Dhj.ci
<br />i.di,)tr uxl {rethrtr,x Jbv.ltrntrrorion
<br />^
<br />ror.cr InF.tk'.omll}$ihillC(yrnd(i)Bnly
<br />ah,v. nEdi,ined In)Fny Ir insFcr
<br />Appliunr or Asen( Sisn"(u
<br />aurhnp. re,n.senrariver ofrht City Dd Counryh
<br />Rev 08-07'2015
<br />DATE
<br />Itrleter Belease
<br />FINAL a_
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