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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS OWNER BIJILDI]R DET,C RATION
<br />I hmby afiim ondd p.flally ol Nriury lnal I ron .xnpl eon ln. cont.ctoB Lictr. LaN fo,lh. follo$ing r.en (Sc.7011.5
<br />tsusinBs ad Prol*strn Cci.): .^., Cily or Cou y $hi.h r.qun6 a p6nn ro conitud. tnd, inprov.. &molish or EIEtr Mi
<br />slnrcrm, pior ro i(s irsuo.., .le r.qutB th. applic l lor such p€n.n to fib a sisn€d sahar th.t he or she is licos.d posxd
<br />ro rhe provGions ofrhc ConrEctoas Liccns.<l Lr* (Chaprcr 9, co,nm€.cins wilh S6lion 7000 ol Dilkion I otthc gusincs dd
<br />Prof6sio.s Cod.) or rhar hc or 3h. is.r.mF lhd.ftom Md th. bsis for lhc all€scd €x@Frion Ary \ioLlion olS€clo! 70ll.t tyrtny
<br />appli.a tor ap.mn subjearhe 0pplicanl lo acivilp€nlltyor.or nor.rhm liv. hundrcd doUffi (5500).
<br />l. N orn( oI lhc pmlcny, or my .nplo,6 lvilfi \ a86 s thci, $lc conp$arhn, $ ill do tn t ort ed lh€ slru.1de i nol
<br />inrodql or olls.d for sl. (56.?044. Buin6s and Prol6sioN Cod.r Th. conlra.rois Li(re lj$ &16 nol ,$ly ro d otrns of
<br />rh. !$pc.ry vno hrilds or impre\6lhd@I\ and *h. dos su.h $olk hlNellor hNlrorlhou[h his or hd own cmployc6.
<br />pruvidal thd so.h inproldnmls re nol inlsd.d o, o,Is.d aor sk Ii t[J\yde. rh. hrildin8 or i'n rovft.n is $ld vi(hin on. ,a
<br />or conDldion. rh€ O{nd Brildd Nill havc lh. burd.n of FolinB th.d hc or sh€ did frn huild or i,nFov. thc pop<ly for lhc Puiroe ol
<br />l. d o\rd dlrh. prctdy. an ercl$nelyconlr.clinr \riih liceoscd c6.ta.1os ro .onsrtucl lhe prcjcl (Sc.704'r, admN
<br />and PFft:snn Cod€: Thc Conrra.rors Lic.ns. Law doB nor apDlyro anorvnc ofpropdy vho builds or implov.s thsFi,
<br />and $ho .onlmds for such prclds $nh a Co racro'1s) lice.$d pu6linr to lhe Cofllractois l.icot tas)
<br />I dn ercrnpl undcrSdiion Il e P( nYihisr.ason
<br />]tqBtrEtsS]g&lItrIIAIA!
<br />DECIAAAII9!
<br />I ncreby.inirn under p.n.llyofpgjuryo.eorrhe f.llorvinr dtlearn ts:
<br />I hrre sd Nill nainlai. a C€.r ilicdt. ol Cocdr ro S.l Bur. lor \.116 comp*salioo. d p.ovidcd lor hy Sdlion 1700 of thc
<br />bbor cod., for rhe pdaor:ffic of th. $o* tor which thc pqhil is Bucd
<br />lhavcand qill'nai ai. workds conrp.Bart'n ihsurancc, d r.qon.d bySdion 1700orthc tnl)or ( odc, ior lhc pofonnuce of
<br />th. \ro for *,hich this p@ir ir i!su.n. M, worlm comFMrion iBuroc€ caris dd policy nunbs a.
<br />.rycr Nunrbq r\ni'6
<br />/f&i,ry
<br />rt a -tcr*t^mancr orrhc s'orr ror rhich rhis pemn is i$ud. I lhall nor mploy.ny p.son in anymdnd_ 6 e ro b€om. subj(l ro r h. *{r}6 @mFsd,on l,$s ofcrlifomia, dd a8re ltal it l should b<.ft sobjct b lnc
<br />soirdl cofi)aqion rmGiod ol S..lion 1700 oa$. hh.r Cod.. , 3nalL lonhwith conply silh rhos pbvisioB..
<br />wARNlNc: rzibrc lo sre Nrkss srrpseltun .ov@s. Li !trla$lul, .nd shall suhi€ct d qnployer ro dnninal poslliB afld
<br />.ivil nnd up N onc hun&ed thoustrd dolls (!100,000), in addnion ro rlE .ost ol compq$lion. ddrgc. d pro\idcd for lhc
<br />".,",0114
<br />frh. Labor Code. inradand tomeys
<br />4lo nroI]--1-
<br />r)r:( r. \R \ r l()\
<br />I her.ty,mnh undd p€nahyolpcrjurylhal I fl li.ds€d undr Folision of( haplr 9 (commocins wnh S&:lioo 7000) oaDivision I
<br />ol rh€ DEins aod PofsioB cod., md my lic# is in full foicc ard €[ecl
<br />0 o
<br />cQlsraIJEllottENlllc_aclilcl
<br />I hr.byaflirm und.r Fn.ltyolrFjurylhal lh@ isa coNtruclio. lddins ar6cy forlh. p€lom ccollhc$ork for Nni.h rhis pdmir is
<br />issucd (Se. 1097. Ci!. C )
<br />AIILICANLIES.AAAUOX
<br />I hsd,r'anim undd pd.hy of pqjory o.e oafi. aollowin! delsll ions
<br />D.mohion Pd,niis-Asb6tot Nolificalion F.d@l R€guhrions Onle40. Pnn6)
<br />Requncd Ldl6 ot Nolificatio.
<br />ffi,;"'d;ilffi''ff*#*;*ffi;**i******,*,,,,,**,*.,,"
<br />atNrc n,enrirned n()ncny fo aper
<br />tpnlicanr or AB6r Sign!tu
<br />rcrmirre ngnrc r prinr r: /-tI\-.Qlezlln?o
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor I
<br />Bondinq / Groundinq / UFER , L\("YlT"m,Y\c\,Cr-X-t
<br />Transformers \
<br />Torqueing
<br />Air Conditioners l.t
<br />Roof Top Equipment ?llt llrt 'bf\+v\\..-*b-")
<br />Factory Wired Unit I- I ['
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />t.\J
<br />Rouqh Z\I,YIQ YKflI vl.-+'4-/ -
<br />Service Meter 2,tlo-\'N I;A/,bl lav>>'/ .
<br />FINAL '>^l tn'\,t ,1-:,+/[\.4 x*l
<br />Notes, Remarks, Etc.v'{ \l -
<br />(
<br />Sub-Panels
<br />*.*..ro C,[,
<br />^" o\l'lTo7-o
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