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ELECTRICALINSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OscrBuildd D.cldalio,
<br />I ho.by .ffin uda Ff,.lty ofpsjury th{ I m dmpt fom lhc Conr&tou Lictu. k* for th. iollowin8 rdon Ge 7031 5 BBinB
<br />ed Ptuf6iM Cod.) Any City or County which rquiB s pcrhir ro co6tud. rlrd, imprcvc &molish d Elair y sr'D.tc, Fio. ro ats
<br />ksud.c, also r.qut6 $. lppli@r forruch Fnir bfilc.ri8n.d n da{ thar h. or shc h li6s.d pudu&t to lhc !rcvisioc old.
<br />Conr&lort Li@*d Law (Ch.pt r 9, Cmncndng with Serio 7000 of Division I of $. B6in6r dd Profsios Codc) or thrt hc o
<br />sh. h qnpl thBciion ed th. b4i. tu thc .ll.g.d dcmrdon A.y violatior of s4tion 701 I 5 by u, appli@l for o Fmn subjdts th.
<br />.ppli6r lo a civil p.ndty ofnd nN$e fir hlndrcd dolls (1500)
<br />I,s owncr of rhr Fopcdy. 6r my mployG with *ag6 4 rh.ir sol. omp.netim, rill do li. wo* dd $c thclE E nor intmd.d
<br />or olI@d ad sal. ( S.c 70,14, Bsin6s ed Prof6im Cod. Thc CdEeltrt Licosc La* dG nd apply to s o*n.. of thc p,oF.ly
<br />wno builds or inp.ovs $6co., md who dc such work hiN.lf or hdclf or lhrou8h his or h.r M cnployG, provid.d lhd luch
<br />imprcvmcnls e nor irt ndcd d orfd.d ld salc If, hovcrd, thc building or improv.mmt is sld *ittin on. y.d of.ompl.!o. O.
<br />Own.FBuild.r will hav. lh. burdd of poving thlt h. or shc ml build or inprov. fd dic purlosc ofsalc)
<br />_1, a omd ot lh. popcny, m c&lsiv.ly @.redn8 ,iln lic4cd @b&I6 b @n5tut lh. Fojat ( Se. 704a, Bai.G ed
<br />Pofesion codc Thc Cort.l*'s Lic4. Ll* dG not arpl, lo e @nE ol proFty who buil& q improG rhotr . nd *ho
<br />cd!&ts f6 snch pmjer5 witn . Conr&G(, li@.d puRumt ro ln. Cdretor! Limc Lrw )
<br />I m.xmpt und.r S4lid .B &PC ftrlht E6on
<br />YOAKESI.COMIEIIAIIAN.OECLABAIIaN
<br />I h.r.by amm undcr poolty of psjury on. of lhc follo*ins d*ldations
<br />I Mvc dd *ill rainrain a Ccni6crt of Consor io S.lfinsnrc fd wort E cmposalio, a povid.d for by Scdion 3700 of $c
<br />Llbor Codc, fo.th. pcrfm @ of rh. wo.k f€r vhich th. pcmir is i$u.d
<br />I hav. edwill m.in6in wdk6 compds.tion insuruc€, 6 rcquird by Sccron 3700 of thc Labor Cod., lo thc pafomec. oa d.
<br />work ftr vhich rhk p.mil is issu.d My wdt R mp€ns ioo inslmc. cuicr od policy nunb.r m:
<br />(Thi. s.ction ncd nor b. cmpld.d if th. pdmit is for O.. hun&.d dollm 1l I00) tr l6s)
<br />_l ccnify tn.lin thc pdfmu.c of 6c work Ir which this F6nir n issucq I shall nor.oploy &y Fson in dy nuncr so s ro
<br />b.c.fu subj.( to th. wort6 ' .mFn$li@ l.E of Crlif@it, d agrc lhll il I should bdomc $bjccl 10 rh. wclcB
<br />comFf,r.rion prcvisions oa Sdrion 3700 of fic Lrbq Codc, I shall, fodhwnh coftply *irh rh@ p@yisions
<br />Dzl:: +- /?
<br />^epticdt
<br />WARNING: Failurc b 3eurc eo*6' @mparsdi@ @vaig. is ol.*ful, sd shall rlbjcd m .mployd lo 6imin.l podds ed civil
<br />fir6 up ro o.c hun<lad to6ed dolla (1100,000).ii sddidon !o thc 6r of 6mFrrrri@, d,mrs6 4 providcd rd ttq Seti6 3076 or
<br />dc L$d Cod., int 16r $d dlomcy\ f6
<br />IICENSED.CONIXAqIABI.DECIdIAIIaN
<br />I h*cby a0lm und6 pa.lry ofFrjury that I e licin&d unda prwisim or chaptcr 9 (co6h.nci.s with s.crion 7000) or Divilion 3 of
<br />thc BGinBs dd Profeids Codc. &d rB licnlc t i. full fo@ dd .f[..t
<br />COXflBICUANIEIDEGAGENCI
<br />I hrlly rlfim unda ,.ndty of pdjury dn lh@ is a cd.rucdo ladiig .gcicy fd dr pdfmre of lhc rdt fd which thi! Frnt i3
<br />i!$.d (Sd. 30r, Civ C.)
<br />4IEUCAXI]IDECIJSAI,IO!
<br />D.molirioo Pmil5-Asb6r6 Notificado. F.dcr.l Rc8lladdt (Tnl. 40, Pd 6)
<br />_ R.gutcd L.nc. ofNotfi..rid
<br />I ccnify rhar thc &dcr.l rgularions rgddin! 6b6tos rcdov.l e ior appl;cablc ro ,'is prclet
<br />* I canry thd I h.v. r.ad this .pplidio. d sEl. $at rh. abov. infomarid is @rer I lare to cmply with all Ciiy od Counry
<br />ordinoc6sdSllt tas Ehtins ro buildin8 consrrucrion, ad hd.ty auL\oriz r.?6at4ivB ol $is City &d Counry io nnr upon fic
<br />abovc Mlioncd prop.ny for insp€clion puD66
<br />-.6ua-/ /2.-',1-4.
<br />6
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />EVDIDE n
<br />Rough
<br />FFRNI I 0t9
<br />FINAL
<br />Notes, Remarks, Etc.sAMLi O'.rO, avv' itoe, uur
<br />Service Meter
<br />L.n.Lr'r AddB: _
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