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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I ho.ulL amrn undd p.nahy of psjury Ihal I m ercmpt fmm lhc Conta.rou- Li.d* h$ aor itu followin8 twn (Sa 70:11 5
<br />Rusin*s d ftofNion Cod.): Any Ciry or Q,u.ry rvhich r.qun6 a p€nril ro conslruct. altF. ihprcve dmolish or r.tan any
<br />slnrcturc. Itrior ro ils issulocc, also rcquts the rppli.dt for su.h Fflnit to fil€ s sistcd slalcmdl lhai h. or sh. is lic*.d p@.!n
<br />ro rhe polisions olth. aonlmcrois Lice.sed Llw (Chaprcr 9. Codnen.ing virh Sdiotr 7000 oa Division .l 6fthc Busins ari
<br />Prol€sionsCodc)orlhsth€orsh.is.rmprrh6.6o'nandlh.b6isaorlh.slles.d.\.mflion.AnyliolarionofSdionT0ll5byany
<br />Applic. foia'tmnsubjdsrhe.pplicanltoacivilpcnalryotnolmorerhtnfivchtndreddollars($500)
<br />l. s o\vncr o f rh. pror.ny, or mr emplorRs wnh $n*s s rlEir ele .on,pdetio., $ill do ih. sort od ih€ ntu.ruc 6 @l
<br />inrolkl or oftr.d for s.le lse.7o44. Bxsin$ and hof6sioN Codc ftc ( ontrador's Licflsc LaN do6 .ol ,pply ro e orhd ol
<br />rh. pru!.ny who builG or improv6 tr6on. dd sho do6 *.h \\oft hims.lfor hmclf or lhrourh hk or ha om dnploy6.
<br />pr$ idcd I hat sucn i,p.ovffnls de tul inhd.d or olI6ql fot elc lf. hos 6's. rhc tlilding or inpo!@m is sld wnhi" onc
<br />'@ofconrpldion. rhc Own6 uuillr $ill na\ c lh. hr&, orpovinr thal hc or she did nor lrild or i,npm\ e lhe Propqly tor lh. I)urF* of
<br />L 6ovnerolrh.rropdy, dncrclusiv€|, contradins Nith li(dsci conttcro6 lo conslrucr lhe projftr (56.7044, Dusins
<br />d Prof6sirn Codc: Ihc Conlracfft Li..nse l-aN do6 nd aDtly io e o\rns olprop.ay*ho buil& or nnpbves lteron.
<br />and \sho conrdds lor su.h pmj.ds witi a Contmclo(n licdcd pucua.l ro rhc contadoas Li..6e LoN).
<br />I ahcr. rU undd S(rion
<br />Dire, Orn.r:
<br />\tORKERS' C'OMPFNSATIOii
<br />DICIAAAUOd
<br />I hcr.by amim undd pd.lty ofpqjuryon€ ollhc iolloNins d*lddio.s:
<br />I hAn dd sill maintain . Cdiificar. ofconHr lo S.lf-lNur€ aor \ o' k6 ..mp.N,liotr. 6 previdcd to! by Sdrion l70o o f 'h.Iibor Codc, fo, lh. pnfonnan..of rh. trork ior whicfi rh. rmnil ie isued.
<br />! la.c ana s,tt mairrain *-los' c. TI,(6arB'n
<br />'n!u' 't. s '6,.reJ b!
<br />rhe $urt fo, $h'ch rhs omrl r\ rsu.J M\ rc'l.t ,('nmerbn ibulalcc
<br />,.",- 4"4,rJ 4.J
<br />Serioa 1700 olthc L$or Cod., aor lh. p6fomdc. ot
<br />ceid dd Dolicy numbd el
<br />3/re/z-";ltyN**-,ZJa|€c-AAi3Gz rrnn6
<br />fl ccniryrhar inrh. p(bman . oarhe $or[ lor *hich $is pdtrrl is issutd, I shall nol mploy any p.son in dy md.6
<br />$ Nb b..onE subj€t ro rh€ Nod<m compdsaiion la$s orcalifomia. md alE thal if! should b.co'nc subjccl io
<br />'h.$olkLs' comBrslion Do isions of S..lion 3700 ollh. tathr (trdc, I shall. fonhwilh comPly wilh lh.e pnrBioro
<br />wARNlNc: Falfure r. surc \orksl co,npcnsalion covng. s unla\rlul. md nmll subi(t qnploy€r lo snnml ldshie af,d
<br />civil fin.s up ro one hundred lhotrqnd doll6 (t100.000). in dddniod kr rhe.osl ot conrp€nsln,n, ddases a Provid.d for lhc
<br />sdion 1076 ofl[. kbor Code inicrsl and allom€y s fes
<br />I hcrcby amnn undcr psally orp.rjury I
<br />DECI,^EAIIO!
<br />undd pro\ision oiCnlpld 9 (...nnm.in8 \ilh
<br />ol th. liusifls md P,olsio6 Codc. dd ny li..nse is in lull forcc .nn e,Icl
<br />Li..nsccrass B
<br />,n,, //ror/2. o
<br />1a r*37,/
<br />I hcrcby nfinn unds pen.lry ol Dqiury lhar thre is a.oNrtudion l.ndih8 asocy lor the pcromance oanE $ort fo! $tichlhis po rn is
<br />r\$.J (SN r09r,(i! ( )
<br />AIEIICANLIECIA8AIJAN
<br />I hed, atrm !.dd p..rl't oapdjury on. olrfi€ lollowin8 deledions:
<br />Dcmohion Pmns-Asb<ror Norili.atioD F.d6al R.ruLtions (ill€ 40, Pan6)
<br />-.Rcquircd
<br />Latd olNodncdion
<br />I cgliay rhd lne f.dml r.sul0tio6 rcsediog 6b$rE rdnoval dc not .pplicabl. lo ltis prcj..l.
<br />-x (d 'b rh,r I ha'. rad rhs applrar ion ad nar. rhar the sbo\€ iolomalion is cold I agra Io comply vnh 3ll Ciy and Counly
<br />^id'n,nc6,nd srar. tiqs rcldrnE ro blrldrn! coBrudrcr ud hftbt aurhort. r.pr6dlali!6 otihis Cilyand Counlrlo nra upon lh.
<br />alh\cn,snlLonei pfuEnv lil Blt.ri()n
<br />.\nplicrnl or \[cnr Si!mrtrrr
<br />/r4.t'(^lld ,//'/2.
<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 / Groundinq / UFER
<br />Transformers
<br />Torquein s
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rouqh)
<br />lt/eter Release
<br />Rough
<br />Service Meter / /FINAL t /'Lt/ 2/24 P/,{/l/0F
<br />Notes, Rema'rks, dtc.I
<br />APPROVALS
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