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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h€r€ly sfinn undr p.nalry oip.rury llEl I en .xcopr 6!,n rh. Codra.toB Lic.B. tiw for lhc lollowing IEdn (Sd 70ll 5
<br />Busi.6s and Profsioi Cod.)r /sy Ciry or Cou.ly which r.qut6 . pdrl to co6tNcl, Ellq. improvc ddotish or rean any
<br />strlcru.e prior lo irs i$u cc. also requn6 rhc appli@r lor such ,6nir lo fllc a siso.d $.l@e th8l h. or sh. i! licffi.d p@anl
<br />lo lhE provi.sioN ol $. Corfiactoas Li.m.d llw (Chapr6 9, ConD..cin8 *ith Seiiob 7000 of Division 3 of lh. Bsins Md
<br />Pof*sion codc) o. thar hc or sh. i! a.mpr thddron md th. b6is for lhc .ll€scd flmprion. A.y violarion olserion 701 I .5 by ey
<br />appli.ant lorapm subjcrsrhc applicad $ . ci! il p.mlry 6f not morc lhm fiv. huf,dr.d dollds (1500).
<br />A?* ",". "4r,"
<br />p.p"ny,
<br />"r
<br />6y cnplolr6 wirh s6s6 d rh.n $k onpcBdlon. w l do n $od(adt nnEl6s mt
<br />inlsd.d or otta.d aor slc (Sd ?044. BGin< ed Proa6io6 CorLr Tn. (.onkctois Licre L5w do6 ool apply Io e o*na oa
<br />rhe pmpdy who builds or nnprclellE@c oid s'ho dG sucfi e& himsclr or h@lr or rkough his or hd om mdoy6.
<br />providcd rhar !u.h imFovffits @ mr hradol or orad aor ek Ii ho*d6. ti. hliBin3 o. impror6*d il $B *thin on. ,ur
<br />of corplcrior th. Ornq B!il,:b will harc lh. hrdq ofFovins rha h. o, ,tc did rcr hild o. inFo!. l!. poFy for $. purpos of
<br />l. s 0*16 oarh. propdy, m cxclcivcly conhcling wnh liccN.d conrmcros ro oNrru.l the poj.cl (56. 7044, BBne
<br />ad ftoftssion Codc: Tne Conlraclor'3 Liccnse Lrw do6 nol !!Dly lo e own6 ofptupGly who boil& or inproc rha@n,
<br />and who contrels lor .uch projcd! qirh a coirado(, licd!.d prEwl b th. conrra.rors Licdc tiw).
<br />_l &n exmpl ud6 Sdtion_. B. &
<br />D,n". - /-t(- 2-0 o*mr:/-
<br />DECI,ASdIIA!
<br />I h*by afid undd p.nally of Fjuy oi. ofthc loUowaie deldltioa:
<br />I havc erd will ,naidoin a Cdificalc ol Comctrl ro Sela-lmurc for wo,k6t onDdelion. a Fovid.d for by serion 1700 ofrh.
<br />tibor Code, aor thc pafonnmcc o I lhc work fo! which th. pnir is issu.d
<br />I harc and will nai.tlin workcrs .o pcnsarion insur.n.e, a rcquircd by S(tion 1700 oflh€ LaborCodc,lorl& prrom&c. of
<br />rhc *oik for $hich (his pmit is ilsucd My worlm conlPl'Mlion imxmce cri6 ud policy nunber &e:
<br />[L4^ro,,nn t" r* *^^anc€ orrhc wolt for \vhich rhG ,,qn is B!cd.I shall.or @plo,eyF6oninmymm6
<br />s d lo bcon suq..r ro rhc wod(6 @nFE.lion las ofcrlifomi& ed a8r rtol il I stDuld b€onc subjd lo th.
<br />wort6'coDp.tralionprcaisiosorse.lion3T00ofthcLatorCodelslEll.fonhvilhcomplyv{hthoepovaioB
<br />WARNING: r2ilurc lo su. \eork6' comp..slioa cove.aa. is unhsrul ed $all tubjal d 6ploF lo aihinal lotlrie ed
<br />.i!il a6cs up ro one hundr.d rnoue dollm ($100.0001. in addit lhe cosl of co,npcNrion,
<br />S-rio.1076 ofrhcLaborCodc, intd6r md attor.ey s a6.a/-/l-ao Y-e
<br />DECIdtrAIIOT
<br />I h@by afm n.d.r p.naiy of Fjury thal I e lic.trs.d und6 Ftrvlrion ofchafld 9 (conf,d.ite *ith Sdion 7000) of oivition l
<br />of lh. Bcins md PDlNioG Cod., .nd ny lic.M b in tull fore &d cll*1.
<br />g)NTIAUCUAIUENDINCICETCI
<br />I h*by amm undd Fnaly ofpdjuly rhar lh@ i. a coiirocliod l6din8 almcy aor fi. p6fom{c€ ollh. wrt tor shich lhis pqnh is
<br />iesucd (Str. 1097, Civ. C ).
<br />AIfI,rcATLDECI,ABAII()T
<br />I badrt afEn undE pEally of p€rjory onc oa rhc follopins deldal ions:
<br />Denolnion Pdnns^sbdlos Norificdion I'cdqal Rcaxl,lioN ( lill€ 40, hn6)
<br />Requted If,llr of Notificalro
<br />I cqriry rhar th€ far..al GsulalioN rlodidB eh6!o. @oval s. not ,pplicablc to this pmjet
<br />(z?,t iry that I have rad Iht apphcarion od starcrhal lh. lhdve infomation is coE€d.I alre to comply Lvilh all C yand County
<br />o.dinancd ed Sbr. ti*s rclarin8 ro blildi.g ion. ud h6cby aulhoizc iv6 of6i! Cily &d Couly 1o ata upon tlE
<br />o.t t / -A'-Zd
<br />ob.ve mdlion€d pDp€ny ior mspdlion
<br />Appli.anI o.Ag tSign,,",.y-,L 4rcoscAro c [*,,t--
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht 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
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<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 />Rough
<br />Service Mety'r -/FINAL // t-{/:aX Ft {aruO
<br />Notes, Rerhark6, Etc
<br />Rev.0B-07'2014)
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