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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER I}UILDER Df, LCARATION
<br />I h6.b artrm ud.r !E aliy oi pdjury thol I m .rcmpl tion thc ConlkoB LicN lnw tor ln followins ,.&. (Se70.l I 5
<br />Busins and rrofBion Cod.): Any Cily or Con y which t.qui6 a psmit lo con$run, ahs, imFova danolill, or EPan &y
<br />srtu<ruc. Fi, ro irs isuec.. atso requir6 rhc a9pli.dl for su.h Fn to 6L a siEncd nrtmol lhal h. o. si. is licoql p@ul
<br />to tbc Fovisio6 olthc C. @rofs LiccMd trv (Chaprd 9. Comcncing wilh S*lion 7000 oaDilisiot I oftbe BNinN md
<br />Prolesions Cod.) or $ar h. or 3hc i. .xdnpt thdctom md lh. besis lor the allcBcd cxdFio. Any violarion ofSa]1ion ?011.5 by any
<br />opplicanr lor a Fmir subj6rs lhc applicd ro a civil penrhy o f nol mor€ lhe fir. hundrcd dolld ($500)
<br />-I,
<br />d ow.d ofrhc prcpely, or my e,nploy6 wilh waae s lheir sl. o,npd$tion. will do thc work dd lhc slrud@ is ,ol
<br />inrddel or ord.d lor sl€ (Se.7044, Busins d Prol6io6 Cod. Thc Codtaclols Licd$ tnw do6 not apply to e owno of
<br />rhc pmp<ly wh6 bdil& or iryrovGlh@n. dd vho do6 such wrl hirs.lf or h.6.llor thtuqh his ornd oM€nploy6,
<br />providdl thal such inprc\mdrs e nor ddd.d or olI6td for $16 Il how.E. lh. buildins or impm\@dr is eE wnhin ohc y@
<br />ofcompkion. d. OM6 Duildg rill have rhc hrdd ofroling ta h. or s,r did rct b{ild or imprcw lh.
<br />',!Fl,
<br />aor $. }4ne of
<br />l, s ownr ofrh. propdr, m .rclsivcly conlrodins pilh licqs.d co rad66 ro codod rn Fojal (56. 7044. BuinB
<br />and PJrEsioD Cod.r Thc Conrrelois LicaE liw do6 nor ,pply ro e oend of pIopsly who builds or @prcv6 lh6@.,
<br />and who coilr.cle lo, such Fojet wnh a Co.hdorls) licmcd puruul lo lhc Comtadoa! LicN tfl).
<br />I ancxcmpl undq s.ction .Ll &l'C iollhis.6on.
<br />D!r. o*rcr
<br />votrxDBsrcorllEltaIlQ!
<br />DICI,AA{IIA!
<br />I h€r€by aflim unds pcMnyofpdluryon.oflh. tollowins d.clmlions:
<br />-l
<br />hav€ ed wiu dainrain a Cdificar. of Co,Mr lo Scl Nur. for srtd codp.8.rio., 6 Fovidcd tot by Sclion 3700 of lh.
<br />Libor Cod., for rh. Ffolrm.c of lt Nort aor
<br />"'hich
<br />lhc Ftni b i$u.d
<br />'1lhs,cand"rlln nch " 0r(6' comp<Bar 'on
<br />NUMCq r.quncd by s..liofl 1700 ollhc !ab.r Cod., aorth. Ffommccof
<br />lhe wo lor which thb DGnil is isued My worl6 comD.Ntion i6uruc. 6id od policy numbs e:
<br />"*., ff l".tit:-;c,?L)f tcL'
<br />"ai"r*,.r,-,
<br />t- 6 j 0QQn1J ( -7o
<br />I c<nirylh in d. pdfonmnc. ofth. work for phich th6 p.ml t i$rol. I shall nol nploy my pd$n in dy ftdn t
<br />s s to haooc subirl lo lhc mrtd' ooEtualio, laws oacaliaon& md .sr lhal il I should bdon subjd |o rh.
<br />wort6' ompcMlio. poli3io4 oasrtion l?00 orlhc bbor Cod., I slEll fodhwih conpl, sirh rllok PmvisioN..
<br />1IAIiNINC: !_ailur. ro *s. *ork6' .oEp6Erio. cov@8. is unlawtul, 4d shall subj<r e dploF to aiminal loBhi6 d
<br />civil finsuptoon hundrcd rho@d dollm ($100,000), in addiliotr lo lhc con otconpcnlario.. dimaB6 6 provided fotlh.
<br />Sarion 3076 ofrhcLaborCod€, int661dd alo@y s ac.
<br />,,,.2 - [l-l u U'A rc
<br />l,tct,tNsltD (oNTR ( T()R
<br />DUIAE4IIqI
<br />I hmby.mnn undd pdahy of p€rjury that I m lica34d undd provGio. ofchapl6 9 (comndcins wifi Sc.rion 7000) ofDivision l
<br />of lh. Busins md Prca6sions Cod€. md
<br />'ny
<br />licds is in tull forcc md .fi8r.
<br />Cb N
<br />i
<br />\15
<br />(- t v,n! 9o
<br />caNrltruqrotr.LExD,llc-ac
<br />I h*by amrm und€r pcnalty ol pdjury $ai rh@ i! a connddion lcndins asocy lo. lhe psforoc. of lhc Mrt tot vhich lhis pqnil is
<br />issu.d (Se. 1097, Civ. C).
<br />AxfI,rcANfDlC!4AAIlAd
<br />I hdlby rlim undd Falry oapdlury on. oa lh. followirB &cladions:
<br />D€mohion Pdite&b6tos Nodficalion F.daal R.8ulaiions (Tnk 40, Pan6)
<br />Rcqun.d ldl6 oi Notificalior
<br />I c€niay lhal the fedsal r€guldioN egddi.s shcslos r.nmval . rol applic.ble to lhis piojdr
<br />lry'l cdiry rha I harc rsd rhis applicariotr ad sralc rhar rhc Ebovc info@rion G cord. I 08re Io comply wi$ atl cny ud counry
<br />ord'lanc6 and Slar. Laws r.l.ring ro buildin8 co.slrudion. ud
<br />i(
<br />r.pr.sralive o l'this City ud County to al6 uron trr
<br />abovc neotio.ed lropdy lor i$petion pulpos
<br />Applic.trl or,\pqr SiAn.rur.:tL -,",2't(- (ozo
<br />n it I \,<, r.,t)a
<br />Site-Work
<br />Underqround
<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 />Bondinq / Groundino / UFER .Xtflaoio ALaro.t<q{
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners I t
<br />Roof Top equipment lthhr aYl'1fr7),lb/b&)ru
<br />Factorv Wired Unit I
<br />Walls (Conduit)I
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouq h
<br />Service ltrleter
<br />FINAL 'Lllltqw fib&q'l 6/
<br />Notes, Remarks, Etc.
<br />siE!
<br />Rev. 08-07-2015
<br />1a ,"
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