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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/stG OWNER BUTLDER DEL(ANA'NON
<br />I hcreby aflirm undq poahy ot psju,.- lha! I d .tcdfl ftum lh. Cdntra.ro6- Li.d* hw for lfi. follo*iry reun (SE 70ll 5
<br />Blrin6s dd Prolesion Cod.): Any cn, or (ou.ry ehi.h rcquir6 a Frnil ro comlrud. ahe. imrrovq dedolish or rc!6t dy
<br />srtuclue. Fior ro hs isu6.c. aEo r.l]lne rh€ spplicer for such pemri lo lilc a sisn.d slaldtrdl lhal hc or sh. b li..ns.d tuNell
<br />ro rh€ pFvisioos ofrlE Contra.rofs Licei*d I-aN (Chapr6 9, Conm6.i.g wnh Smrion 7000 olDnhion I olrhl Businc$ ed
<br />ProfNions Codc)orthar h. or sh. is.rmpl rhd.fronr and rhc b6sis for rhc allcs.d cro$nrn Any violatio. olsdion 70ll.s hy ,
<br />applicanr forap€mil subjcrsrhc applildrroa.ivilpcnahyolndrhorcrhenvehundrendollais($5m).
<br />l. s o\ ne'ol rhe propeny. or ary employG r'ilh s alLs s lhcn FE compd'rar ion. q ill do rh. { ork md rhe slru.rrc G mt
<br />inrcfldd or oifr€d lor elc (Se 70,14, Busin6s ed P(fsions ( od. Th. Cont.dois l-icse li\r do6 nol apply Io 6n o*'od or
<br />rlEpmFiy Nhohil&ori prov6$do!- d $ho do6 such \ o* hims.lf or h.R.laor rhouSh fiis or i( o\ n .nplola6,
<br />prolid.d rhar such inpruvmnrs ec mr interal or olrddl lor ele. It ho*6 s, lh. trildins or i'nrovd is $ld wnnin .rc ,a
<br />ofconDler ion. thc Otr ns lJ'rilds will hilc dr. hid6r of prcving rhd hc oi sh. dil n.r build or im!rcvc thc pmpoly for Ihc purpose ot
<br />I. a o*ncr o irh. Fop6iy. tun e(.ldsi!.ly conlm.rin8 $nh licdrsed contraclor ro consrrucl rhc pmjar (s( ?044, BGIN
<br />.Bl Proicsbn Cod. I h. Conlriclois l-icdsc I aN do6 rol apply lo m o$nd ol pro!.n, sho btrilds or imp.ov.s lhsNn.
<br />and who co.r.dsroi such prcjca si'h a Conhdo{r licEMd puGuant rolhc Conracroir Ij.de l-a*)
<br />I en .r€,npr ond6 sarion
<br />Drre: Osner
<br />woRxiRsr coiiria_Na;TroN
<br />DECIASAUa!
<br />I h6eby amrm und.r Fnahy ol pgjury on. of th. lollo*'iry dfflealioN:
<br />I hav. md sill,minr.in aCelificaleolconsenr to SelfJNtrrc lor \vorkss compdetio.I provid.n aor6ySclionlT00 otlhe
<br />trh, i'oJ. fc"hc rd Ltu.c olrh. rr for(htrhrh.p6riba.J.
<br />tL I ha\ e and s r Ll rainGr ( orlss cnmncNar'on 'nsurinc€. 6 reqund b) s..r ion 1700 of Ihc tibo. ( ode for lhe prlomecc ol
<br />lhe \or[ for Nhich lhis p.mil is i$u€d My vor*6 coi!ftarion iaurmcc.Mi6 and tElicy nrmbs dc:
<br />,*., 101w
<br />nro,,,.,*. ' VIJC,S aIlgz O 11 *rn* ' l\ l1t?ELD
<br />I ccdliyrnir in rlE p.rfonn.n.. ofth. work lor shi.h rhis p.nnil is issucd. I shallnol dlloysy p6on id any mmnn
<br />s mlo beomc bj4l lo lhe vork6s' compcGarion laNsorcaliromia dnd,,!d lhd ifl should b.comc srbjtrl lo thc
<br />*ort6 comFrelion rovdoG orS(lion:1700 orlh. Llbor Cod..lsh3ll.lodhrvnh comply withrhos pmrisio6..
<br />WARNING: Failur. ro sulc \ork€6' comp.nelion covems. is u.la$ful. ed shall suhj<r an mployd to aiminal poaltis.nd
<br />civil litrcs up to one hundr.d thousnd dollds ($100.000). ia addilion lo lh. cosr olconp.nsriod. dmt3e a ptovidcd lor lhe
<br />S.crioa 1076 ofrhc Labor Code. inl€r61od atlomev s ld la
<br />DECIABAIIO!
<br />I hs€by a,Iim undr pdalry o f Fjury rhal I d lic.ns.d undd troeilionoachapld 9 (cormacinB rvnh Scclio.7000J olDivision l
<br />of thc Busind md PrcfsioE Cod€. md
<br />'ny
<br />li.ce is in full forc ed .fi41
<br />,.-.".'*'Cto,,-,".ll4lu,zo l,icmcNunbd: 'Vl\rtvt+ dZZ
<br />col alcrjoNLElDllclcElcr
<br />I ha.by 0rrm ond6 Fn,liy of pdjury lhal lhqc is a consruclion lddiis alocy tot rh. pdfomsc. of thc sotk for qtich lhn p6nn b
<br />issucd (s{ 1097.ci! c).
<br />AESIICAIfDECLAAAIIO!
<br />I hd*iy allm ondd p..aky of lgjury on.ofrt.lolloving delealions:
<br />Detulnio. Pmirs'Asb6lN Norifi.ation Faldal Rcsuar ions (Tnt 40, Pan6)
<br />R.qun.d l,cll6 of Norilicaion
<br />I c.ni! lha rbe a.ddal r.sul.tiotr qrdinB NrsIos rmo\ .1 .re not applicshle to lh,s projd
<br />Y4.*,r, u,o, , nu"" *.,,,,is amr(.rnr Md srrrc rharrh.abvenrlornmrioniscor€ci I aslelocondysirhallciryand(ounr!
<br />odman.cs and Srarc l?Ns rrlari',r r.ln'iunrr 'i'.h.tr. rkl lici.1,! xrrlfflze dn$ ofrhis Cirv md fi,unr) k,.nrd trnrn rhc
<br />abo\c nrmrioned pftrpen, fo! insp.crion
<br />Alplicrnl or Aeml Signrtrr.
<br />Pcnn iIm ninc (print): t\
<br />r q ,,".1/4 ftnzo
<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 I D*rt)ct -H.8-7
<br />Transformers l t,
<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)I
<br />lvleter Release tl4,u D*ooa -+n
<br />Rough
<br />Service ltleter I
<br />FINAL D/W)*.&ffirlTTNotes, Remarks, Etc
<br />+
<br />COMMENTS
<br />.2*
<br />*". t lqltnzo
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