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ELECTRICAL.INSPEGTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION <br />I n.rcb amrft undd poDlry oapdjury lh,l I m ermpr Eon rh. Cont.cto6 l-icm. L{e for thc lollowinr r.en {Se.7031.5 <br />Businds and Ptufsion Code)r /\., aily or Counl, $hi.h r.qrne r p€mn to connrud. all6. impolc. donolbh or reAiii dy <br />stnrcru.e prior ro irs isuancc. ale r€qut6 rhe applic r for such pcmir ro file a r,8n€d stsr.md rha h. or sh. is 1i.6s.d pouumr <br />ro rhe pm sions ofth. conlraclois Lic€.s.d La* ((naprer 9. Comm.ncins rilh Sdion 7000 ofl)ivision:l ofrh. Business fd <br />Pmf6sions Codc) or llur hc or she n ercmpl rhg€iioft and th. bais for rh. alleg.rl eranprion Any violarion ofS..lion ?0:r1.5 b, an! <br />Applicaor fora p€.hn subjers rh. atplica to acivilpenaltyofnor nor. rhM liv. hodrcd dollm ($500) <br />l. 6 osr€r of thr prorEny. o! my cmrlorG \rirh Lvas6 s lh€n $E compss.lion, Nill do rhe $ork and th. ntudr b nor <br />inrodql or o[r.d lor s]. {S{ 7044, B6in6c ed &oa6sioN Code Th. Contadois Lic.n* La* do6 nor apDly to o orvn( of <br />rlrcOoFly who btrilds or ilnlro!6 tl6@n, ud {'h. do6 such $rI hi'nselfor h6s.tfor rhtutrEh hk orhd oqn anploys. <br />/.!ided nlat such imfrcvdnols orc ml inlodal or ofieGd lor sols I I no*6(. lhe hrildins o. iq,mwhdi is $ld wihin on. ,ar <br />olcodpldidc rh. o$rd Builde $i11 h.r. th€ hrda oaproving Od h. or shc did nor boild or nnprove fi€ propoly lor $. pupos oI <br />l. .s o\ ns of lh. rrlpsly. dn erclusircly contractins Lvirh licctrsen conrmdoG Io osrrud rh4 Foj&1 (s( 7014. Ban6 <br />ed ftlfBi,h Cod. l he Conkacroi s l-icms€ l-as do6 nlr .mly r. ar o\rn6 ol0ropcrt $ ho builds or nnprov6 lhs6n. <br />and who conlmds forsuch p.oj.c1s Nith a Conrrnclo(s) licos.d pun@r ro thcCoirraciois Li.dsc lrv) <br />I n€r€,npl undsSdlion <br />WORXERS' CO'PENSATI(TN <br />DECTAAAIIg! <br />I hn b' rrtrm und* penillr o r pdjory on. of thc lollorins delamlionsl <br />I ha\€ dd {ill mainrain r Cedificar. of Consdfio SclfJ nsuc aor sr ies comp.nsarion. ds previd.d lor hyS<rion ]700 ofrhe <br />Lahor Cod., for lhe rEfonne.. ofrh. *orlt lor wfiich ih. pnnir i! isu.d. <br />I h.v. and Lvill mliirain $ork6 codt Ealion iNuranc€. 6 r.qur.d by S<l n :1700 of thc bbor Code, for th. pgiomancc of <br />rlt Nr! for \fi,ch rhir pesn is isudi Mv work6 conp.nsarion n&ran.. crid ed t licy numbd {c:n. FqQ(,,",".*-I > Lok< {)r< + Casr=lLz <br />LAoo 5 4Lla - oz Erpire oJ--{( -zoa <br />I ccni! thal in thc pdfomance ofth€ Nork for vhich this Fmn is issu.d. I shallnol onploy rny pdso. in 4., monr <br />$ 6 ro t iom. sbj<t to $. *ork6 comFsrion l,\* olcalilomia. rd rere thd if I should b€com. subjdl ro lh. <br />s..16' .onpens.rion pmvtiom of Sdlion 1700 ollh. Labor Code I nd l. lonhwilh comply Nilh lhoe pm\isio6. <br />\IARNING Fail!'e nr *cu( *!'kcrs cotrrtlNarnrn qxc'ilc,s unltrstul, &d shill $bic.r an Lrnpl.rcr k, dirniMl p.n.hns aod <br />(tril lincr up k, .nc hundred ihousxnd d.ll3^ ($100.000). tr, id(iirnnr nr rhr oa.dmp.6arion. dona8cs 6 provided lor ihc <br />xE:l'T:1T;l,t( [\s )( (rNIR.\( IOR <br />DDCTASAIIO! <br />I ncEbt amm ondd pmah, of pojury thrt I dn liccGcdund6 pbvision oachaprd 9 (coNnacins withSdb.7000l orD,visionl <br />ol rh. Busines and Prof6sioG Cod.. a my liccB. L in full forcc ed €ildr <br />j1 J-5^1 <br />AXSUCANLOSCLAAATO! <br />I Hy amm uod.r poalty olpqjury onc ollhc tollowing d(lualiois: <br />Dcnmlilion P6mns-Asb6ros Notificarion F.d6al Rqul.tions (Till. 40. Pd6) <br />Reguted ldts of Noli6cdion <br />I cctiry lhil rh. Ldsal r.gulalioB reutrdin! Gbdros rdnoval ar. nor apflicobl. ro rhis pmje.l <br />l.difyrharlharcrcadrhirapplication d(arerhatlhcabovcinfomrari.niscord l a!i& ro .onpl! $irh all aily and Count! <br />.dinlncs dd Slare liss rclarinE lo building coNrrucr i.n. d <br />abo\c D4lionedpropcny for inspecrion purp(ls6 <br />aurhor;. rerr.srarivc.f rhh cn, dd countyto dl6 rFn th. <br />Applicatrl or ,\gfll SignstrreA4A -tc Lf L,\ <br />*,.,1-b-zd <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 />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 />Rough <br />Service Meter <br />FINAL /-7 7- 2o DN /d) <br />Notes, Remarks, Etc. <br />Under Slab / Floor <br />Meter Release <br />.a &P( larlhisre6on <br />,1,..sccras L-'zo <br />\^,. /-e^'z't <br />ca.Ng!aucrIaNuBD!!G_&G!!(Y <br />I hcab, aflifln unds lEialryof!.rjury rhat rhsc is a coElBcrion lndin! ag.n y tn rh. pdlonnancc ofth. wolk lor $hicn lhk p€nnn is <br />issrcn (Sa 30q7. Civ C.). <br />I cndo \ Nme <br />Ldrde s Add,6s: