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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUIDER DELCAR I'ION
<br />I hcrchy afllrn r.dcr Fnah, {,1ncrjrry rhar t !m crcmfl fron rhc Conlmctnl l,hnsc t,w fir rhc folLwin! rc.on (sc. 7i'rl r '
<br />Busihcss and Pft,fc\slotr c()dc)r Any Ciry or C.xnry which rcquirc\ a tE rir k, .onqfl.r. ,ll.r. nryrorc. dc Dlhh or ruj)an my
<br />(rucrurc. plior ro ils nsu0n... olso rcqun.s rhc,rFlicrnr rd ru.h p.iinir ro filc, signcd * cmnt rhd trorshc ir liccnsd punu0nl
<br />b rhr Fovnn,ns ofrhc Conrrrcttr\ Lien\cd tjw (Ch!flcr 9. CommncinE *irh S.crio! TIXII or Di!i\n,.I of rhc Arsirc$.nd
<br />Pbf.sions Codc) ot rh.l lL or sln- k crcmpr rh.rufon rnd rhr bnris f lhcnlL8cd.x.nDlion AnyviolorionolScclionT{)3l5hyuny '
<br />apnlicurr tq! pcnnil suhjcckrlt dpplic,nr lo rcivilpcnrllyolnol nnnc lhan iv. hundrcd dollrr (55(x)l
<br />I. ns owncrofthj roFny. or nr, cnrtlo)r.s wirh *r8.s,s rh{ir slc comp.trstnnr. willdo lhc wo.k ud rhc sltrNE h mr
<br />i crdcd orofl'crc{iforslc(56.7(,4,1.Businc$lndProfcsionsC.dc:rheContacroisl-iccoscIr*6esnorrpplyhanork..r
<br />rhc pmp.ry wh) huilds or inv,mks rlEen. rid qlt, d,a such k)* ,rnnscll o. h!^clr or rhnuAh his ., hcr own rnrkycci
<br />lmvid.d rher su.h i'ntmr'Enrs ,n frn inrodcd n oficftd ,b' sld li howcw. rhc hoildinS or inlrorcrrcnr is sold sirhin onc tfl,
<br />oa co'npbrion, thc Ow.cr Bdldo will halc rh. hurdc. ol ptulins rhar hc or \h. did nor buill .r im|,ovc lhc pmp.ny lor llt purlDs of
<br />Ld\okncrofrhcpmp.dr,rmrr.lu\ilclycotr,.ringqirhli.ctr{d.ont(hhhcon{ru.rrh.troJLtr(Scc7}l1.tlu\in.\\
<br />r Pn'liishn Cillc: lMCotrrm.l,tr \ Liccnsc t.{w (locs nor rfplyro rtr.*Nr ol fronony*h. huikl\.r nn!(,vc\ rhcrcon,
<br />r *ho.onhrrsror{rchpn'jc.r\wnhrAnirarkn(9ltcctrsdpr urf,rhrhcC.fiur'\ Li..i{ Law).
<br />Ir cr. rpr und.rsNri(,, .u &llc turrhnrravnl
<br />Irslt O*ner
<br />ItaB[IBrra[lfENstttllNIrt!:r .BtrItQ!
<br />I furrby rtltr utrdcr pcuxlr!ol l)orN.!.nc ol rhc n)L['Bi',9,1..Irniotr\
<br />Llhrvc,.,l*,ll@' JhaCc,tf*arcorcon{nrroselfjn{,cforwortrx.ongr6sarion.N rmvidcd ror br s$li.n 3?O0 ot ltc
<br />iff, c"a". r".,t" *r"**" orrh. *o'r rq trhrh rhc Nmr F Fsu.d
<br />_lhavcandwillnrinlain$orkcscompcnsolio.insura.cc.$nquncdbyssliotrlT00oflhctborCdc.l'orrhcr.rlortunccoa
<br />i\is;fxko. omF*dion itru*mc mri( a,n e"ricv.!nbd @,
<br />'luL\ rI 6-t f
<br />lccn,fy rhr in rhc p.ifornuncc ofrh. Nork n)r wh{h rhi\ F-rmir is ssucd. I sh.ll nor cmploy 8try pcron in on} manner
<br />r) nsh tEcom subjccl tolhepolkcr(conFnsalion lawsofc0lilnrtri{. lnn l8Blhal ill slsuld I'ccolE subirl b rh.
<br />B.dc( snrpc.sati.n [ovhions olSatiotr ]7mof rnc htu C.dc.lshill. r'onh*ilh comply wilh lhoc Fovisio.s
<br />WARNINC: Flilurc b scur!
<br />civil incs up to otrc hundrcd
<br />rorkcn ompcnsalion cov€rl8c t unlfl*ful. rnd shnll sohj(r utr cmployd ro oinriril Fnahts rnd
<br />thousnd dollan l$l0o-O0o), in addiriotr to rhc.osr ot co'npcnsurioo. dr@s.r ,l rovded ror rhc
<br />- inlcrc( and allorrcy\ fces.
<br />ul nrrrrr rr,Vfl- '
<br />I {tNsFr, (ttN'tIA( ttlR
<br />DECL{RA'TIoN
<br />I h.dhy,r6rm ud.r rcmliy or p.rjuy rhar I rD li.ioy\r undcr pr(,visi.n.fChdpr.r I (om,Ekin! $ith Sd6n ?000) ofDivnion 3
<br />ol th. Businc$and Prcicssi.nsC.de. and nry liccnse n in tullrbrceadcff$
<br />('t t)"***'*. IDDYl 67
<br />YLslt {-
<br />C(TNSTRUCTION LENDINC A(:lINCY
<br />I h.Ehy ullirfl u cr lEnallyofp{rjurylhalrhcrc is!conslrudntr bndins'scrcr artr rh. FrtornDftd orrh.workforqhichlht lEirnir n
<br />nnd ts( :1097.civ. c ).
<br />AIILICANLDECL/IBAIIo!
<br />I M'y aflinn Dndci pcnal'y or pcijury onc or rh. rolbw ing d&ld,r ions:
<br />Dcrmlilion Pcrmih Asbcstos Norificolion [cdcral Rc-qularions (rilb40. P0n6)
<br />-Rciuircd
<br />t rlerof flotific ion
<br />I c.nllvrhd rhc fcJcBlrcguhri(,n\ rAJding r\tf,d.s rnx,vxlrrc n.r rtrfl'crhlc t) rhis r(rc.r
<br />-l
<br />ccniryrhnr I h,v. nadrhk 0lpli.ationatrd storrharttuat vc infonn.riotr is comd I a8re ro q,ry,l, wiri oll Ciry Lnd Counry
<br />ordinorccs d Sratc rjws EhlinS ro buildin8 consrdction. ard h.r.bylulho z rc[csenrati!€s of rhh Ciry ud C.u.ly ra .ntcr u,x,n itx
<br />rh.rr mnr,.kJ nm|.nr ror m"F.ro} nuIry, I t
<br />App.cu,or^r6,siam,urc -N(,'- *,, -llt'yl4
<br />Prmr*nom.(Drrn,): W Le
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Rough
<br />Service lr/eter
<br />FINAL zlt'71[fi,,u41ns,
<br />Remarks
<br />l\4eter Release
<br />Notes,Etc.
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