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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT'ILDER DI'I,CARATION
<br />I horchy annm undcr lcnohy (,f pcdury thot I m cxcmtr tmm rhr contacbN Liccnsc tjw for lhc aollowin8 rcab. (Scc.70ll.5
<br />Busin.rs ad frotussi,n C.dc) Any Cit, or Counry Bhich requncs i Frmil lo onslrucl. allcr, nnprovc. demlhh or Elsn y
<br />stru.rur.,I.ftbn\ huak..,le r.q!tc\ rhc lpllicant lor sochFnni o file a sisncd (atcmnr rharhcor shc n liccnsd 0uNlnl
<br />b rhc novisionr olrhe Conrrlcroas l-iccnscd hq (Chal)lcr 9. Comnrncing ailh Sccrion 7000 of Division I of rhc Bnsincs and
<br />Pr.lc$io.s Code) or rhnt hcorshc isexcmpr rhcrefr.mud thc hash ftn r he alhscd cxc mprion Anyviolarionoasdcrion 70:ll5 hyany
<br />apnlicad nr c pcrnir subjcch thc amlicanl ro a .ivil t mh y ur no! mrc $a nv. hun&ed d.lltrs ($5cn).
<br />-1,
<br />rs .wicr ol rhe l,tr,rEny, o ny cry)loyrcs with q.8cs ,s thcn sb .omp.ns.rbn. Bill do r work.ln thc slnrlm h mt
<br />irlcnJcd M orcrcd r.r slc (s( 704.,1, Blsinc$ lod h,fc$ions Codcr t hc Conlracxn s Liccns ljw d.es nol apnly t' an owm! of
<br />rhc pmpcny *ho builds or irr{mrs rhcrcn. rjd who dB ruch wd( hnnrlf o. h.nclf or rhr.u8h hk or hcr own employc.c.
<br />pnvidcd riar su.h imFoEmtrhmmt inrcfrlcd oroftfd for ek ll ho$uri rh. tiiklinS.i irrl,swm.r h $ld wirhin onc rw
<br />ot conDldion. rh. Oercr BuiU6 wil! hak rhc rdrdcn otroviq thar hc {, shc did mr l{ild tr iq'mvc thc pmrrcn, fin rhc plrrEs of
<br />l. dlowncrurrhcptupcny. mr.x.lu\i!clyconrxcri'rs $irh I icc n\cn co nrlcrtrs k, co.n rud ltr txrjd (Scc 7044. Bu\im\\
<br />and lll,f.x\ion Codc: lhc Cooradois Licctrsc Law doN tur attly k) M own.r or ptr,p.ii y Rh{r huilds or mtnvcs r hcrcon.
<br />and aho.r)nrtuckfdru.hptuJ.itsirhrftnrEckins)licenrdpuruanlhlh.Gnnnckr'\l-iccn*Lnw)
<br />tg ,,".., x Lu-vv;tu
<br />w{ rkryF\S' ('(,nlr} Ns^ r'!oN
<br />4LCIJ&IIIO!
<br />I hc.cby aifirn undo ,.nalrt of r.rjnry om olrhc aolk'sinE d lrnri(,ns
<br />I hrvc url s ill mntrrin a Ccnificrrd ot Con\c ro Scll:lnsurc ft, *orkcr' ompcnqrion. {s Drovntcd nn bySdrn,n.lTfx) ofrhc
<br />utnn G)dc. for rhc p. ormrmc oI rhc wort tor which lhc pcnnil n hsuql
<br />_l hrlc lnd will nrrn ain luikch- ..mFn\in,n insuBtrcc. rs rcquircn hyS.crioo]T0Oofrhc lf,borCodc. [n rhc Fdnrnume of
<br />rhc work ,br whi.h th,s p.hnn i\ isskd Mysorkc^ .onpcnstrliotr in\ufttreericrn F,lrynumhLr:rc
<br />_l.c ilithrr hrhcpcrfofln,ftc.rrhcwo'kntrshirhrhi\pcrnii i\ i\\rcd,I \hrllnorcmrhy nrr$snt i" trr trimr
<br />v' !s ti E(om {rnrc.l ro lhc wo*crJ co rlrr\rriotr lrw\ of Cnlrn)nth, rtrd 4trr rhnr i f I skruld hc.onE subF.t ro rhc
<br />*oricrs cnmpctrlriion prcv,\ions ol Setrtr :1700 .l rh. ttrhr C{xlc.I \hrll. fonhtrirh.onpll sirh rk,\. ph!,(i( r
<br />civil ln,cs up r. orc hnndrcd rhousand dollfs (SlO(r.(XX)), i'r rddiridr k, rhc co{ ol..rI{n\nrn,r, drnrpc\ rs frorid.d ntr rhc
<br />sccrt,n 1076 olrhc lltnr Cdc,',",5f34 - inlere( arl .xomy's Lc(
<br />$ ,rrrr,*", )l I
<br />I hctohy dffirfrrnd.r p.nrl'yorFrjnryrhat I ur lieBll uoncr r.ovnn,nolChaprcr g (ommnci.E with Sd
<br />or rhc Busincsrnd ProicsiuN Codc. ind nry licctr* | in rullrdd d cflirr
<br />CQNSISIICIIINIENIIIII,iIIiENIT
<br />I hcrhy amrm rndq pcnalry o{ Frr!.y rhal lhoc haconsrddion bn{in8 l8cncy for rhc Frfomretrcc of rhc wo lor *hth tht Isnil k
<br />hsucd (Scc 309?, Civ C.).
<br />AIILICANLDESdA.AIIQN
<br />I hod'y !fim under pcnrlry ofpcrjuryone ollhe louowinS dcl,ralions:
<br />Dcmlilion Pcrmn*Ash{os Norificdtion F.d.r.l R.gul ions(Tirlc 40. Pan6)
<br />Rcquncd hrrcr ol Nolirf,nlion
<br />-l
<br />ccniirrhar rhc fcdcrcl rcSulotions E8&l,trB.sbcstos r.nblaldc noraptlicrbrc b rhis pmi\r
<br />-l
<br />ccaifyrhat I hlvc rcad lhh {Iplic(ion and sIllcrh lhc trtrvc innrmtiotr hcorc.r.l a8R toconllyw hallCiryandCounly
<br />odinanceslnd Sr c Llws Ehriu ro builditrB consrrucrion. iJrd h.rcbyaurhorizc rc!rcscnl0iivcs orrhk Cnyand Counryro cnrcr ullon rtE
<br />abo(
<br />'mtrtiomd
<br />ptupcdy lor i,NF.rio6
<br />Applirsnl o. Aseni stEnrrun L ^,.,oSlsolE!\4EN::Y SON1CA M a'
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Siqng (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondi ng/Grounding/UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough 6/rq/tq ;lplctt -b)
<br />FINAL (d4fiA -'1 -s&u-{a) t
<br />Notes, Remarks, Etc.0u
<br />---)
<br />Under Slab / Floor
<br />Service Meter
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