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ELECTRICAL.INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.OWNER BU!LDER DELCANATloN
<br />I h.oby ailrm u.dr ll.nrl,y of tEijury th,r I d.x.qrr fiom rhc C6nrebh Lic.n{ bw nr rlE rolhwlr8 rc.$n (S.c.7o]l.J
<br />Ausiness ad Profcssiotr Codc): Atry City or CoMly whi.h r.quncs tr Fnril lo corsldct. alla. tn rcvc. dcmlish or rcpan an,
<br />rmcrurc- dorro ns hsuarc.olsr rcquires rfic.,rplicanr for sucnI'c mir ro lile ! sisncd strtcmnt rtdr hcorshc i! liccnsd rxrsanr
<br />b rhc provhions ol thc Cont0cto. s Liens.d La* (Chrrr.r s, Comncncing wnh Scdion 7m0 ol Divtion 3 ollhe Busincss and
<br />Pmfc$ions Codc) or lh hc or shc is cxcmtl thcrclrom Md lhc b.sis lor rhc lllcrcd cxcrylion AnyviolalionofScctirn?0315by!n,
<br />trpplicant for apcmir suhjcck rhe ltplicanr lo!civilpcnahyofnor morcthan firc hundr.ddoll6\ (5500).
<br />ff t. u. "**, or',* IFr,"ny. r m, cry)loyRs wr h wtrE.s ss rhct wlc smp.trsu$otr. *'rl do rts wtr* ud rhc srnrtuc h mr
<br />ini. l.rl oroficr.d tuqlc (Sd.7044. Burimssand L'roit{st,ns Gdc Tfic Conra.rol q l-ic..$ tie d{)cs nor apply ro rtr owRr of
<br />rh. pm0cny who hoilds or impmws rnmn. rrrl wls dm Mh m* himrcllor hcrel{or lhrcu3h tis or hcr owr cmplo}rcs.
<br />ptuvid.d rhar such impmrtmnk m tur imend.d o.ofirrd lor slc Il h.sw. ttr t{iklinS or inporcrnm h $B uirhin nnc ,e{
<br />orcomplc'i,G rhc Owrcr Blildcr wiU h,k rhc hunj€n otl,lvin8 rhd hc o! nE dij mr hild or in!ftk rhd ptuFnt ror thc puqDs ar
<br />-1,
<br />0s owncr or r hc pm|Enr. :n cxclu\ivcly .onrrNrir'8 wirh li.cn{d cotrrNtos Io consrrucr thc I,.jsl (Scc 7044 Btrsims
<br />Dnd fl.fcsbn Codc: Thc Conrruckx r l-icensc lis docs nor lptly ro an o$ocr ofpmpcny who buikl\ or inprcvcs rhcrco.,
<br />ond who .oma.hLrsurhrojccuwnhsco.h.ro(O li..n{d punua rorh.conrrdoisLiccns ttrw).
<br />I rrrrrmpr trnd.r Sccri(tri . A & PC f{xrhi\rcrn)n
<br />o*"' B- 13- 2u ri< u**,,
<br />DECI.A.EAIIQ!
<br />I h.rchyrlTnDUdddN lryof t).rjury.m.f rhclnlk,wi'r!dc.lrfuridr\
<br />lhrlcird*ilLmrnii',rCcnificarcorCon{nin,sclflnsurclors.'lcncompctr\rrtr,n.r.pmv'lodnrbys..ii.nSToiJolllN
<br />l,ah.rC{xlc- forlhc pc.&.!nrncc.f rheqn* t)r $ntuh rhcrcnnl n nrucd
<br />Ihavc d rill mainrrin *orl.ra .on{rnsrr bn nrsuratuc. rqun d hy S&r ion lT0O or rhc b6or C.dc. lor lne priormnce of
<br />rhc wo* for whichrhilNrm[ is issucd. Mysorkd{ (,mltnqdi inrur f,u .aricnrn ,olicy nunrbcr m:
<br />,lu(,.nt, tnur tn r* * o,roncc orrnc work I'or which,his pc,mir F nsucd, I shsrr noi €npk,ynny p.(on o a., mMnc,
<br />$ ,s r. bcom suhic.r b rhc *o*cB mmpcnsriuh hss dr C,lir.mia. nrd aBm th.l if I slmuld k om suhrccl ro ltr
<br />wo cs con{.nsari,trtimvisionsolSccrionlT0Oof$ctitncodc.lsFall.fonhwilhconrtly{ilhlhoctmvirions..
<br />WARNINC: failurc h *.urc workc^ om|{trsri,rn .ov.r.Fc
<br />(nrl in.' ut1 r. ur hutrJrcJ rhou.bnd d.llar. rllrx).rio,. rn r
<br />S$rion 1076 olrhc bhn Coic. intcrcs aM llkrrcy s Lcs
<br />h unliNlul. rl nl'll {,6t..r rD ycr kr di nnrl Fmhi.s md
<br />ior. Jrnll{rr r\ tfuviliL1t lnr rhr
<br />^*,1E:'13 - ZoJl3
<br />^oo'n*,, \
<br />IICEMII].IONI8ACISA
<br />IECIdBAIION
<br />I hcchy lffi.n lndcr FMlry ot r.rjurr rhst I am lie.in !.dcr prcvnion o, Chrfl$ 9 (smmfting Bilh sdion 7{XxJ) ofDivisiotr l
<br />of lh. Busircs end PDfcsrions Codc, and my liccnse n in tull foc ard cilccr.
<br />CqNiIEUI]IIqNIENDING.AGINq
<br />I h.mby rtrm undcr Fnntry of ,.rru.y rha( rh.rc Lr d.onrrucrio. lcnding r8.my for tlE Frlo1mncc of rhc mrt for whi:h rhG Fnir is
<br />isslcd (Ss.1097. Ci!. C.).
<br />aftucANfDEctAtdllo!
<br />I hcrehy dnm undcr pcnolry otperjuryonc of rhc followinS dcclnrutions:
<br />D.fr)lnbn P.rmirr Asb.nos Norifkalio. F.d.nl RcCul io.s {Tirl. rl0. Prn6)
<br />Rcquncd bncr of Noif.dhn
<br />-l(cnif)
<br />rh{ rhr icticrdl rcgularFn' rsddrtre d'tE{o. rcrN\rlm nor lnflkdblc ro rhr nmiyr
<br />A/.c(,nt thd I nrw rcut thn lpplilrrnn and dJ,. Lhtrr ,h. att,vc inromri.n n comcr. I 4m to comply *irh rll city ond counry
<br />onli' n.ds,n{l S(rr lnws r.l lirt ro huinlnB.otr{n,.ri(r,. rl fu'rh,ru rctrc\.mrrivcs ofrhF Ciry.rd Coutrr, lo cnrcr upotr lhc
<br />oh.\c mnrioncn nnFdy Inr in\nccri.nturp\c\/'
<br />n,Orr.r r"r n**rt**r"*Dl 244 v o*" j p171%fi
<br />n"-,u* ,,.",rn,,, D( G, /oez,t C--,./r trtt ,/ c,' v
<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 />Buildinq
<br />Under Slab i Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Cerlinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lvleter 2 IfFINALK/zf/r4 --ffi,1
<br />Notes, Remarks, Etc
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<br />COMMENTS
<br />Cnricr:
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