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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER OUILDER DEI,C RATION
<br />I hcrcby ,iltm uRlrr pcnilry 61 ,'.riury rh"r I d .xcnlpr fn,n rhc Conrra.ro6 Liccn{ tjw io. th. ldloqinB rcasn 1Sc,!.1J-1 1 .5
<br />Busincss a*l Profcssion Codr): Any Ci!, or Coun'y shhh r.quncs 0 lErnrir to consrud. allcr. imnrolc. d.mlish or elut cnt,
<br />struclurc. lrbr b ns kurncc- rko rcqutcs rlrc mtltanl for such lEnnit lo ilc a siSned slolcmnl rhat tc or shc t liclo\ed l]!ro r
<br />r. rhc lotisio.s oldx Conra.ror's Li.rn*d Iau (Chrfl€r 9. ComfrcRin8 wirh Scdion 7filo of Divirion I ofthc Ausinc$ rad
<br />Pmrcssions Codc) or th.t hcorshc hcxcmfl rhcrctonrand rhc b{si{ forrhclllcscd cicn,pri.'n Anyvioldi.nofSccrionT}-1l.5byd.y
<br />aptlicrnr Lru l.rmh subjccB thc aprlic,trr lo r civil lemhy or nor mrclhnnfivchundicddollds($500)
<br />l. r\ owncr of rhc pop.ny. d .r.hsivcly contrr in8 wirh liccn\rJ contrro^ k, .oiifl.t rh. Imr..r (S( 7(N,1. Itusrncs
<br />ann PDlcsshn Codc: Thc Conl!$kn s Liccnsc Low docs nor anflr ro.nowncr olpror.ny who huild\ or in,pDvc! rhcrcon,
<br />rM who .o tucr\ ntr surh ,rorocrs wirlt a coirtuckr(n licci\dd n b rlr c.nnacrols Licc.sc bw )
<br />",.'rrlj 7o6/(</<,,
<br />DICLAtrA T
<br />I hcrcbyamnnu.dcr pcnalryolIl juryoncofrh. folkiwi.g dd.lnr ions:
<br />I hav. .id will roinbin r C.niarar. or C.n*m r. Scll ln\urc aq *..kcn .o'n .nsrion. .s t$vidcd for hy Selion 37m of rhe
<br />blnr Crxic- tu lhc pcrfomncc ol rhc work in which rhc pcnnil ir issuql
<br />lhrvc rnd willmainrrh s.r*cr{ conrFtrsdion insurancc, rq rcqun.d bySccrim 1700ofthc tibor G)nc.l'or thc Frn,runcc ot
<br />thc work for whi.h lht pcirnit is issucd. My wortcn .onDcnsd io insuntrcc cMicr nnd policy numhcr rrcl
<br />Poli.t N0mb.r: Ertircs
<br />-l
<br />ccnitylnar in rhc n rrormance oarhc sork aor snkh rhh rcrnir n nsucd- I shrll nor employ,ny pcr{n in riy man6
<br />n' rr ro b..onB sxb)c.r ro rh. wo u6 .o.pcns.rion lrw\ or Calirorni( ,nd .8m rh{ il I should tf,.o,rc !'hjcd ro rrE
<br />eork..J conDcnsdion l,ft,visioN of Sertun l7m of rhc tjhr C.dc. I \hnll. fonhwirh .lmply {ilh lk){ l,(,vhion\..
<br />WARNING l-rihtrc lo surc worhcn c.mpctrrolion colcro8c rs \hrll srhjcc! rn cmplo$r t, di'nim! lEn,lli$ rnd
<br />DEq,dAAIIQB
<br />I h.rcby offirnr undcr lEn.hy of Friury ltal I 0'n liensn undcr povision of Cnapr.r 9 (ommmins with Secri,n 7000) orDivhion l
<br />oi rhc Ausift$ {.d Prcfcsions co&, a,td my li.c.s is in lull a6r€ .fr1 cltml.
<br />CotrlE.lor:
<br />CONSTRUCTI(}N LENI}INC AGENCY
<br />I hcrby lr'firn lnder pcnalr, of Fdury lhdr rhcE h a .onsiruction bndins lscncy lor rhc Frfo@n.. ot rh. hrt for whth thh p.mit k
<br />issucd lse. 3097. Civ. C.)
<br />AIPfICAILDES/AAIION
<br />I tEnby dfinn ondcr pcnrlryorpuijury oN of lrs rdloqine d..hdrn,rs
<br />Dc'n.liinnr Pci,nirs Ashc{or Norifi.trrbn Fcdcirl Rcgxlrlims (lirl.4l). Pnn6)
<br />Rcq0ircd hnd of N.riliurioi
<br />-l
<br />cenilylhd rh. lcdcral rquhlions rcEuding rc i;i rprli.rhlc k, rhi\ pn+d
<br />_l..nifyrhar I h3\c rcrirhi
<br />orl'naDc.\ 8nd Srrrc Ir*s rhr
<br />6lx)vc n{nrnmd propcny li,r i
<br />Appli$nl or Aa€nl si8nalure
<br />'r^
<br />LFe t,.onrdy wnh,ll Cil, ind Coutrry
<br />\cnrdnG.rrhis Cnyand CounrytD cntcr upon thc
<br />,.,. otf 6/1{
<br />/6p-08 b.r1 rve,t-e<_
<br />Site-Work
<br />Underground
<br />Li ght Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh).3-/
<br />Ivleter Release
<br />T
<br />Rough .b tla-79 J/.-{.1 )@,
<br />FINAL r-t6 -/8 t@
<br />Notes, Remarks, Etc
<br />Pole Bases
<br />Service lvleter
<br />J)c-9,*l
<br />-1.
<br />!s osncr of thc !rcrcny. or my cmployees *irh wracs .s lhcn soL conrFnsul ioo- will do lhc work Ml rhc \rru.rm i\ nor
<br />inrcndcrl or ofiercd aor slc {5(.7(}44- Busincs and Pmacssions Codc Thc ConrlNrna\ l-ian{ ljw do.r nor atrly ro an osncr da
<br />rhc Imocdy 'ho builds or inqr.res rh.Nn. &xl *ho d@s su.h w.rt hnb$lf or hcrulf or rhruugi his or hcr.wn c,nployccs,
<br />,iovid.d rhar \uch i'nplrft,mnk c fr inr.ftlcd o' .llcRi f(n {lc ll h,mvur, ilE huitling oi itrpmv.m h $kl uirhin onc }la
<br />or comobrbn. rhc Owrc. auiHc, rill hlE thc tlrdcn of pmyiu $ar lE or sh. dA ft)l buiE or inpovc llE rmFny fttr rh. purr{ or
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