|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUII,DER DELCARATION
<br />I heEhy ufltm ufrlcr Fnrlly.f pcrjury rhnr I o cxchpl liom rlr C-nrdcroB t-ic.nsc Llw ror lh. followin8 rcas. {S.!.?l)11.5
<br />Bxsinc* and Pioresrion CGlr) Any ciry or C.unry shi.h r.qunc\ a Frnir ro con$Dcr. alrs. imfmvc. &m'lish or dp3n dy
<br />slruduB. prior io its isuans, rko rcquncs rnc amlicmr rb! such lEmir to filc a sismd sr coE rhat L or shc L( li.cn{d pu$u!trr
<br />t, rhe l,(rlisions olrhe ConrE ror': Lic.nscd Ltrw tchnprcr s, Coomn.ing with serion 7ux, ol Dirision I of rh. Buainc$ and
<br />Pmfc$ions codc) or rhd h. or rhc k cxcnDl thc.cfiom and rh. basis lor rh. allcsen exemprn,n Any violationorssrbn?011.5 6y stry
<br />xprliclnr aor a pcmir subjecrsrhc dpplictr.r ro a.ivilpcnalryornor modrhan nv. hundrcd dolldB (Ss(Dl.
<br />-1.6o{neroflhepropcny-(r6renpkDtcr*ilhN!gc\r\rhctnrlcco.f.nsrtnni.willdothcBorkandlhcsltrl!ruisBninrcnded or oiIcrcd for slc ( S& 7(N.1. Busi,r* md Ptufcsrion\ Cudc Th. Conlra.ror's Liccn! Law docs nor lpply io ,n oskr of
<br />rhcporf,ny who builds or inlmvcs rhcmn. .*l wtb dfts such w hnnscllorhcr.llorrnnushhi\orh.rowncmlloyccs.
<br />providcd ihar snch nnp(^tnf, h d N inrcnd.n or ofictot lnr !'k ll h*c!r!. rhc huiuin8 o, inDomor is eU wirhin oic ,r
<br />olcomphrbn. rrE O*!cr BuiUcr willhnvc rh.bord.noflblinErh, hcor\h.didinn ttrild or inqmlt rc nmFny lor rtf, Nqbs of
<br />L B ownsr ofrhc prcp. y,! cr.lusivcly.ontmcring snh li..nscd .ontacro 6 lo c.n{q'cl rh.Ir*d (Scc 70,14. Busmss
<br />dril Prdision Cod. Thc Cotrrr{cnn s Liccnsc Law docs nor umly ro an own.r ol tt'!c y wh. huilds or in[ovcs rhcrsn.
<br />and who cootrlcl\nn{uchpmjcd\wnhaconrm.ro(rrliccnscdru uant torhcContndoirl,iccn\c L!w)
<br />-l
<br />imcrcnrpr undcr sccli0
<br />Dlte OPne.:
<br />rtrop,rrp.s' c-oMriNs rroN
<br />uEcLa8arlo!
<br />I lLrcbyrlfirm undq pcnah y of pcrrury ore olthc n k {ins dcctarlrn ni:
<br />I h,vc dd will rMinlri,r r Cc ilicalcofConscnrr.Scltlnsurcn,*orlsi.r,ftp.nrdn,n,arl,ovidcdrorbyS(rion:171)0.lrh.
<br />tihor Codc. ror lhc r.rrorroncc oflhe wort fo! which lh. pelmil n hsucd
<br />rcqtrirL{bySccri.nl7u)ol rhcl,h.!Gdc.rorrh.PcrlirnMkcol
<br />rh. $ork trwhichlhi\ n.nnii is r\lucd Nlysorl.rs .o nr nNUrflEc.!dcr Nd rx'licy nunrhcrtrrc
<br />I..nirt ihar ir rhc |,cnnmrNc.f rhc wnrk r which rhn plnni n tsucd.l shillnor cmphyanl Fr\)n any ranncr
<br />so Nlo tEom suhtcd to th. workcr co'.pensarion laws olCalirornia. Md agN rhii ifl \hould hcconrc subrsl ro lhc
<br />*o cH cotrDcnsarionfr.vhionsotSecrion:l70Oorrheltr'}i,Oxlc.l\hall.rodhwirhc.nllllyRirhthospmlisi.n!
<br />WARNINC l-t'ilurc h Edrc s.rrrr\ L.rycnqr'ni .}vcrd8. is unlowtul. and shall suhjccr 0n cry)loyct ro dninal lrnlllrs and
<br />civrl fincs un honc hunded rh.utrnd dolld!($lrxLrixrr. 'nJdd 'nn
<br />rn tr cor ^lcomFn.alnn. d.ruse\ * p'o!ldcd Lr
<br />'5c
<br />i.)",,-":";"":n'r,'r ^-^XY"/ Z" " .-
<br />LlcaNsElD Col\T(A(',rOtr
<br />|rESdAAIION
<br />I lEEhy rfii.m undcr pcn.lly ot p€riury llEl l.n [encd hdcr ,'mvishn ol Chafl.r 9 (smmminS *ith Scclion 7000) o{Divnion:]
<br />or rh. Burincss d PmrcsllnsCodc, ond n,li.ensc is in tullfole!ncfccl6-(ro 2 L/?
<br />&
<br />CAXIiIf,IJCIIANIEIDINC.ACEN.CI
<br />I h.rc$y aillrm u cr lEnolly ol lcrjury rhar rhe.e h a co.nrud ion kndinsaC.ft, rItr lhc pcrfotntrrc olthc wmk tuwhich!hi\ Fnnir is
<br />issu.d (S{.:1097, Civ. C.)
<br />Lctrdo \ Namc
<br />-
<br />APPt ICANT I'FCI IRATrcN
<br />I llrhy anim uodcr penalry.fP.rrxry otrc orrhc f.UoRnrt d(lmrnnis:
<br />Drmlirion Pcrmir*AstEsros Norifi cnrion Fcdcrul Rcgrhrionr l-l'irlc 40. Pd6r
<br />Rcquncd Lettcr ol NolifEalion
<br />Iccnifyrh,ilrl.durlr.exl.rotrsrcgrdnrEi\Ls!o!.hvrlnrcnorinllicabkn)rhi\pn+cr
<br />l.cnilyrhlr Ihnvcrc lrInrnnlicari.n x] s{rc rhrr rhc stx,vc inlni,n r dr n ..ii&1. l rAre h (.n{'ly wilh !l! Cily rtol Counry
<br />onlimnccs rnd Slrrcl-iws rcl ring huildi'rgcon{Dcri,nr. klh.rchynurhorizcrLrru\crdncsolrhisCir}ntrdC.unryr)cnr.rtrFmrlf,
<br />rhovc rtrri(fudpn,It(ylar
<br />\Dpliunr or,\Arnl \ixntrlurr 'Z ta
<br />,Va/-H)
<br />*,",')/so /t*
<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 / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipmenl
<br />Factory Wired Unit
<br />Walls (Conduit)/'L-t"/2( 21
<br />Walls (Rouqh)
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilinqs (T-Bar Bouqh)
<br />Meter Release
<br />Rouoh /-z-n 2t z'2-
<br />Service lVleter A
<br />FINAL 2-+-t7 |.r"V+10)
<br />Notes, Remarks, Etc V
<br />k
<br />t---+---
|