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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNDR BUII,DER DELCARATION <br />I herchy alfirm unaer pentrlry of pcrjury rhar I m.ftn l rbm rhc Cont,.-ron Liccnrc kv lor rhc foU.*ing Ea$n lscc.7oll.s <br />Busincsc atui Prorcssbn colc) Any Cily or County Nhich rcquircs a pcnnir r. .on{ru.r. alrn. nq,rov., demlth ot Epat roy <br />(rucrure. dorro ns issudns, sls rcquircs th. lprlkanl ror sx.h Frn ro file a sisned $atcmnr rhar h.orshc h liccnscd ,nnuMt <br />ro rh. [ovisions olrtr ConrrErois Liccr+d Liw (Chatcr 9, Conmcfti.B wirh S.clion'7000 of Divnion:] ofrh. ausincs 8nd <br />PmlcsionsCodc)orrhorhcorshcicxcmprrhcmfbnandrhcbdshrdrhcullcscdexcmptit,n.Anyvnndi.rorserionT0ll5hyun, <br />ryplicanr lor a pcmn subj(G rh. alplican' ro acivilpcn{lrrornor nxE ',un fivc huidrcddollar*($500) <br />-1. <br />rs owns ol rhe pmp.nr. or ny c.trlort.s wirh wag.l 0r rhcn sh corFcNarion. will do Lhc aori lrd ir. etuN n mr <br />idc nrl or oltcrcd for slc ( SN 704,1. Busircss lnd Pmlc$ions Codq fhc Conracrofr Lkcnsc hw docs nol srl,ly ro {i osncr of <br />rhc rmpcny who builds o. i,r{reB thctu( nd wh. dd. soch $r& himsclror hcrselror lhml8h hh or hs o*ncmployccs. <br />Fivid.d rhlr such inqmrnEnlc N ml nicnLd or ofasl fo! slc ll lnwcwl rlE t ilding or ifiDmE rnr is sld {ithir onc <br />'teol'corrykrion. tlr O*ncr BuiUo will hdr rlr burd.n or Foving rhnr he or shc did ml tuild or iq,ow lhc pR,pcny aor (tt PU4r* or <br />-1. <br />!so*ncrolrhc prcI].ny, nnr cxclusicclt cont,crinB *irh li..nsd.ontaclorlo consldcr rlr rmii (sc.. ?o44. Buiimsr <br />snd Boftssnn Codc: Thc Conrrrrols Liccn$ l-uw dm\ nor appl, b nn ownf .r rropcn y *ho nuildr or imlov.s rh$sn, <br />and sho .onrh.k for sxch loFts wirh a co mdo(n li.cnscd purlunr ro rhd contr.ioai Ltcnsc LIB) <br />I a .rcmpr x6dcr S(trr <br />II()RKI RS' ('()Nl PllNSA l l()N <br />DEcld.Btrllrlx <br />I hcrchy Jillrar undcr pctrrhyoi Nrlur y otrc ofrl[ lolk)wi11! dcchfuri.rs: <br />I hrv.,.dwill.un air oc'cnificrrcolconserrh Scli lnsurc t r sorkc^ d,f,p.nqliotr. as tovidcd lorbySccrnnr lTfi)orrhc <br />Inhr. O!r€. fo! rhc pcrforurc. orrhc wor* lor *hich thc p.rtrlir is nsucd. <br />t hdvc rtrd willmtr niin workcis compensllnrn insuarcc. !\ lcquircd by Scri(,n lru) tlrhc hhor (.odc. lor rhc pcrtuntun c of <br />.onrnrtr\arnrin{rrn.c.r rrarkl0nlicynumh.r!r. <br />*r51tr2rl'n <br />_l.cniiy rhar in rnc pcrrortutr.c orrhc *ork ror which rh,s lchrn n issucd- I \hall nor cnrploy any p.son in ony flronncr <br />k, * k, b..om subJL{l b rl[ qortcn'conrcn\ei ioo l!*s ol Calilnnil rnd ,8e rhd il I should tEconE \lhJcd ro rh. <br />workc^'co,np.nsrn,rpovnionsolScctionlT(x)ollncljtrrCodc.lshlll,ronhwilhcomdywirhrhospmvision\ <br />WARNING: Iailur. ro $crrc sorkcB .onpcnsdn,i .ovcfulc i\ unh$tu]. \hrll suhJccr ,8lrl,,y.r !, dmirul P.trrlris ud <br />b onc hundrcd rhousind d.llnrs (Sl{X).rx)O), ir dddIn r <br />ss"'.ru,u*",luG <br />DICI.AB{IIAN <br />I hcrby dflirn u.df p.nnlry of pcriury th0t I am liccnsn undcr prcvision orChaprd 9(.ommmin8 wnh Sdhn 7000) ofDivkion l <br />of thc Busircssand Pn,tcliioB codc. and myliccne is in tull forcc en efiecl. <br />\rOtrrta. <br />6^k ,--.. <br />CANiIf,IqUOXI.ENDINIiT;INIX <br />I hcrchy nlltm undcr pcn.hy of lcrjury rhar rhcrc is a consdcrkr. lcndinS.Scncy for lhc !.'n'orrorcc 6rrhc wdr* for whi.h rhh Dclnril is <br />ksu.d Ise..1m7. civ c.) <br />ATTLI(3NI"DII;I.AAAUA! <br />I hmhy rnim undcr p.trdly of pcriury onc oflhc lollosins dcclurulionsr <br />Dc.rlirir. P.rnrirs A.h.sos Norifi.0ri.n FcdcEl Rc8rlariotrs (Tnb40. Pd6) <br />R.qun d btrcr of Ndifr.lion <br />-l <br />ccniiyrh rhc ridcral Egltlriotu mgrdi68 Nh.{usomovrl,rc norrDDlicnhlc lo lhis!x,it! <br />#1;**,;r';lr;"xrsll t codccr. t asr. ro.srply wilh allCiiyand Colnry <br />rcprcsc uriler ofrhis Cny rld Counlylo cnler u,x)nrtE <br />rA,uGo.a4]!tvc nrtrri(nEd nmrcny li)r <br />ADDlicrnl.rAftnl Sirnalum <br />Da*i L A,{' <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safely /Low Voltaqe <br />Fire Alarm i Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bondinq / Groundino / UFER <br />Translormers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Roush .*tZ nli0t(>\76 <br />Service It4eter <br />FINAL "t/r*Y c\ 8-8 <br />Notes, Remarks, Etc <br />*" AL}G <br />knd.,\ AJd..\ <br />- <br />.-------T------ <br />I <br />fT