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..\
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