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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER OT'ILDER DEI,CARATX)N
<br />I hctuhy inrn undcr pen.lty of Dcrjury rlur I m €icnpr fs,n rh. Co.rd.m Liccnc Lau for rhc loll,osins rcrmtr (SL{.7011.5
<br />Busincss ,i Pror'ession Co{r): Atry Cily o, Counry which r.qunc( a t .mit lo .onslrucl, alrci inlnrv., d.hslish or rcnlt ony
<br />nructurc. priorlo irs issusncc. al$.1!uirc\ rhc 0ltli.anr rorrmh pcanil lo 6lc o siBncd {urc@n' rhar hcot shc n licctr$d pundanr
<br />ro rh. rmvisions ol llr Contmclor's LiccnEd lnw lchaptcr 9, Conm.n.inB with Seclion ?000 of Divhi,rn ] offic ausincss and
<br />Pmlcsions Codc) or rhal lE or rhc is er.mpr rhcr.ft,n and rhc basis f.r lhc allcs.d cicrytion. Aiyri.l ionofSalirn70.115 brrny
<br />aptlicanraoraFrtuir\ubjrckrhc,ppli.anirotr.ivilpcn0llyolnotmrclnli6vchundrcdd.llrs($5m).
<br />-1.
<br />!s ow..r orrhc prolEnr. or my cnDloyrs wirl wagcs !s rhcn hb.on{8ns!ri.n. will do rh. wa*.nd Ltc slMlurc h mi
<br />inrc.lldl or ofi.rcd ror sL i Se ,M4, Susincss lnd Profc$ions Codc, Thc Conrmtor s Liccnt lj* docs nor dPlll r. an owrcr of
<br />rhcpmpcn, who hr ilds r impn,vcs rhcNn. nd wh) docs suct wl]r hinsclf or hc(.lf or rhhugh his o. icr o*n c l,loy.cs,
<br />pr,lidrd rhar sucn inpmrftnh m no( ir cMcd or.fcrcd f.r sL. Il h.rever tlr hiHine .r in{mltmnr is ell sirhin ok rttu
<br />orcon!)lclion. thc o{ner Buitlcr *ill hrt rh. L{rdcn ot rovine ird lr or shc dil mr huild or in{,mYc rh ,mFny lor rhc !uqn$ ol
<br />1..\owncr.lrhcproncny.xmcklusii.ly.oir!.ri.swirhlircns.drotrlrrdorsl('.onnftdrhclrojtu{sc.7(11-1.llNnts
<br />ann lh,issbn Co,i ThcContictr'\Li.c.scLrsdocsrttlDllybMo(ncrofproncnyshobuildsorimPn,vcsrh.rco.
<br />rtrd who .o rr.rs for such nmich wirh r Cofitrcro(s) li.cnscd ttr'surtrr rorh.Contrncrois Liccisc tjw).
<br />-l
<br />ancxcmpr uktcr Scction B & I'C f.rrhis tua$tr
<br />Drlc: - ()*ne.
<br />woRKERStOLTPEnSATIOl\i
<br />DECIABAIION
<br />I ncrcby rinn undcr pcnrlty olpcrjury o@.rlh. foll.win8 d*laBrn,n\l
<br />I hrlt $d will tuinhin r Ccd iltarc of Conscnr ro Sclf lnsdrc ft, sork.6 con{Etrsolion. as Imvilcd tot by S{rion l7O0 ol rh.
<br />Lxtxr Cdq ror rhc p.rr.rtuna ol thc vork lbr whth lhc pcrmil h hsuc
<br />-! hav. lnd willmlinrrin $ork€^ .onD.nr,io. iNur.ncc. trr rcquitcdbySccrionl70Oo{ih.tjh.rCod..forltcpc ornbncc.f
<br />rhc *st ro, *hich rhis pcmir is issu.d. Myworkas onpctrsalioo inu'anc.cdtrid 0!n Fli.y numbcr ee:
<br />(--
<br />\'ri(v
<br />S!^te tr^^a
<br />4 t)o'.+'.t-t t I
<br />l.cnifyrh.t in ih.0crlornune olrhc work f{r which rhi\ pcrnir is n\ucd.l shnllnolcmpby any Pcron in iny nrnmt
<br />s as ro hcom lul'Fr h rhc ao&cN c.nrFnsnrion lars ol Cnlifornia. afrl,8mc rhdr if I shoxld h.conE ublccr tu rlt
<br />*orrcr'connn\ari(npn,vi\i.trrofScclion3?00oflheLatnC{xlc.lshsl!.ronh$ilhomPlruirhrho{I,rovi1t,n(..
<br />WARNING: Faihrc Io scur€ workcn'omri.n\alion L-lcrast i\ unldstul. dnd shrll suhirr an cnrploycr ro siminrllrcnlik! and
<br />civil fincs ufr to orc hundrcn riouslnd dollah (t100,0{n), in rddirn tu thc cosr oa compcn\arhn. da,Mgcs as prolidc{ r(r rhc
<br />Lrlir(inlc. inrcrci rnd rrttrmy \ lic:,L..lt r
<br />ut[N.!!]lQrl]ldl.lutr
<br />DECI,ABAI]O!
<br />I hercby aflnm ondcr Ftulry or p.rjrry fial I anr licnsn lndcr Fovision orChaprd 9 (ommncitr8 wilh Secli.n 70001ofDivision l
<br />ol thc Busines and Ptuac$i.nrCod., tnd my li.cnsc is in tu ll fotc. atrd cfaEr
<br />ir-
<br />l.('"
<br />B asr 1/" t> <
<br />+-i)Y ..",,,"'.,,4-k <kf L4"ra-tn'7*-L Z-
<br />CANSIf,IgUOII,INIUNCAGIICI
<br />I hcrcby rllirn und.r lrnahy.l pcrrury rhd rhcrc i\ i.onqflcthtr hndirs r8cn.y rhr rhc pc.fornhn.e ofrhc wotk l'or shich rhi! P.mir ir
<br />i\{!.d (Src .1097, Civ C.)
<br />AIIIIOINLDEII,AA{ION
<br />I hd.hy rliim undcr p.tr,lry ol !€rjury one olrhc roU,)eins dcclaElion\:
<br />Dcmolirioo Pcrmik sbcdosNorific,rion rtdcrsl Rc8ullrions ll itlc.t0- Pan6)
<br />R.qun.J I crrcrol Nor'll.rho
<br />l.cnilyrhd tu tncnlr.Srl rion\ rti'di'rE rsl[(o: rc r,ril.r. f,r rInli.trhl. brhn n()iccr
<br />I cenify rhrr I hnvc r.rd rh$ qrplicarionoi darcrhrr thc at-!c innnndrion i corccl I aSrerocomply ![hallCiyud (.outrry
<br />ordinakcr rM Strrc ljws rclalitrE ro buildinE .ordrucrion. ald hcrcby rxrhornc lc|rc\cnl.rir$ ofrhis Ciry 0.d Countyro cnlo ulxln rlt
<br />L \'rc mcnrioncn nn'pcn, rff 'n\l!cirrcnt,rnoscs,
<br />fippricmr or r*mr sisururc 1/4
<br />yo^n",,,-" oa^q, .y'/,24o lt1 laLc7
<br />,"," z/>q/t r
<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 />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Bouqh)
<br />l\4eter Release
<br />Rouqh Flqltg ,.Ul5frt )
<br />Service I\/eter
<br />FINAL s/t7t/9 aa19
<br />Notes, Remarks, Etc
<br />lcnd. . A\ld'c!
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