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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.CO-MMENTE OWNER BUII,DER DELCARATION
<br />I hcr.by arnrn und$ !.n,lly of pcrjury lhrr I m cxcmpr riom lhc Q)nlrn.roN Li.cnsc Law hr $c iollowinS rcason (Scc7031.5
<br />Bu\ine$ and Protc$iotr Codc)r Atry City or County shi.h lcquncs a ,rrni lo con(ruct. alls. imrrovc. dcmli\h or qrun lny
<br />(ru.rur.. prior b ns isruare, dlqr hquirerrte applicanr for such p.n r ro lilc a rigftd {dcnEnr lhd lh.r shc ( li.cnsd pusuan!
<br />ro rh. rmvnionr ollh. Conrm.rols l-iccnsed L.w (Chaptcr 9, Commcmin8 $irh Scclion 7OO0 of Dirhioi I ofrh. Buiinc* and
<br />PrciasbnsCdic)orrh h.orrh.kcxcmprrhcrefromMdrhrb,sisi{nrhctrllc8cdcxcmprnrn.Anrviul0lionoiSc.lion?0ll5by.try
<br />rpplicant for a pcmrit \ubjcck lhc opplicanl loa€ivilpcflahtofuot mrclhan nlc hundrcddolhr (S5@J
<br />l. r\ ovkr ol rhc poFdy. or my .,nployr.s *irh sa8.\ !s rh.ir *nc .ompcns.ridr. *nl do rh. $or* dd lhc slMe is nol
<br />inlctucd or orcrcd r,tr elc (5(.7(14-1. Busincss dnd Prorcsk N (:od.r Thc Cbnlrdcln s Liccnsc ljw docs nol lmly ro an .wrcr ol
<br />rhe porEny rvio builds or inDo!.s ficen. and etn nocs such si. himsclr or hcrcltor rhroughhk o, hc, o*n coplort.\.
<br />providcd rh.r n8h in{'mtmnts a mr inrcM.rl orofcrcd f{tr sh lf.ln,kEr. rhc toiklin8 or nm$unnr is $H wirhtr'nnc t(i
<br />of onD[rion. thc Owmr sui s *ill h.!c fic hudln ortrcvin8 rh,r hc or sh. dil mr hoild or irprovc rhc popeny tor lhc puDoc.f
<br />-1,
<br />{s o$ncr ot rhc nopc.lr- lnr crclusircly conrmcliry sirh licctrrd conlr{cton ro (on(rucl rhc ,mjcd (Sa 7lt4.r, Bu\incs
<br />!M PitrLsslo.cl)dc: Th. Cotrrrrk s Li..ns. Lrw docs nor lpplyb u ownd of pn'Fi!! *h. huild\ or improvcs dcrco .an Nh. conrrncrslorsu.hroj€crswithrContrrcro(s) li.ctrrd pursktrr ro rhc Conrlucroas l,rcns Law)
<br />-l
<br />!mcrc pi undcr Sc.ri(
<br />l*","tuqt1, z'tl M^rL 9nq[,t'
<br />tvuRx!rLs ('()[rr[:Ns^Ttd.r
<br />D[llAnArll)N
<br />I hcrrh! rlfin, utrd.r r^-nrliyofp.rjurtotu olrhc ftlk'$i',9 J.chrrnn,\
<br />I hrvr ftlwill.r'n rinr('c ificar. of C.d\cnr b Sclf l nsur fitr *orl(c^ onDcn\rii,,n. ns ln,vi.idlnrhyS.crDtrl?0O.lrhc
<br />l-ahor Codc. nn rhc pcrhrnranc. olrhc sork li,r $hich rhc t.lnril k i\\ucJ
<br />rhc sork for $hich rhisFrmir i\ i\sucd My*1n1.( compcnsalion i'r{nicc caricr and rnicy nu ,hr n:4u -scr,, .. c
<br />AcA n"ta1- 1 _Expn.s:u-/ _tq
<br />-lccnily
<br />lhd iD rl{ pcrloflnrrcc olrhc work n)r Ehi.h rhr pcnnir h isNc.l. I \hrllnor cnrploy !n} l)cr.n in lny maoncr
<br />w, rs h bcd,m subjcd ro rhc !o.[cB compcn\arn,n he\ oiClliforni!, ud uarce rhd ifl should ltom sub]xr ro
<br />'lE*orkcr conri.nsrion rmvi\ions otScclion.lT{roofrhe ljlry Code.l shall. ronh*irh..nlply wirh rh,{ prt,e(nrnl
<br />WARNINC: Frilurc ro $curc *o,kcr' coaUcnsarion corcraA. is ntrhwiul. lnd sholl subccr on cnDloycr lo oi inrl Iltnrlris lnd
<br />civi! lincs up r. onc hundred lnousotrd dollors ($loo.Our). i. addition lo rhc cost ofcomrcnsllion. d,rogc\ !r proliddd for thc
<br />Ssr ion 1076 of rhc l-alnr Codc inicrcsr and dromv\ t cs
<br />*^*,, i'if i 4, z-11 I -;;:;, M"rL 3 o>tb, L,ICENTED.(TNUA(IUR
<br />'DEgIdAAIIIJN
<br />I hcmby.rfirmnndfi p.naxy of r.rjury thar I am li.cnsn undci pmvhion orch.prn 9 (cormrcin8 wilh Sclion 70(X) ofDivnion I
<br />of rh. Busincs and Pmfcst,os Codc, ud mr licensc is in full fore ud cftccr
<br />A
<br />.,..,'...,,.. C-1 O
<br />f *," 1.,,, 11, Zoi? ,"^,,,,,",
<br />,l".t r. Nn rrr.r,-7/ 4 I q 3
<br />ATILIIItrIDECLABAIIAN
<br />I rEi.tty atim lndcr pcnalr, of p€rrury oE ol lhc follo*in8 dcclarar ions:
<br />t)tnslition Pcrmih-Asbcslos Nolificllion a,edcrll Rc8ultrlio.s lTnt 4l). P!n6r
<br />-Rcquircd
<br />txtt.r olNolifi cotion
<br />-l
<br />ccnilr rh0r lhc ndcrd rc8ullrions Esr(in8.ctE(os icmvnllre nor{tlicablc ro rht projftr
<br />ordinan(srn.lSrrrrlf,w\rclrriiBbbuildnrgroi{.rn,a.aftllrrrhynudxrncrrfrc\cnurivcs()frhi\CirtaDdCounlyl.icnlcrtrF,nlhc
<br />Y:::[T*%T/"W ^," )r,,/11/, /3
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool. Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bonding / Grounding IIJFER t
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Solf it Rouqh
<br />Ceilings (T-Bar Rouqh)I
<br />Meter Release 7
<br />Rough
<br />Service lvleter //lo*,(Yt/
<br />FINAL ?-Ll-te J )e{>-+D(Et)\
<br />Notes Remarks, Etc.
<br />Pole Bases
<br />t/-/t
<br />a
<br />IANSIAICIAIIENDIIC.AGIM;I
<br />I hcdhy nrfirm undclrnalryorr.rJuryrh{ rhnd is a conitucrion knding aec..y hr rh. lafoi,Dn.c oflhc sork lor which rhn F,mil i\
<br />hsucd (SN.109?. Civ C.).
<br />trndcr's Nonr
<br />Lcndcll AddE$
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