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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS ()\lNl:R BUll,llllR DELc,\R,ll loN
<br />I h.rcby nllirln undq reoalrr r,f pcrjury rhol I an cxcnDr rtu rhc C.trlrrclo^ l-iccnsc tiw for llrc tollo{ing tctr$n (S( 70.115
<br />Busincsx !M Prcrcssion Gtc): Any Cil, or C.umy which rcquircs a Pcmir lo onslru.t. aho irflovc. &mrli\h or rcpJn inv
<br />\rdcrue- rior b ts nsu!rcc. lto Eqxios lhc qrnli.anr aor \uch Fnnir kr lilc ! sigtud iatc'mnl lhol hc or shc i ticcncd PUmmr
<br />ro lhc pmvi\i(ins or rhc cotrt.crofs l-iceo*d hs (chlprcr 9, ConnftkinS wnh Sccrn,n 7(]m ol Division I drrh' Btrsin's md
<br />Profc$n'ns Cod.) or lhrr hcorshc ircxcmpl lhcrcfto lnd lhc ba{is ror rhc ollescdcx.tuflbn AnyvnnutionorsdtionT0:11.5bvrnv
<br />appli.,nr for r pclmil suhJcrrs th. stpli.ant lo acililPcnalry.fnor mrclhon fivc hundrcd dollds (l3n)
<br />l. $ owncr of lhc ltr.lfdy. or nry cnplolEr wirh sdScs as rhcir $le .onr.n\dion. will d! llt {orr uld rhc snd@ is mr
<br />inrcrt|d or ofl.red r.r $lc rse ?O14. Blsinc* nnd Pmfcsions Codc Thc Conractois Licensc riw docs nol aPplv !o on owrcrof
<br />rhc rn,pcriy sho hoildr or nnpore. Emn. od who dcs skh M,ir hinscllor hcr.lror rhnnrgh hh or ltr 6*n cnlnovcc\-
<br />pfuvidcd r lrt sDch inDrovc.Enb d frr intcBlcd .t or.B1 f{, {h ll h)kvcr (lE huiding or itr{htlm.r is $ld wirhin orc r{
<br />;lconqJhri4 rtr o*rcr Auibcr ,ill ha\t rh. bun ofProri.slhd lEdsrf,dil mr tlild or impnM lhc lFFnv ro: rh. turpos ol
<br />-1.aso*nrrol$cpn,pcny-a
<br />cr.rhiv.ly.ontrNlirrs wilh liccnlcd .oDlriclor lo .on(ru.r rhc lolccl(Sa.7o1t B^inc$
<br />a l PftJfssihCodc: Th.ConttcrolsLiccnsc lj*docs mr trpllyto ano{ncr orFoPcnvwho huild\ or improrcs rh'rcon,
<br />{nd who comm.k for such Fojccrs *nh , conricro(, liccn{d ptr(unnr h lhc conr'acftt Lhcns uwl
<br />I crcNo utrdcr Sc.r
<br />6 L.azo <!S(o
<br />3
<br />CONS'fRIJ(1]IoN I FNDING AGFN(]Y
<br />I hcrby lmrmunder,,cnalryofp.rju.ylhal rh!rc i{ t.onsdclion lcndins asc.cy for rnc t'(rfornencc ofrhc wor* {or rhichlhir |Ermit is
<br />hsu€d (Scc. lm7. Civ C.).
<br />APPLICANT NFCL RATION
<br />I h.r'by,fllnnundcrynnllrr.rtdrjury one ollhe l'ollowiir dcclahtiLins:
<br />Dcnrhion P.mnsAshcsros Norificarion Fcdcrll Rcsulalions (Tirl. 40, Ptrn6)
<br />-Rc!!t
<br />d lxflcr of N.tificrrt,n
<br />l.drilyrhd rhc ltdcral rctuhriotrr rcB ding tr\Irdo\ rc.{,Ml rrc nol rtPli.rblc to rhn !rojccr
<br />l.cdilt rhrrl hi\crctullhis!Iplicari('nMJnd.rhd rhc lltx)vc inlnrnri.tr iscoilccl lrgrccr
<br />. in.n.c\ r Srar.Lrwrrclali4lohuilding..DNrr.riotr,iNlhcrchyrtrrh.riltrcltrcscdrrivc\.f
<br />ak,vc nEnriurd pmpcn, Li iNrcclionI)u
<br />Applicanl or A8cnl Signaluft :
<br />,Q"7 /nL-r2"15
<br />o conply qirh lllCny,trd Counly
<br />rhrsCr) ond Cnu.ryh c nulsnrhc
<br />*,"-2fr/s
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<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 />Ceilinqs (T-Bar Rouqh)
<br />lVleter Belease
<br />Rouqh
<br />Service ltrleter
<br />FINAL zlcs ltx f-ntn*t 4.,,
<br />Notes, Remarks, Etc
<br />"*ffi
<br />I hcrcby.mnnundcr pcMlry or pcrjuly orc ofrhc follosing dmld0lions:
<br />-l
<br />hovc od siu ndmai. . Ccnifrdlc of Con*nt b sclf'lnsurc tor workc^ comrcnsal io.. !s Fbvil.d lor bv Scl ion l7m of rh.
<br />tjbor Codc. for thc pcd.rro..c or lhc uo* for *hth rh. pcmfi ir nsued
<br />,ldfho"c aid *ill 6!ii!,ii wortcn coopeordrbn insnrlnce. as rcqlncd hy sccrion l?00 or rhe Lf,hor codc. ro. rh. Fro'nErcc or
<br />thc sflk fowhrhrhF n€m r F\u.d My*dkr^ s,r{t$alr.n in\uEr.raEf,r ad n lk, ndrnrrr e
<br />,*", PAc"r rtC r /
<br />n,.,"..*,-!DA @oa-Q2Ql- r,,". 1/z-z//?
<br />-l
<br />cdity thar in lhc pcrto,mftc o(rhc solk fo. *ti€h rhi r.rnir is nsucd.l sh.ll noi.mplov anv P€rsn i. anv mrnncr
<br />s * to Sccom slbj.rr rd ihc uorkes' conqrnsal ion l.ws ol C,liforni[ and agm rhar if I sholld rrconr bjcd to rhc
<br />workcs am!€nsalion pbviqi.nsofScclion 3700.lrhc rih.t Codc.I shlll- tiinhwid omplv Nilh rho{ lmvhions
<br />WARNINC: Fdilui.lo s.urc vorkc .omr..sdion cov.mse is oni,wtul. n.d shlll s hFi an cmFlolq lo dimin lEroties ond
<br />ciril fi.cs up ro onc hundr.d rholrlnd dolltrs ($lOO,(xlO)- in dddirion lo rhc cost orcomtc.srliotr. d!@gcs ns providcd lor rh'
<br />Sc(ri6n J07o.llhc tit-{ C.dr. d'cr+{ Ed atroirEy\ lccs
<br />,n" @I'7/7t4o,u-^, E--
<br />I hercby amrn undcr ncnolryofFrju,r rhd I an li.cns.d lndcr Pmviiion orC:lEPlr 9(.omren.inC wilh Sslion 7000) olDivision l
<br />of rh. Businc$ lnd Pmfcsions Codc. ad hy lncn* is in tull forc and eltecr
<br />tfid(r . N.'n,c
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