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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BU I I,DER DEI,CA'IATION
<br />I hcrchy olfirm unncr pen,lry of Friury rhar l o crc,npr lmn rhe Contacro^ Lic.n* tjw lor thc rolloqin8 rcusr lscc.?(rll.5
<br />Br\iicss ,nd Pnrf.stkrn Cdi.): Any Cnt or Couni, *hkh ruqun s d Fmir b onirucr. altc( improvc. dcmlhh or rcIEn My
<br />nrudurc. priorlo its issu cc. al\o rcquncs rh. anpliu.nt lor such lt.nnilto lllca rigned ndcmnr rhm lf,orsh. ir l,cc scd ,ur$Mr
<br />ro rhc provisio.s ol thc Contacrois Liccn$d tiw lcl[|,cr 9, aonmkNin8 wilh Scdion TOOO oa Divhion ,l or rh. Busincs rnd
<br />PmicssionrCodc)orlhlthcorsheisexcryrlhercironondrhchasnforrh.rllcscdexedrrn,n nyrn arbnorScclirtrT0ll thy.ny
<br />lprlicrnr lor ! pclmil subjsls rhc lprlicanlro acirilpcnalryolft nnnc lhm fivc humttcd d.lhs ($5fi))
<br />l. rs .wmr ol lhc trcrcny, or nry cnDlolecs wirh sagcs !s rhcir {nc coryrn\al ioo. will do rhc tort Erxl rlt imtoft (
<br />'xinrcd.\l or ollcrcd ,or slc (Sa 7(N4- Businc\r nnd Pm,cssiN C.xlc Thc O)nta.ttr\ l-kcnr llw docs not q,Ily h {n ow"er ol
<br />rhcpmEny wh) ttri}:rs or iqrovcs rhcrsn. e, wth des suh w.* hnns.lfor hcnclfor rhmueh hh or hcr nrn cq,lorccs,
<br />providcd rhar su.h inpowftnrsm mr imcd.t orofi.Rn li,r ek.l( hokv$. rhc bliltina or impNEmnt h wld *irhino'r rru
<br />oa.or'l)kri,n, rhc O,mr Buiki€. will h,w rh. hrddn ot pmvins rhd h. or shc dil mr buiH or nr$mw rhc pmtEny for lhc puqnsc ol
<br />I. r\ owncr ofrh. pnipcny. drcx.lusiv.lyc.nrn.ri'rg *irh li.cn\cJ cotrtrcr.rs ro.nr{rud rhc protccr lSc.1(}14. Bu{nc$
<br />rkl hofLssh. codc: The Contrdols Liccn$ Lrw des flor ipllyro.r owncr oipropcny{ho builds or tnpnrcs rhcrcon.
<br />anJ shr conrncls tor \uch proFcrs wirh r contNktrG) liccnsc.i I)UsuMr b rhc contactr's Li..n\c hw)
<br />lndcxcnfl u.dcrsccrio
<br />rl)ax,EB!:raulltsA:Ita!
<br />DDCIdSAIIS}ts
<br />I hcrcby rf,nnr utrdcr pcnallyofpcrjury onc oilhc nnk)*inE dccl rrlions:
<br />-lhavcod*illnuinrain
<br />aCenificaleofConscnr ro Scli ln\urc |or workcr'ompcnsrk n. pr.vid.drorbys(rnnrrT0Oolthc
<br />lrtff (bdc. for rhc pcrf.rmncc oirhc aort lor qhich ihc pcnnn is nsucd
<br />I hNc and *ill ruinl3i! *orkcrr compcn\arbn insurrmc. a\ rcqdiftd by Sftr n,n l70O oI Ihc hbor Cbdc. for thc pcrfonrun.c nl
<br />rh. w.rk fd which rhh ncmir is hscd. My workc( omncnsdx in\urjtrcc cnnicr md policy numlicr ae:
<br />srtak fi.,'4d
<br />WARNING, lirilrc to \ccurc wortcrs conrp.trsirion.ov.rrsc n trnhlr l. rnJ \hrll \ubi.cr an..r oy& k, .rinnrl Nnrltics trod
<br />civil ftrcs up ro onc hundrcd rhot$nd dollls lSlU).1)00). in: diri(n,brhe.onor.o.1p.trsrn.dnn+csrspovnlcdri)rlhc
<br />S..ri,r,.lo76olrhc lilhorGytc- i' crcn J
<br />lz5/tb
<br />DECI,AAAIION
<br />I hcrcby rmrm undcr pcnollyoflsjurylhal I rm lian$n undcr povnion ofchlprs9 (onrm ingwirhSccibnTcroo)olDiviriotr3
<br />or rh. Bxsifts {.d Pbr.ssions Codc, aid ny lilcn* is i. 6rll forc md .ficr.
<br />Dlaq3L
<br />7tL?/13
<br />CAXSIBUCIIONI.ENDIIGNAENCI
<br />I hcrcby afiirmundci Fnallrotpcrjlrylhal rhcrc is a consldcri,n lc.din-q aseicy ntr rh. Frroi.Ucc of$c aork lbr uhtt thn Fnil is
<br />lsucd (Sc. lur7, Civ. C.)
<br />AffIIIANfDEgI.Af,AIIq!
<br />lN,yanlmundcr pcnoltyofp€rjury one of thc toll.*itrg dcclmolionsl
<br />D.molltion Pcrmirs Asb.sos Nolificarion Fcdcml R.Sul,rions OnE 4'{J. Plno
<br />Rcquinld L.lld .l Notiarcation
<br />_l crrilyrhll rhc fcdcral rcguldions reprding r\h.sr.s rc.r,vul r. n r ottlic.hlc to rhh pm]c.l.
<br />'7*4ll.cnrryrharlhatcrcodrhisopnlEahonand{urcrhrrhcrhovcinlorMrionncomcllasdroeq)lywnhallCilyandCounly
<br />onlimnccs.nd SIfu tjws rcldin8 to builditrB consrrucrior ud h.rcby outhorizc rcprcscnruri!.r oflhh Cny Md C.unryto enlcr u,$n lh.
<br />Jh*c mnri,,ncJ I,n'ncdy fur in<p.diun purp.*r
<br />nrr,,".,, r. nr-, a,**,,*' d:lftff-a,t/
<br />bl,)
<br />75
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communicalions Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<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 Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough 1/4/*s\ r1t
<br />Service [/eler
<br />FINAL 1/ rVt*9D 6A
<br />Notes, Remarks, Etc
<br />ID/SIG.
<br />Pole Bases
<br />.,"r*.,*,, (Zi135Rl 7 o*r",, 5ls t,t 18
<br />l..niryrh.r i.rh. p.riormmc of $c work lor which rhk p.rmn is nsucd.l shull not cnrl'loy !n] pc6oo in dny tunncr
<br />y, as l0 be.om subFl lo lhc uorkcn corrpcnsiion laws ofCllifonria, aEl laec rhDr itl srhuld l$.m snbir! ro lh.
<br />wortcF ompcnsrion povhio.s oaScclion:17(Dolrhe Lltn C.dc.I shsll. fdhwnh..mply wirh ihos povnions..
<br />Ixtulcr'\ dJ'c(
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