|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG COMMENTS OWNElI BTIILDER DELCARATION
<br />I hcrcby ri,lrm uMc. Fnahy or p.rjury rhd I d crcmrr fmd rlt Co"rr&loR Ltcnsc ljw for rhc iollo*ins rcaso rscc 7031.5
<br />Busincs a,n Profc$io. Code): Any Ciry or Counry whi.h ,.qui(l a p.rnir ro .onftu.r. aho. inpiov.. &mlirh .r rclrtr any
<br />srdcr!rc. pior to irs hsuane, als rcquiEs Ihc npplka for su.h pc.mi( b fik a siBftd sl,rcmnt rhat tr or shc i li.ened puNuanr
<br />to thc i'ovnn,ns of$c C.nracbCs Li.cnscd tju (Chaprcr 9. Comm.n.inE wnh Sc.rioi 7{XI) of Dilhion:l .frhe Blii'rcs lnd
<br />Pn,rc*ions Codc) or thar h. or shc is cxcmtl rhcrcftom a.d thc basis for rhc rllc8cd cxcmplio. A., vi.hlion of Selhn ?031.5 by lny
<br />ippli.aflforapcmnsubjcchrhc,pplica.rbrcivilpcnahyolnormrcrh nlc hundrcd dollF (5500)
<br />!.,s owncrnfihc proIf,ny. ornycnrpn,ylcs wilh wascs.slhcir slconpctrs nnr. will do thc {ort ud lhc slruclurc is nol
<br />i cnd.J or ofi.r.d li, elc (Se.7044, 8trsinc* a d tunt$ions Cod. 'l hc C.n rucroi c l,iceis Llw docs not lppiy to ai owncr ot
<br />rhc p.pcny uho builds or impmles rhcmtr. drd who docs sn.h mA hims.lfor hcrcllor Ihmueh his or hcr ow. cmplolccx.
<br />prcrilcd rhd such i.rlmwmnh d tur imunth.l or.lTcrcd ,or Eh It hoMq rhc hildin8 or impmrmnl i\ $ld *irhin onc )rr
<br />ofdnt{,lcri.n. thc Owncr Buiuer Nill h0!e ltE ttrdctr ofrmvin8 tnn hc or snc dil d hoild nr in{ro* fic poliny ior thc [drlx'*.f
<br />I. .s ostrn or rh. In,t dy. m cr.lusivcly ..nrrrcring sith l&na! contracron ro con(rucr rhrymjccr (S( 7044. Bu.ilcs
<br />arn h.i6sh. Codc:1hc Contrfror's Li.cnsc L,w ddr nor npply ro an.wncr orr.p.ny*ho buildr.r nnpr.vcs rh.r.on.
<br />a.d who mnrrlcls for ruch rnoFrs trirh r Contmcro(s) liccnscn puGurnr ro rh. Co rn.rols Licctrr Liw)
<br />I dcicn undcr Seclio I & PC turrhn rcr$[
<br />Iltxf,E8[rl]ullNs{L[rN
<br />DECLAN{IIQX
<br />I hctoh, nflnn uM.r prMlry.f p.rjury oic.frlc n,l[)sin[ dEhrarii)n\
<br />I hnv. ,ii *ill tuintdi a Cenificrre of Conscnr ro Scll ln\urc for r$ke^ mmpctrsrn,n-!s provid€d lorbySccrion:17(Ootrhc
<br />LrlEr G)d.- lor rhc pcrformncc oI rhc solt lor *hich lhc pcrnrir h h$cd
<br />_l haw lnd will nEimain workcB comp.nsatbn insu.dc., a. Btut d by S(rio. l?00 of th. tlbor Codc. for llE FrfmMc of
<br />'hc
<br />trorkfor which lhi: tlcmir ir hsrd Myqnrkdi c.'nFnsar'on rnomc.corE d t$lEynumb.r @
<br />c, e, Stalr Erc-lq21\3o6 t7
<br />I..'riry rhar in rhcri.rlormanc.orrhc * * ror rhichlhh pcnn n ns,cd- I shrll nol cnrplo, any lcnon in uny Drnmr
<br />so s lo bc(nm uhFd ro rhc *ortsC .o rFn\rinnr L*s of Caiif{mil snd r8rft rhd if I \hould hrom $brcd b rh.
<br />w.dcrs conr!.nsariotrIrolisiotrsofS..ri{ :l70O ol rhc litxr C{xlc. l \hrll, n)n hwirh .\nntly R irh rhiM nmvhio \
<br />WARNING Fuilulc lo surc workcn'conDcns ion stcriSc is unliw,iil. ond Wrll suhFd an cmplor€, Io cri inal Fmhics snd
<br />.i!il fincs up ro om hundrcd lhou\and d.llln (Sl(x).u]l)), in iddinon ro rhe co{ .l conD.nsalion. dam8es !r ln,vidcd lnr thc
<br />S.cri(r :1076of Ihc,f,txrcldr inrcrc(xndrrrrrv \li.s
<br />1129i4?t lv,on"'nr,l/11
<br />DECLANATON
<br />I heEby !flirm unncr l)cnalryofp.rjury rhnl I m lian..d und.r Fovision ofChatlcr 9 (onnrncine with Sction 7m0)oiDivnion 3
<br />of lhc Busift* &d PNfes.iotr{ C.dr, ,.d n, liccn+ n in flll fo,e and .fis'.
<br />3 lol-7qj l-
<br />7D,r/lb to
<br />CAISIBI]CUIINIENDING.dGIN.CI
<br />I hcEl,y !fiirnrundcr pc.ohy of pcrjury lhal lhcE isa consloclion hndinS aScncy for the lcdommncc oflhc sork tor qhth rhis Ilcrn l h
<br />issucd (Scc.3097. Civ. C.)
<br />AI]LIIANLDECLASAIIQ!
<br />I hsrtyaltimu crF.dryof Frjury om of rhc follo*i.e d*lmlions:
<br />o.mlirion P.nnirsArbc{os Noiincdion Fedc.dl Reslhtions lTnle.l0, Pan6)
<br />Rcqrtcd lrncr of N.rifi. i,i
<br />l.cnilyrh r rhc fcdciiltulul.!otrs [SnklinA a\h.(or rcnx,vx]arc n.r trpfli. lrLft, rhh t,e&cr
<br />etl ccrtily lhnr I huvc rcsd rhG applic&rion md srarc rhoi rhc ltrrvc inronmtiotr n coret. laare to comply wirh rlr ciryund coonr,
<br />ordinanccs ond Sratc Liws rcLriry to huildin-q c.nstrucrion. d{ hcrcbyaurhorizc rct cEnrarilcs ofrht Ciry and Counryro cnrcr upo" rlr
<br />abovc rB0linrd pm!.ny for irspRlio. pur|xi*s
<br />.\ppliunl f,\Arnl Sixtr lu 7l25/lb
<br />\hrlltr
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soff it Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough f/4 /t,t SDgY
<br />FINAL $/t511 9L6't
<br />Notes Remarks, Etc
<br />h
<br />Pole Bases
<br />Under Slab / Floor
<br />Air Conditioners
<br />Service IVleter
|