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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS (,WNER BUII.DER DELCABATION
<br />I hcrhy affirm ond.r prdslry ol Frrury rhd I m cx.nDi rmnr rhe Conr{im Liccnsc Liw for lhe followins rc&a. (Ss.7011.5
<br />Busincss rM Profc$ion Codc): An, Cily or Counlt which rcqunA o pcrnrir ro consltucr. !lrd, imFovq dcnEli.h or nprt {ny
<br />srrucrurc. Friorro irs hsuurcc. lho rcauircs rhc amlic{nr for suct rEnnit ro lile a siso.d $rar.'rcnr rhd tror shc is li.cn$d purulnl
<br />b (hc F,visbns of rhc Conrrucror's Li.cn*d ljw lchapr.r L comcncin8 vilh SNtion 7m0 ol Divhion 3 oflhc Brsinc* dnd
<br />Pr.r.sionsCi.)orrhartrorshciscx.m rnrcfromlndrhcbasisli,rlhcsllcSe(cxcmplion AnyviolalionolsarionT0ll5hyaoy
<br />lpDlicant lor 0 ,tcrnil suhjalslhe {rlic.nrlor.i!ilpenaltyorootnnrcthlnfivchundrcddoll*!(S50o).
<br />l. ns owncr ofrhc po,rnr, or my cmployccs wirh wagcs n lhcn st ompcnkrion. willdo rlt vo.t and rl'c dftr@ i\ ftn
<br />inre cn or oficrcd for rlle (S( 7ltl4. Burires lod ftof€ssions Codc Thc Conhcroa s Liccn* tiw docs nor apply lo an oanc, of
<br />lh. pmrxdy wtr, builds or int mRs rhmn. ed who dmx such wr hrmrclforhcrscllorlhmu8tfihorhcrowncoll.yccs.
<br />providcd rhor su.h impn,rmnr( m (, idcnl.d or olliBl lor ek li h,Mhi rtl hoikling oi i'ntmvcmnr is q,kl wirhin orc J{(
<br />ofco.llllc'ion. fi. o,rrcr Bui[cr willharc ItE hodcn ofrovinS lhar hc or snc dn mr l{ih o. irnpDft lnc polxny ror th pu{rk or
<br />rhc Drorcny. ncxclu\ivclycontrrcrinswirhlic.n{dcontucr,At,conrtu.ritr|tr(iLrr(s..7{}:l,1,lrurinc$
<br />,dc: Thc Cont .ttr\ Li.cnsc Lrw docs tror.Ftilyk, in.wncr oftr(,lEny$ho huildror i'npn)vds rh.rco..
<br />lnr6 ,n, \uch pojccr \ *irh r (irnt rtrni 9 licctrsd pur\utrr n) rhc
<br />P('
<br />DECIATAIION
<br />I hcrchy llinmudcr pcmllyoipc.juryonc otrtf, nnhwin8 dcclmrion\:
<br />-l
<br />hlvc en will minrain ! Cen ilrolc of Cotrsir ro Sllll trsurc for *ortcn comj{.s ion, d rovidcd for ty Selion l?00 of lh.
<br />kh.r O,lc, forlhc p..lornDftc of$c so for whth rh. Fnnn is nsucd.
<br />-l
<br />hrvc rnd will mrinrli', *orkcrs com!.n\rrtn, insrra'r., a\ rquimd hyS..rioi lTUlolrhc LnborCoJc. tur rhc !crl.rnun!.ol
<br />rfu work lar shich rhistcnnn i\ is\ucrl. Mywurk.^ cu rpcnsdror r\ufuncc crricrnnifl,li.ynunrhcr ecl
<br />Poli.yNumb.r: Eirtc\:
<br />-l
<br />ccnily rhll in rhc pcrtornrncc ofrhc work n, shich rhis r.rmir i\ isiucd. I shrll nor cmtloy atry pcretr in nny munrct
<br />sr dr ro h.(oft subj.cr t, rh. workc^ comlrtrslio lnws ofcaliforni{. rnd i8rcc lhul il'l sh.uld b..oft suhjer t, rh.
<br />wo*.n.oq,cnetionflovisionsolScclion]?00ofrh.trborCodc,Ishall.iorrhuirhcomply*nhrbs
<br />WARNIN(;: liilurc b $.nr. sorkcr comptn\Jrion.ovcBlc i\ unlJ*lnl. r'xl (hill
<br />civil ir.s up ro onc hundrcd rhou\anJ dolh^ (Sl(X).( O). in rddirion
<br />S(ri.n lltr76 ofl,lc Ixlo, CodUmcrc{ and dt
<br />*"' r hflT *,
<br />DICI,I.8AIIAN
<br />I hcEby lafim un'ler p€nalryolpcrjnry rhnr I !d li$n$n under lrornn orch.picr9(.o mEmi
<br />of $c BusiRss lrd PmlessiorNCodc. o,n nrylkcns is in aull loR. ard criacl
<br />Q I
<br />C(INS'TRUCTIoN LENDING AGI'NCY
<br />I hcrcby rlltnr undcr IEMlly of pcrjlry lhar rhcrc h u snNlru€thn hndins ulcn y ror rhc pdldnmftc ofrhc vork ior whichlhis lcimil h
<br />isucd (S...l0)7.Civ. C ).
<br />AIIIIqANIDECITIAAII!)N
<br />I h.r$y rninn urdcr pcndlly ol pcrjury onc oilhe lhllowing dshrorions
<br />Deffnirn,. Perhn\ Ash{or N.rifi.arion Fcdcrrl R.laldrioos (Tirl.rto, P0n6l
<br />_Rcqun d Ldrcr of MriLarion
<br />I ccdilyrhd thclcdcrdrcguhrt,ns rcsoftlin8 lshc{oseflnulsrc nor$plic!$lctu rhis F!..r
<br />_l ccnilyrhrr I have rodrhis rpplicrrinmJ {rlcihrr rhr*iv. nna fr{r I n8rcc b.onDly wirh trllCiryand Counry
<br />odin.nrcs ind Srolc L.ws.cblirr k,
<br />.bvc nrnriomd lmpcny for i,rpccl
<br />Appliotrlor&mlsi8MluE
<br />-Peni,t.Nn ryna,,, j(1_Lel?_L >/1 ::.:LLH
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Bouoh)
<br />Meter Release
<br />Rouqh
<br />Service lvleter 1 I
<br />FINAL ^hbn7 twwl
<br />Notes, Remarks, Etc.I \)/ /
<br />APPROVALS
<br />Pole Bases
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