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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDER DELCA R-ATION
<br />I hcrchy afiiirn under !.n0hy of pcrjury rhll I am ercmpl fr,to rhc C.6rra.r.s Liccnsc tjw for rhc followins rcasn (scc 70ll 5
<br />Bu\i.cs rrxl Prorc{rion Cnld)r An, Ciry or Cornry whkh rcquircs ! Fnnn lo con\locr. 3lrd. irptuvc. d.mlish or rcr.t lny
<br />slructurc, prior lo ils knlancc- aho rcquncs rhc DIplicMl f(tr such pcmir ro lilc r sieftd shrctrnt rha' h. or she i\ lkcn*d po ue
<br />ro thc povhi,ns ofrhc conhclols Licctr$d L{w (Chqrler 9. CommcncinE snh sc.rion Tuxr of D'lhion I ofltc B!sirr.* lnd
<br />Polcssiotrs Codcl or lhll h.orshc ncieopl rh.tcfn, nnd rhc blrir ror rhc alh8cd .xcm ion Anyviol0lionoiSe'iin70ll5by!6y
<br />lrplicunrtn!pcmislbjLrkrhcltpli.anrroacivilpcnaxyolnolnwclhotrtvchund.c.ldollar(5500)
<br />,r I
<br />^
<br />L\l/6\ osns ofrhc pnncnr. or n'y crylnrc\ wirh tr rEcs as rhcir rolc .r,dpcn$rion. wru do ltE wtrk $d lhc sltrr@ $ nyYrcnkn nr oli.red for ek (s6lol4. Bd\dc\ ind Pn'r.sionr codcr Thc contacloas Liccn\c Law d{*s ior sprly ro an owftr oi
<br />rh.l,bJt.y wlk) boildr or ii{,o6llErcn. urt wlf,r drcs such R'lt hnn{lf o, herclf.r rhmugh hir or hd own .mtloyccs,
<br />provnbd rhsr such impmumnls n nor hrcdc{ or ofli*d 1'or slc. If. howcrci rh. buildin8 or irq'roEmot is sld wilhin ot Fr
<br />or.onrphtion.lfu Ovner Buildcr willhlw rtc t d.n olpmvins rhr! lEordEdU mr t iLi o. irlImtt ihc Polf,iy for tr purF $ol
<br />l. Nowncrorrh. Eo!.dy. a crclusivclyconli.clins wilh li.cnscd conrmcro^ rd conntu.r rh. p$j..r (Scc. ?o1,4. Bu\inc$
<br />atrd P,Drc$i,n Code: Thc CoDrmcifi s Lic.nsc Ltr* ducs nor apply b dnownct olpolErty wh,r 6uilds or inpn,v.s rhcrc.D.
<br />and who.u[EcBlorsuchpm]ccls*irhaConrEcro(s)liccnscdptrrlDdrbrhccinracror'sLiccn€tiw)
<br />;:*0{er\
<br />Setion-, B. & P.(
<br />ttu ORner:
<br />I hcrcbynfiirnr undcr ncnnllyoipcrjuryonc oaUc ro,bqins dcc
<br />-l
<br />hurr lnd sillnuiarxii rCeniar.rcorConseflt b Sclal,Nxm Lrqolkcrs .annpcn\0rion, !s proidcd fot bySNtio 37(XJ ofrhc
<br />Labor Code. lo! lhe pcrlomunce of rhc worl foi shth rhc ,,crhir is issu.d.
<br />_l hrlclodqiU nrinuin work.if.omp.n\.rion insufuNc. os rcqunL{byS$.'lion17(x).rrhclrlxtrcodc,rorlhcPc.totmonceof
<br />rhc w.rl auwhthrhisFrnrn is issucd. M, workc6- omp.nso' ion imuamc caricr anl Flicy nrnhr dcl
<br />f[lJ/.D,r., -,r," n-r,*tunlc rrhc$Nki,tr$htrhrhisrnnirhissucd-Ish(llnorcmrl.y'ny!.,son,ninymonrcr_ kyA t. b..unr uh].\rro rtu qorkcis'mnrr.nsJrii,n,!ws ol Califnnii.,nd agm rharirl should tEom subj.tr to rh.
<br />workc.rmpcns,rionpmvisirtrsofSNtion37()()ofrhcL!tD.CdqIsrtl,ronhNirhomPlywilhtho$Pnvtbns
<br />WARNINC Frilurc ro Kur. nrkcn'.ompcn\ari('. $vrhgc is unlu$tuL rnd shall \uhi..r rh cmplortr io ai ril P.mnics und
<br />ci!il l-Lnc\ ut ro onc hundrrd rhoutnnd dnllxrs (il(n.0lD). ir ddil n kr rhc.osl o f .on'r.n\ar ion, d,truBcs !s
<br />:::fr;l+iIt4-'
<br />I hcnhy fftrm undd p.nahy ol pcrjuy thur I am liccnrd lndct ni0n orChnprd 9(c.nrnEncing silh
<br />Liccn\cN!mh.r:
<br />Co rnclor:
<br />CONSIB!]EUONI.ENDINCJIENII
<br />I hcrchy,filnDUMcr F..hyoinciwy lhar rhcrc h r oo(ocri,n lcodi.S agcn.y ft, th. Fdntnuncc.arhc *ork ror whrh {hh lEnnr is
<br />hsucd (Scc 3097. Civ C )
<br />txnd.ls Namc:
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<br />ATILICANIDICI,AIAIION
<br />I horr,y arm ondo pcnrht ol pciJury om oi thc lolLsin8 dccltrol iorr
<br />Dcmolition Pcflnirs AstEdos Norinc.riotr F.dml Rcguldions (Tirlc 40. Pan6)
<br />-Requircd
<br />L.(cr ol Noriak ionr,ilyth.l lhc ndcral .csularionr rcssdina ,\h.sbs ,.,B,ul dc .ur apflicablc lo rhn pmjccr
<br />rhd I harc lcad rhis splli.li i{ni s l { d ihar dr ab\c nrl.rmdion is .orel I l8rr t, .omIl} *irh .ll Ciry .nd (bunry
<br />Shrc Lrwsrcl in8ro buiuins nr dxl hcrrby aurhorizc rcl)rcsnlnliver
<br />$or. trrnti,nrcd pn)Nny tur fisJr.l otr lurtx
<br />Applicnn( or AEul signslufr
<br />r(
<br />0
<br />'iaru-""
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />[/eter Release
<br />Rough
<br />Service [t/]eter /t I
<br />FINAL @,/24//t l'ffi qn,O8,/
<br />Notes, Remarks, Etc.\l/\:-.,.
<br />ID/SIG.
<br />Translormers
<br />ol rhc Burinr$,nd Pmrasio.s Codc. and myliccrsc is ir tull ftxc!ftlcffccr
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