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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
<br />I hcrcby offifln undcr !$!lry oi pcrjury rh{ I a'n cx.frpr iiom rhc ConlBlo$ l,iccnsc LIw for the t lowing rcne. (SR 7ol l.5
<br />Businc$ otrd hoicssion Codc) Any Ciry or Connry whi.h tcquies tr Fmil lo coo(ocr. slic.. in ov.. d.mlish nr rcldn aiy
<br />(rucrure. prior lo ns i\suaie. llso rquics ih. appli.d ror such ,rrnril to filc ! sismd sllrcmnr rhat h. or shc G lienscd puruant
<br />ro lhc [ovisions ofttr Conlr0clols Liansd l-l$ (ChlFrer 9. Comftn.ing wnh sccrion ]mO of Dilision I of rh. Bu\in.$ a.d
<br />Polcsions Codc) o! thal lEorshc isdcnrfl rhcreftod{nd rh.hNis lorlhcdlc8cdcxcmplion Anrviol io.olscdiotrT0ll.5l,yony
<br />4rliclor tora penir suhj(Grh. appli.anl lo acililpc.lllyofnot nmrclhan tivc hund..d dollrsl$50o).
<br />l. .s ovn.r oi rhc l,mFny, or my empb)ccs silh wlses as rhct v'1. .dq).isd bn. sill do th. vork atd rhc srturm is fln
<br />inrotu or oric.cd for sole (SE 7(|44. Busincs Md PioL*ionc cMc Thc Contrucrols Licensc L,w do.s nor rpply b !n owrc! .f
<br />rh. r,Tlrny who hoilds or nrymrcs rhcmn. ord wno dNs sh wr* iinNclfor h *lforlhnu8h his or hs owtr cmPloyccs,
<br />providcd l hlr ruch imlnrkmnk m ft, ii cftidl oi oft Nl f(, slc. ll ho*8. rh. ltrilding or itr{mtnx.r is $ Rnhinorc,ts
<br />.rsftdcrirn. rrE o,ner Builtcr willharc rhc tDrdcn oapDt.g rhd lE or \hc dkl nort klorimPmrc [rc ImFny ftr rh. p!.F* of
<br />-1.
<br />as o*ncr ol rhc Dron ny, lnr crclusikly c.ntd i,rg wirh li..n$d c.ffadoN lo .ondtucr ri. E j..t lscc. 7(x4. Blnnc$
<br />,nd lbftsssn Codc: Thc Cnnlrrlols l,iccn\c l-a* d.c\ nor aptly b s. usncr ot proFny who builds or ntrPn,!.\ rh6.on.
<br />and rho conrncls for slch rmre.r{ wirh r csntekJdO li..nicd l)Ursurnllo lhc Cn ructnsLi..nrtjw)
<br />-l
<br />nn cxemat utrdq SL{li0 B &PC turlhi\rcnron
<br />Ir.le:-- Oi...
<br />woRKEii' ai)MPBl\iaiio-
<br />DECI,AAAION
<br />I hcEby afifl, undcr pcn,lly of rcrjlry om of rh. rollowine dccLrarhtrs
<br />-l
<br />hrvc and will nEinrsin. Ccnifrarc orc.nenr ro sclf.ln{.e ror workcs con{rnsatioo. r\ tmvid.d ror bySelion lrm ollhc
<br />trboi C.dc. for lhc pcnonEmc ofrhc $ot for whth lhc p.dn i! iqsu.d.
<br />-l havc etrdwillnrintlin sotkcB cosp.marion insunmc, as rcqutcd brSsrion:1700ofrhc bbor C.de. tor thc rdfotmun.c or
<br />rnir is k\rEl My *orlc6 .onrF sdion in\unrcc cmi.r dtd Iblicy N'nbs m:
<br />\.\ .\q .
<br />l..dify rhDr in rhc tcrl|rmrncc olrhc w.rk for -hich rhk pcnnn is n\kd. I shill not cnrtk,y lny pcrv,n ii tny mmct
<br />so Nro lEcomc \uh]cd ro rhc wor*.^ cotrIrnsdion hw! rfCllifdnio. snd lgrct rhd ift \hould hc..N subjsl lo lhc
<br />sorkcn co'npcnsdn,n tn,visi.ns olscclion lT0O olth. trtnr Codc.l shall- r(dhwirh..nply wnh rhos pnvnn,ns
<br />lurc b s.urc worlcr' compcnerion covcage h rnlawfnl. and shil subrccl .n emlloltr b.riminal lEfllri6 ond
<br />o.c hundEd rhonMnd dollar (Sloo.lx,.l)- in addirion ro rhc c.s of con$.
<br />,,JUN ii'ru]q":;;::,t*
<br />DECIAf,AIION
<br />I hcrbt afiirnunds lcn.hy ot tlcrr!.y rhlr I M ljentsl ud.r Fotision ofChlptcr 9 (omemiog wirh Scclion 7m0) ofDivision l
<br />or rh. Burin.s ,rd Pof$sn'ns Codc. snd my li€cns n in tull ro,e ,nd ctfsr.
<br />:::ju -(^^.,o \ooft{?ft,f,TrlY*."",*",". k^ktrn-
<br />COIEIBUSTONTENDING.{GENCI
<br />I hcrchy aftim undcr FinxyorFiiu.ylhal llEc is a onnNdbn lcndinS dgen.y ro. rhc p.Jfoirrorcc ollhc !o,k rd which rhis Frmit i{
<br />nsucd lsc.1097. Civ. C.)
<br />AIIL&ANLDEII.ANAIIAN
<br />I l*rcbyallj undcr tcnllry or'pcljur, otu orlhc n,lbwirt dNln(ion\
<br />D.mnnion Pcnnn$Asb.(os Nolifi.ilnnr Fcdcrol Rcguhrirns (Tirlc.10, Pd6)
<br />Rr{lrnrd l..rrcr of N,Iili(iri(ir
<br />I ccnilythar llE fcder! I rcsu lar io.r r$rding rsh.(.s rcrmv,l dr. nor amlicahlc rolhis!n,jd
<br />Zl enilyrhlr Lulc Md rhi mlicarion un $.tcthar lhc ahovc infumrn,n icotr cr I t8talocoq)ryq hsil c randcolnry
<br />ordinaMcs,nl srrrc l-aq\ rLrii8 ro buildirS coNnrcr
<br />abr trrnrioned fmpcny fu i',\pccrtun purpo\cs
<br />rlnr{ ( ir) rtr(l(itrtrryb. r.rrll rhc
<br />Applimnt nr Aacnl Sismlurr:l
<br />i(!r. t hcrbyiurhori^ t
<br />il 2018
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />lVleter Release
<br />Rouqh dzo/r?-,1/^rr'4 /r)
<br />Service lr/eter {/'u//,qDGb
<br />Notes, Remarks, Etc
<br />FINAL
<br />bhdci\ Nrm
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<br />tlnl.l\ Addrc(:
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<br />,y'.;*'
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