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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BU!!,DER DELCAN-ATION
<br />I h.rchy ,ifrn xnri$ !.n,lly of pcrjury that I o cxcmpr frod rhc ConnncrtrJ Liccnsc Lar ior thc lolLwine ,casn (s.i ?0ll 5
<br />Busnrc$ rftl Prclcsion Gxic) Any Cny .r c.u y which rcquircs r ts ir lo con(rucr. rhct, inIbv.. &mlhh or rclan rnf
<br />nru.rur.. prin r, ns issrrcc. llso rcquic\rte amlicarr lbr such pcmirk,lilc u si8ftd stntcnEnl rhd hcor shc i\ li.cnscd 0uFuanr
<br />k, rh. F,vi\idx.ritr conldcln s Lienscn Law (Chaprcr 9. C.'. trin8 with sccrio! 7trco of Dillioo I or rh. Blsincs and
<br />PoLsio Codc)orrh hcorshc hcrcnrpr rh.rcf..nnnd rh. bNi\ nrrhcallc8cdcxcmplioo Aorviol,lionofSl_rion7oll.5t'yany
<br />.fpliclnt lnr r ncxnit suhj(lsrhc appliclnr ro rcivilp.nahyorno' mrcrhan tivc hutrd(d doll&r (S500r.
<br />l. ,\ owmr or rh. pmlrny. or my cnployes *irh vases a\ lhen v,b cotl*nsotion. will do rhe sork !d rlx idrm is ml
<br />inrc.icd or oficrcd for elc ( Se 7014. Busincs ed Profcssions Codcr Th. Cnorrrcroir Lien* kw dms nol apnlv lo o o*er.f
<br />rhc lln)rrny wb boildr or in9rcB l,Emn. ad who dm $ch k* hin\clr.r hd€lf.r rhmu3h tG or hcr own .rll)bytcs.
<br />provil.d rhat such nnpmwnrnts m rcl inrctol€d u off.tn for slc. ll howcE. lh. trildios o' nrplMft.r is sld enhin ore )tr
<br />orc.'r0Lr in. db ovncr auilhr will h!rc r,E hrrden oi p,oving ds, h. or sh. dn d ttrild or tqrct rhc I,BIdy r., tE puqn$ ot
<br />l. rs ostrd of rhc phrcny. {n cxclusively coirrdi.E *irh lic..scd .ofta.k s b .otr(rucl lhc PRU.cr lscc. 7(}l-.l- Burrc$
<br />ond Fnll\shnCodc:'fhcConrrk'rLi.cnscLlwdocsnot.pplyro!.osncrofnn)Pnyuhobuildsori.Dio!e\rhcrcon.
<br />rnd sho.oirtudslusrchrrejcckwirhaConkxct,rl9lic.\cdtutrutrtr'turhcO'nlrucroi\l-icc.*uw)
<br />I Jmcxcmor u.rlcr Sc{mn . B & PC i,tr th^rcrsntr
<br />uof,trE&s:l;l0MlJNsarl0N
<br />DFCI4RATI(IN
<br />I hcr.hy rlirtrr utrdcr FctrdlyolI'crturyonc olrh. nnhrinB dNlardn,nr.
<br />I hrvc ar*l *illnurnra o Ccniicare otc.n*nr ro s.lHn\rc for krkcn mmpenyrlion- !s providcd fd by Scdioo 3?00 ollhe
<br />Llitr Gxlc. tor rh. p.irui,uflc of lhc vork for whth lhc ri.rmil h hsucd.
<br />-l
<br />hrvca Eill nuinrsin *orkeB compcns ion insunNc, .s rcquncd by S..ri.n .1700 of thc bhor Codc. lor ilE Frromtrcc ol
<br />ir is issucd Mywo*crs comncnsalion in\uramc cmi$ { B,licynun$crm
<br />I
<br />t.\.Ya-
<br />-l
<br />ccniryrhd inlhcrcrtormnccor(h. uor* ror qhichrhis Pciinil n is\ucd, ! \h,ll nor cn9loyotryrcnon in atrytunn$
<br />vr Ds b r*.onr sxbj..r ki rh. worlcr' onpcnerbn hws or C"liftrnia. and i8E rhlt if I \houli tEcor subj.c' r. ltE
<br />eork.ri .onFnsdrion p$visi'ns oa Sccl ion ]700 of rhc L,tn Glr.. t sh,ll. lonhwirh ompl, wirh rl*M lovisions..
<br />WARNINC: ljrilurc ro su'. *orkc'i .oml..slrion olcm8c ir utrhwful. ud \hall \xhF.r m cm0loytr lo oiminalFtuhas d
<br />civil fincs up ro orc hundrcd rhouend dollds ($lu).ux)). in rddilion lo rhc co{ or conDc \.rion. d.fluscs !s pr.vidcd ror thc
<br />S..ri!,r n)74 or rh. LLNtr (irn trir,.n rd rnrr .v
<br />,,.JUll 1 1 lfi'Q
<br />^*,,*.,
<br />DECIdBAU{,)!
<br />I hcrcb, aflirn !nd.r pctully or p.rjury thll I m liensd undcr pnlhionofChDpr$9 (commncitrs qirh Scdion 70m) ofDivision 3
<br />ol thc Busincss.nd Pmlcssions Codc,,nd ny lic.nsc h in hrll forc and cficcl.
<br />lo€'rtffiV'al-ua"-
<br />CoNSTRTJCTION LENDING ACFNCY
<br />I h@6y !fino undcr pc.0lry .l ,riury th lhsc h ! conslMlion Lnding tBctry for lhc Pcraotmncc o, rhc wotk ior which lhh pcmi is
<br />tsued (sa.:1097, civ c ).
<br />I c.niry rh.r rhc fcdcral rcBularions Egddins asbelos rcmval &. ml .rplicat k lo thh pojccr
<br />/|Efcdilylhur t hscEad rhF innlMrrcn0 sdcrhol thc al-vc infomrion iscorer.I !8rc ro comdy *irh oU Cny nnd ('outrry
<br />ordin(nccs ond Sr c Li$sEhros k,bundnr! conslruclion. ond hcrcbr0ulnori&e c\ dlrhis Ciry md Crury'o cnr.r upon thc
<br />.h{c nrtrliotrcd polcnr litr i,rspccri{r purFs.s.
<br />iluN n n 2018,\Urli(hnr or .\,l.nt Sisniltrrt *f-
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />lVleter Release
<br />Rouqh 6 \z\\9 l,tdsrru
<br />Service Meter
<br />FINAL ?fl-Lrlt ,D'69
<br />Notes, Remarks, Etc
<br />t trJci\ l..'trE
<br />-
<br />APIUCANLD,IiSJAAIIAN
<br />I hort'y Inundcr penalry ofp.rju.yorc oflh€ lollowinE d(lmrions:
<br />Dcnmlirhn Pcrmih Ast nos No'ificaiion F.dc.trI RcSuld ions (TitL 40. Pan6)
<br />-lt.quircd
<br />txtrcr otNorift arbn
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