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ELECTRICAL-INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUII,DER DEI-CARATION
<br />I hcrcby aflifln under pcnllr, ol pcrj!ry rh,r I dr.idn{r ar,d rh. (t hcbN Liccns ti* for rhc rolh*in8 rcavrn lsccTo:ll5
<br />Businc\s u"d Prutcssid C'od.): Any Cny .r Counry wlri(h r.qui$ r Fymir n' connrucr allcr. improlc. rtmlih or r.P n riy
<br />{d.rurc, priolr. ir i$u!mc, oko r.qut.s rh..|/ica lor suchFflnir ro filea sisied {dctunr rhrr hcor \hc h li.cnted pu6u r
<br />ro rhc F)vnnnN of rhc Coo'.Er{n\ Lidnscd lnw (Chrprcr 9. cunlmn.rg wirn Scctin ?dx) of Divnn :l of rh. Businc* ,nd
<br />Pturc$i(,ns Codcl or rh,r h.o.sh. kcrcmpl thcrcfo otrd lhc hasis lnr rhc alleEcd ricmprn,n Any vnnariotrolScdion 70315 by rny
<br />*lplicntrrlb,aFrmiisubjcchrh.applicurxracivilFntrlryolnormorcrhn fivchtrndrcddollah($500)
<br />L as o*Mr of rhc phtEdy. or my carplores with 'r!cs 0s Ihcn sb .ompensar ion. will do rhc qdk ! th. slEclurc is nol
<br />inlcndcd o. ofrlrcd tbr slc (Sa.7044. Busiess and Protcs\ions cdc Th. cnnklcror's l-kcnsc l,s doci not.r,rly r, ,. oPnn of
<br />rh. DFp.dy wtu huilds or i.Illos rh.rcn, 'rd who d(s skh h* hinsclfot hcr*lfor rhou8h his or hcr dwn cnlloyecs.
<br />p(,v idcd rhr! sNh nnEorcnrnls N ml intcfrk or ofiut1l hr sL lf. ho*evcr. rtr hildi.E or inpii,E.Enr is mkl rilhin .m )tu
<br />ofconr0lcrion, rtr Osrcr Buiti( will harc rhc hu&n of prcvins rhir h. or \h. did nor bnih or nryoE fie polmy fDr lhe lluqns ol
<br />-1,
<br />tr\o*mrof rhc pm!.dy. a cr.lusivclycontNir[*ilhli.cnscd.onrn.l{nsl()con(ru.rrhcpn,J.ar(S.c7()4]t.Bu{nc$
<br />trM PmfL\su Codc: l hc G)nraclois Liccn{ Lnw docs noi rpply h rn osn.r orpo!.ay wh() builds or inrprorcs rh.rcon.
<br />und wlo $nrn.r\trslch pmrrch wirlr C.nri.td\) li.cn\cd lurunnr torhcCo racnn \ t.iccnr Lrs)
<br />__t
<br />c) / a z.rat'l 4*{Da'tl!an8!!$(1lM[Nl]r]I0l
<br />l2l:tl.d-BArlltr
<br />I hcr.hy alrim undcr pcnally ofpcrjuryonc.flhc loln,*ios dcchr0rior\
<br />I hrvc .r{ will minrlin a Ccnifi.atc ol CoNcnt to Scll lnsurc for sorkcn conpcnerion.N Imvidcd for bySc.rion:1700 ofrhc
<br />btrtr c.dc. for rh. Fdormncc oflhc work lor pnich thc pelmit h h\ued
<br />Ihi{( *illnrn ain*orl.rarotrln. \arnnr in\urricc. "s rcqnncd hyScdion.lT(X)olrhc l!h.rO)dc. ntrrhr Frfornrn.c ol
<br />rhc *ork lor whichrtir lcmir i\ i\\ucd My work${ .onp.nldrn insumn(.1ricr rnd plicy unrh.rd.:
<br />Rnicy Nun$.r:-Expncs: -
<br />I $niryrhxr inrhc pcnbrnmrccofrhc work lbrwhichrhis pcimir is hsued.l shallnor. 1ploy.ny Pcfon inlnyflranncr
<br />n) s b hcoaE $hjcct to rtE workcr c!flrpcnslrion laws oi Cllirornid, md a8rc thd ir I should trcom slbFr h
<br />'h.wolkns conrros.tion lmvhions ofSccrion:l?Of,oflhc Lak, c(xlc,I chall. rodhwith conrdy wilh lho{ pEri\ins
<br />WARNINC: I;trilurc h *.urc warkcs .onrp..s.ii.n .orctusc is utrlawrul- and \hall \uticc! an.'ryloyci ro dinrin0l [Enrhics ild
<br />co{ ol conrn isrnii drnhlc\ d\ p(,vnlcd tur rhc
<br />inrc.crr 3M 3rnnfty \ icc.
<br />httro'/1I
<br />IIECI,Af,AIIOB
<br />t hcrby afilrn undc. p.n0lry of pcrjury lhal I am liansd under povirion of Cbafl.r I (smminS wnh Sdion '7000) oi Divkion l
<br />or the Bu*ircss and Pmr€ssions C.dc. .rd my licc.sc is in 6ill foe and eil(l
<br />t Ot d6?{
<br />GA * c,,r*d", LiZ+t b$ED;E,, t f*"lt*hd.fi.-
<br />IONSIBu(:IIONIINDINC-&AINCI
<br />I lf,rcby.fflrn ukLr |roalr, oipcrjury lhlr rhcrc h r $n$rucri,n hndins agctuy f(tr rhc nQloflMrcc olih. work fitr (lri.h rhn Frmir is
<br />issucd 1Sc. 1097. Civ. C.)
<br />AIIIICANLDECIAf,AIIQX
<br />I H,yailm!.d( p.nNlry of pcrjury onc of
<br />'he
<br />lollowing d(ltralions:
<br />Dcmlirbn Pcrn ls-Asb.sros Notificlrion Fcderal Rceuldrions (Tirlc,lo. Pd6)
<br />Rcquircd Lltcr oi NolifEotion
<br />! c. ifrrhd rh. f.d.rdlrcgul 6trsrsrdlng ashcnosrctrs\rl{c nor rpnlicnblc h rhi\ pn,i(r
<br />I ccdilyrhd I l c rcal tii\lpnliqrion ael {arcrhar rhc rtxrc inlnnn.rdr i\..rNr IllgNhcomply{irhrllCirtnndCoutrry
<br />odinrmcsaM St ctawsrcl iry to bu iuins consrrucr ion. dhc rhorir rcpr.scoralivcs oilhis Cily!0d C
<br />hxc
<br />'mnri('ncd
<br />pmncnyl{n iist crn pxrlr,*s
<br />pliunl or Arcnl Sitn,tun:*r" G,
<br />Ttau ,d Lt zr,( ot''
<br />^f;E
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Boof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />lVleter Release
<br />Rouoh
<br />Service Ir/eter
<br />FINAL 6bs/td -..-X<rl l
<br />Notes, Remarks, Etc.
<br />Transformers
<br />Cdicr
<br />civil lincs rp ro onc hundrc{ rhoustrd dollns (lrltD.oo0l. in {ldition l{)
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