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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION <br />I hcr.by affirm undcr pcnalry of rcrxr, rhc' I am cxc'npl lmn lhc ConrEctor Ltcnrc tiv for tht folh*ins rclen (5(?011.5 <br />Busincss ind Pmrc*ion Codc): Atry Cny or Colnry $hich rcquircs a pcrmir r, q,nsmd. olrf, iop&vc, dcmlnh n rIEtr trny <br />strcturc, I,ior lo irs isiuMcc. lko Equircs rh. upolhanr for slchFdn ro fih, qigicd sdr.ftnr rhal h.or shc is liccnscd ru^urnr <br />b rhc pmvnions ol rhe Conhcrois t-ic€nsed l,aw (Chontcr 9. Commcrciry wilh Scction 7fix) of Divhion :l ofrhc Busines rnd <br />Poicssions Cod.) or rh.r hc or {hc i{.r.nnr rhcrcfrofi tud thc hlsn lor rhc rlkscd excnprion Anyviolari,nofS(li].70115 byan, <br />amliranl t'or ! lcrmn subjcls thc ipplicanr lo 0.ivilpcnnlryornor mrc thr. fivc hn.drcddolles($500) <br />l..s owmr.lrhc pmp.ny, or trryc 1lbyoi wirh w,!cs !s rhcir {,lc .onwi\!r idn. willdo rlr wtrk und rrr iflcM k !x <br />inlc.d.n or otlcrcd fd slc (Sd.7o4.1. Busincs and Piorcsiois Code Th. Conro.ttr s t.ien{ La* d..s nor rptly ro M owncr oi <br />rhc rnlrny qho tDilds or iromrcs th.mn..nd who d6 such *od{ hinsclror hcr*lfor lhmugh hh or h$ own.mllo}ecs. <br />p..viJcdrhdt such inpiDrmnk m mr Lncnded or olTcrcd fo, sh lt h.uvci rhc huildinB or im{,mrcmnr is hLl *irh'nonc rr <br />ofcorphnn. th. O*nd Buiklg sill havc rhc bonlcn of Fovin8 th.r nc or shc dil frn huilt or ilnprow rhc pmFny for thc ptrqi,y or <br />-1.asowtrc.ofthcpotrty.nncxctrivclr.ontrr.ririgwirhlicriscd.ontr.r.rstu.otr{fl.rrh.Frjc.i(scc.?(,44.Bunrcssind l\ofssbn Codc Thc A,nracror \ I iccnsc l-aw dcs mr olply to an o*ncr of proncrry wh. nuiks or impro\ cs lhcrmn. <br />rM qho co.trmls tur such prcjccrs I [h d Conrmcb( n kcnkd prrsurnr ro rhc Conbrcroar Liccnsc bs). <br />Ln'cx.'npr udei s&lion <br />!ll4tr0&t:l;!J!lfjNta.Il0! <br />DEgrradIIAN <br />I hcrcbyaltn und.rt nrhyofFruryoN ofrhc inhwirg d(.-lurarirnr <br />lhrvctn uill uiflniiaCcnrlkrtrotco{nrr'Scllltr\urcturrork.^.otrrp.\nrion-r\p(rlidcdf(trhySc.ri(8l7mofrlr <br />Lntxtr Gxlc. ntr rhc pcrforroDcc ofrltc w.rli for trhich rhc rcnnn k nsucn <br />I lmv. rnd willmrinrrin workcra conD.nr.rioo insuratuc. sr rcquird hySc.rhn.lTU)ofth. tlkrCodc. for rhc tsn mnccot <br />lho work for whi.h rhis p&mir is nsxcd. Myw.rkcr! conDrnsrrion insuBn.e .mifi rnd I li.ynumbtr rcl <br />PolicyNumh.r Expnc\ <br />\{ARNINC: l:rilurc lo ecurc workcs conrpcnslrion ..rttu8c is ntrlnurnl. in,l nrll sr$r.cr rn cnlllolcr ro criminnl Fnalric\ !ftt <br />ciril nncs up ro onc hundrcd rhousand dollor ($lm.m0). in 0dditnn ro thc co(ml.nslion. d!ru8cs as providcd ior rhc <br />hc l,oh.r Codc, inrcrcn ind atrormy s tccs. <br />tl <br />I hcrby aflir'nrndcr pcnllryoffFrury rh lnmliccn{drndcrpovi\ionofchaprd9lconmci.ingsirhS..rion7fi,$)ofDivisi:1 <br />ot rhc Bu\ircssand Pro r'es io ns Codc. !toImyliccn* h infull lorcolldcllcd. <br />I hcrchy afinn undcr lxnllryofp.rjury rhar rhcrc is tr cotrsrucrion n8cNylorrhcpc onnrncc olihc wor[ lorshichrhi\ rcnnir is <br />is{cd (Sc. l0i)7. Civ C I <br />AIILICANLI)IiCIABATA! <br />I lE hy llinn trndcr penalry orpcrjlry one orrhe n,lhwins decllnrions: <br />I)c'mlirn,n Pcnnir+Ashcnos Norificrrin ledcrul Re-qukbns (TilL.,0. l,rn6) <br />_Rcqtrncd l-crrc! ol Norifi carion <br />I cc rlyrhd rlr. fddcfulnluhrnrN fttrrdntF rstrio\ rc x)Hlarc norrpplicrblc b rhisrn)rl.r <br />rlrc fi)rc inhnlari ncom.l I rare r().onlnll *irh xll ciry rtr (ini <br />irc!olrhisCi!yJndCounr,k, r rcr tr <br />f^r,Lv^ <br />,"," sf.\tG, <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />S pas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipmenl <br />Factory Wired Unit <br />alls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Bqqsh <br />Service lVleter I I <br />FINAL U s//B UC3P <br />Notes, Remarks, Etc <br />I crniry lhtri in rhc pcrfo!run.c orrhe work lor which rhn ncnnil t i\\u.d. I \hrll nor cmplo, an, ptno. in rnt <br />'nahncrqr N r, trdotrr subicr o rhc workcr coq'rtrs n,n hw\ ot Crlirorni,. ud dlrc rh,r ir l sl$uld tronr suhF.l k, lhc <br />*olkcr.orqu!.rnnpirrvisioNoiSc.rionlTmofrh.tjhrGdc,ls&nl,fonhNnb..mrlyrthrho*pfl)visions <br />T <br />I <br />=