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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUIDER DELCARATION
<br />I hureby affi,ft unddr pcrxy or pcrjury th I an cx.mpr rrcm lhc ootrractoF Liensc li* for lhc followin8 rcasn 1s..7031 5
<br />BusirEs 0rd Profc$bn Cdc) Any Ciry or Counly qhich rcquircs a Fmh tu .onsd.t. d'd. improv.. &tulhh or EJEI any
<br />srru.turc. prinrro irs issuane, dho rcqun.a ihc,,rDlicant ror $rh Fflnn ro filc 0 siSncdsralcmnr lhar lEorshc ir lic..scd i,lrsmr
<br />ro rhc nbviiions oftlE Conrraclor's Lienscd La* (Cnlpler 9. Comicncing wi(h Sftrion ruo of Division I oa rh. Bx\in.s nnd
<br />Pmlcsions Codc) or rhd he or rhc h crcq)r lhcftfrom and th. blsh tar thc alle8cd cxcmnlion Anyviolsrio.orscdionT0ll.5bya.y
<br />applicsnr lu r F nir subj(F lhc applicanl ro acivilpc.llllolml nn,rcrl[.6vc hundrcd dollrrc ($s00,.
<br />I. rs otrndr orth. EoFny. or mycnrDloyes wnh srscs 0r lhcn sb c.mFnsarion. silldo rh. *drk Md rhc {trrurc ( Nr
<br />i cfrld or ollcrcd lor slc (Se.'.?O4tl. Busincs an.l I'rofc$ions C{nlc Thc G,nkNtu s l-icctrsc L.w docs not lprly h M o*ncr or
<br />rne pDIrn, sho builds or idpmvc\ rh.r([ yluho&rs{xchwrLkhanscltorhcrrllorrhrotrghhkorh.r.wncthtloyccs-
<br />polidcd rhar such imlr(^tnEm\ d. mr intcMcd or oficNl nx {lc. lt hoqcvcr. lhc h'ildirs or impoltmnr t $U enhin om }t3r
<br />olco{'kr,.rhc()*ncrauitlcrwillhrvrrh.hurdcnofrnningrturhcorslr.diltrortnrihorimpmlrthctFfaryL!rictu,]xmo!
<br />L ns owndr ofih. !tupdy, onr cxctusnrly lonlmctnrs wirh licctrscd conrmcrors h n,n{ .t rrE lRrctl lscc. ?()l,l. Ad\inc$
<br />aftlPmli-ssionCodc:lhcConlracloist-iccnscLasdocsnorapplybdownuror[orcny*hot'uildso,inprc!.lrhct.i.
<br />.nd *ho .onrrk ror su.h pn+ca w h 0 CronrDdo(9 lkcnsd Ntsuonr rorhcG,nrrrcrois l-ic..{ Law)
<br />I rhcrcntn uMcr Sccrn)
<br />Orne.
<br />uoaKEf,l:laurDNsAlto!
<br />DIICLABAIIO!
<br />I hc'.hy afftn, uid.r f.arlry ofltrjrry otrc ofrhc nnkrtrnrA dc.Jihri(rF:
<br />-l
<br />harc onl will mrinrtri.rCcnifi. .ofCon$trr ro Sclf lnsurc n, wo cm conDctr! ion.rs pmvidcd fdbySNrioi 3700ofrhc
<br />lj&, G,Jc, t, rhc Fforl:rlmc o f rh. qo* fur whi.h lhr p.rnir is is\ucd.
<br />lh3rc ntrd sillminnrin *orkcrl co'npcnurnnr in\!raic., k\ Rqxncd byS(rion lTl n oi rh. ljho! Codc. forrhc prntrfrrn..nr
<br />thc work ior wnichthk I'crmit is nsud Mywork€rs n,n nru n(.rnur ikllr'lrynurh.tnrc
<br />-!
<br />ccnililnor ir rhc performncc ol rhc sork ehich rhis F: nir 'r rssucd. I \hrll nol cnrpl.y uy ncron i. my Dtrtrcr
<br />(, rs t, trroft $hl(r t, rhc w.rkds comt cns mi hss.lCrlifornin. i lsrccrhrr irI \buld h.onr {bicd tolhc
<br />workc^ conTcnsdinr pn,visn,ns.fS.crion 17{Dofrhc tjtn Codc.Istull. fonh$irh coqrl, sirh rhos lovisi(,ns
<br />WARNING: Failurc ro scurc workcr conrpostrrion covcnsc ix unl,Rtul, dnd .h.ll suhj$r on cmPlortr lo simitul p.tulri.s,nd
<br />civil incs up lo om hu rcd lhousstrd dollas {$ll)0.0o0). i. rldin,n k, thc.on ol co,nPcnsorion. damBcs ar Provt.rl rdr rh.
<br />sccrion 1076 ofrhc tibor Codc, inlcEsr and ltrorrcy\ fces
<br />5/z-.,lt<appllenr: D".O*
<br />u(:.ENffI}(:9Nl&l!ra,E
<br />DESJNAIIA!
<br />?oget 1,."-
<br />I hcrhr rlfirh trndcr fcnnlryofpcrjuryrh[ I rm li.!ns'd unds arevnion ol Chlpr€r 9 (co'nmkin8 with Sdion ?UD) o,l)ivision ]
<br />ol thc Businc$lnd t'mlcsn,isCodc. rrl ny lk..\. is in fullfd.c rlcliicr
<br />'7rr417
<br />5/zz /tt coNr*,ir D.'-, 't ?u12, \;-..;;
<br />CANSIAICUONTENDIN(i.IGDNI:I
<br />Ihcrchy116r !nd.r pcnJlryorpcrjxrylh.t rhcrc n tr.oNlrucrior! lcndirya8cncy ror rhc r$ruriuNc orrhc sort t whichrhnF-r.rh i\
<br />i1{rd 1S.. r0q7. Civ ( )
<br />AITLICANLIECI,AEAIION
<br />I hfr1,y rmm undcr pcnrlry of pcrjlry.nc otrhc nnk,wins dmlnrarion\:
<br />D.rtulirnrn P.rnnrlAsb.sos Nori6.alion lidcral Rcgul.rions ll irlc 4). Pdn6)
<br />Rcquncd L.lrcr oaNolilkdtin
<br />l.enitt rhnr rhc fcdcralrc8ulatiotrs ESrdinS asnc(os rcmoval nr. nor,pllk blc roth* pn,F_l
<br />-l
<br />ccrlilyrharI ttrvc rcld rhisappli.srion,.dsddhar rh. dt$rc nrronrurior iscorccr.I isrcc rocoh ywnhnICilyndCounry
<br />ordinrnccs ond Srorc Llws rebring ro buildiog .oniru.rn,n. Drxl hcrcby 0ulhorizc rcpresn!(ivcs ,)t rhn Ciry trhd counlyto cnlcr uFrnrh.
<br />rh)vr nrdri()ncl pnilnny
<br />.\pplirn.t r, \x. l Sisnnlorr
<br />4-te Ztlt
<br />,," 5/21/ fX
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Solf it Rouqh
<br />Ceilings (T-Bar Rough)
<br />ltrleter Release
<br />\
<br />Rough L-12-tg t-tttiN'l 1)
<br />Service Meter ,\\-
<br />FINAL 7-t1-lv \.u-i'16
<br />Notes, Remarks, Etc
<br />t?ndca\ Ad&c{
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