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ELECTRICAL-INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEIi BUILDER DELCANATION
<br />I turchy sffirn unds pcnahy {,4 lcrj '
<br />y rh,r I m crcnrpr fon r hc CoirncbB Licen* Ijw f rhc fouowing rcdmn 1Sc..70.11.5
<br />BusiNss ond Pmfcssn,n Culc): Any cily or Coun(y whkh tuquins r lEmn ro cotr(rucl, rlrcr, improw, dcnrlhh or Eplir 0.,
<br />srructur. Drhr to ns hsuare. ako rcquias thc !!,rlirant for such |]crmir ro tlc a sistrd sralcmnr rhar lE or shc h lienrcd l,Irtollr
<br />to
<br />'h. tmvkrns oflh. contrrdor's Li.cnscd ljw (ch,nrcr 9. connRrcing wih Sccrion 70{D ol Division I ol lhc Businc$ oid
<br />Pmfcssions Codcl or lhor 1.. or shc is cxcrnpt lhcrefronatrd lhc h.sn lor rhc ullcscd cxcnDrion Any riolarionorSccri.n 70-l I 5 by,ny
<br />amli.anr fornpcrmn slhjsrsrhc aDpliclnrro dcivill,cn0lryofnor moErhan fivc tnndrcddolldrl$500)
<br />_1. ,s o*kr ol $c pmFny. or my cmpbyccs snh wrC.r as rh.L q'k .nm!.ns.rbn. $ill do rlr rnk onl tlE ,ltrNE n ml
<br />inrcndcd or ofcrcd for \ok (Sa 7044, Businc$ 8nd Prorcssiotrs Cod. Tic Conlrlck s Lic.nsc t w des nor rtrrly &r $ oskr or
<br />rhc lmOcdy who buildsor nnFmrs rh.r.ur Md who dds su.h w.rk himscllor hcMlf .r rhmu8h his or hcr own cmlloyccs-
<br />p.ovidcd rh8r slch improkm.k m nor i cnded ollcrci l'or {lc ll fu)*Br. rhL h iHing or i'npn,Etunr is v,Il wirhin um }axr
<br />ofcon!,lcriu lhc O*rcr BuiUq *ill hlw rhc hrdcn ol pmvi.g lhd hc tr shc dil ml huild or iqret $c nrFny Lr rrr pLqb$ or
<br />-1.
<br />as o$ncr ol'rhc pmnq ly. amexclu\ivclycotrlrucrirg wilh liccnscd c.nlr(krs r) .on{tucr rhc poFcr (Scc 70tr4.8u\i,tu*
<br />,rl Ptuh\nn Codd lhECoitdcror'sLiccnrcLdsdo.snor3tplyrorno*rcrofp$lrnywhohuildsorimfove\rhcrotr.
<br />rnd who cootradr rd such rorcts wirh a Conrflcro(n liccnscd,,usur.r ro rhe (t'nnlctois t.iccNc t w).
<br />lxn,.r.m nfflcrSc.riLrr .ll &P( litrr[.r.r!n,
<br />I)Hte ()rn..
<br />ITOXKEBS]COMPINIA.II!]N
<br />DICIIIXAIION
<br />I hcrcby llfirm hdcr pcnalryofFrj!ryonc oflh€ lolloqin8 dcc,Mlions:
<br />Ihdvrtr'xl*illtuinrrinrC.nifi.ar..lC.nscnrhsclt'lnsurcn,r!6rkcr'.o tP.n{ ion.as pr)vidediarbtsc.riotr17fi)ofrlr
<br />Uhor Cdc. Ior thc pcnbnmnce o{ thc wolt lor *nich rhc pc.n l n isslcd
<br />I hrv. rnd *ill trrir xn, sdrkorr .onIf, sr.on nntrrr0cc. rs r*tutr.,l hy srlnr 17(Xr.f rrtr' I nhor (irl. nn rlr
<br />n nsu.d nly worlcrr on,rcnsrnm i
<br />I ccdili rhnr h rhc rrlnr ol th. uork ior whi.hrhis p.nnlt i\nnrJ I \hrl tr'{ un$1,,v in\ r{'\otr in rn\ nunn!r..rfi,\'r" r r.r,,,,,r.i^-.",* -r';-, r,rr"v' st' hcdnrE uh,.d ro lhc workcK .onrF-nsrrion hw\oiCrlirornir.
<br />sor[cr( compctrsarion nmytion\ ofS(rnn] lT0Oofthc lihor C{xl..l hconplyw hrk)* orisn,ns
<br />W RNINC l;.iluc t, s.'^u.c snrken'.otrrrNali,r covcnsc is unhwrul.
<br />civil iinc\ u! lo orc hundrcd rhou\lnd dollurs ($l(x).Ox)r. in rddi'ion tr I
<br />ll sxbj..r rn .mpkJycr r. dimiMl pcMltics and
<br />or.ohr.ncation, danq.s ar rrovidcd for rh.
<br />Sccrion 10?6 ofrhc lih.r Code inrcc{ ud nm!\
<br />I hcrchy rflnn unncr pcnrlryotperjurr rhd I Jn l'.cns.d udcr pro orChrprd 9l.onmkinS wnh Scdion 70OO) ofDivisn,n:l
<br />or rhc &r\irr$ an,l Pdt\sioFC lnd my liccn\c h ir Inll lbrcc aar..lccr
<br />6T
<br />,""' f
<br />I hcrcby rfitnundcr pcnalr, ol,lcr,urythar rhqe is a q,nstrcrhn lcndins ascrcy for rhc pdror@mc olrhc work lor whi.h rhh F mil is
<br />iisxcd lscc.1017, Civ C )
<br />AITLICANLDECLAEAIIII!
<br />IhdrbyrmmundcrpcD0lly ipcriuryorcolrhcfollowirgd(ldrations:
<br />D.nmlnion Pcr.rirs Ashcsros Nobncarion FMcral Rcguhrnrs (Titlc t0. Pan6)
<br />Rdquntlt Ir(cr of Norifrlrnnr
<br />I ccrrilyrhd rhc icdcral rcNl.lions rclrudins ,1rc nor opnliQhlc b rhis pmrLrt
<br />-lrnif)
<br />rhrr I hrE rcrd rhi!lpplicarionand{rrd I M inrorndion h.om.'. I altm ro coorrly wnh aI Ciryaod G,unly
<br />odiMnccs ond Srnlc tius rcLriq ro bui h.rchy rurho.tu rcprr\odrr*.\ u
<br />nho\c Dc rrnrd F,Nny lnr i'r
<br />i,/u
<br />Appli.anl or Irnl Si*nrlur.
<br />U.*n." n,." ,rnnt,, Y rp t+\l
<br />rrh^c yrnd C.unlrro cntcr uFrr thc
<br />.",. - ah/,rVrnttf'-
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lite Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rou h (.,</1t46 )lr
<br />FINAL r\s \q )' lil a'it)
<br />Note-q ReMr(s, Etc
<br />/12,) ehA ([- l,t r*^ S cz64l
<br />^ou,lrw
<br />-+
<br />Communicalions Cable
<br />Sub-Panels
<br />Service lvleter
<br />(a-
<br />t.ndt,'. AnJ,..\
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