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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DELCAB-AIION
<br />I h.r.by ar0nn und.r pcnalry or p.r,trry rhdr ! d crenFI fmh rlE Conta.ro Li.cnsc hp tor rhc followinS rc!$n (Sa 7031 5
<br />Busim$ nd Profcssion Codc): Any Cily o. County *hih n{uncs a ,s'nir to con(dcl. altci imnrort. dcmlirh or Eoln dny
<br />dtucfu,c. Fior ro irs issum.. al$ rcqut* rhc !p icanr for sucn pcrn lonh!\i8kdndeftnr rhar h.6r sh. i! li.cnscd puis r
<br />to lhc pmlkiom of rhc Conhdols Li.ensd bw (Cha cr 9. Co'nnEminB sirh Scclion 7O0o oaDivhi.n I oflhc,B,rin.$ rod
<br />Pn,fcsiionsCodc)orriar heorshc n eichp hcrcamn and rhch€\is lor rhcalkgcircxc.nprioi AirlioldionoiScdiotrT0ll.5byany
<br />omli.anr for a p.rmi' suhjeB lhc b,'tliclnl u a civil Fnalry of nor mrc ihan livc hu ndtorl dollds ($5u).
<br />l..s osrcrofrhc proncny, or nrycmplorrcs sith w.Bcs $ lhcir elc .{trrpcNnrion. will do rhc wo ad lhc sIntllE is nor
<br />inrcndcd or.fttrcdforslc(S(.70r4,tsusircssandProfcssionsCodc:lhcContmcroi\LicenscLlwdocsoor$plyt,utrownfior
<br />rh.nnr|tny *lb boildi.r in]|mEs rlEmn. md *ho dds such *r)* him*lfor hcrsclfor rhmuAh his o! hcr orncnlnloyccs,
<br />poviacd rhar iuch i'nE lcnxn( m mr inr.dlld or oflcril for slc ll hNdd. rh. hoikling or in!ftwnEnt h sold withrtr .rc r
<br />olco'rphli,n. rlr O*ner Buiher will harc rhc burd.n oi pmvitrs rhar tr or $c dil mr huild or iqrcr fi€ trrdy tor rrr pu4x,s or
<br />L r\o*ncrol rhcprnrcnt. ancxcltrsnrlyconrrlcrins wirh licc.scd coftnctn\ b on(tucr rhc pmjr.r(s( 70{ir. susncs
<br />Md tbLshnCo'lc ThcConta.ror'sLi.cnrchwdocsn.rapplykJrnu*ncrolftupcaywhobuildsornnpn,vcsrhcrc.n.
<br />! who conrrocrs for such pmrccrs wirh,Conr.acto(rlicenscrl pulsur hrh.C{ntrcktr\ I-iccns t]s)
<br />-l
<br />dm cxempr hdcr S€dion-. A. & P.C lor rhh rcason
<br />D €: ovmr
<br />!!}EtrEBI.STMIENIAI]A!
<br />DICI,ABA]JQ!
<br />I h.rchy ailirm undcr p.n.lly of p.rFry oE of lh. iolloving {h.lmrio.s:
<br />I hrvc .id wiu minr.i. a CcnifKtrtc of Conknr ro sclr-lnsuft for wor*m @npc,rqlion. s Dmvi(H lor by S<rion 37(10 of the
<br />tiln, Codc. tor rhe IErfomN of lh. ell tor *hth rhc r,€dir is isslcd
<br />trl hrvc .M w' ll tuihr.m wo*c^ c.mF.nolon in{urJft., 4 cqniEd by Ser ion l?00 of lne Labor Codc, for rhc pcrlomocc of
<br />rhc *{k for-$hEhrhr lt.rmr ri nsu.d My\orkc^ mnll{nqnon hlutumc cMrr &'d polr} numhrEc
<br />,,"*, A^p-, c a,a Z^sc, c,h
<br />**,*. UJ C ti
<br />I ccnily rhrl in rhc p.rrormn.c oflhc *o* for wht h rhis F mn is issucd. I sh.ll not cmrloy otry p.con in any nercr
<br />s s ro hc$m slbFl b lhc mrtal smncnqlion hws of C.lirorni!. aid aBE rhar il I slDuu bccotu robirr ro (hc
<br />*ortcn'conEnsllionpovnionsofScclion3?00ofrhc&borCodc.lnE[.fonhwirhomplysithrhoEpolist,ns.
<br />WARNTNC: Flilurc ro slc ktrk€ c..D.nsdrio. cdvcEs€ is unhwhrl. rnd \hall iubi{r an cm,,loyrr lo simi,ol ,.Talri6 and
<br />ciril ,]tr.\ trf ro onc hnn,lrrtl rh.ur nl Jo
<br />Scrrnn,.ll)76ol rhc Lrhtr(inl.. inr.r.n nd
<br />F.nsarn,n, dar4cs as prcvi{led r'o. lhc
<br />/8
<br />DECIJBAtrON
<br />I hcEhy arfirm und.r F.aht or Frlury thlt I am liensn undcr pmvisio. olChlplcr 9(commncinB wnhS.cti,n 7000) ulDivisionl
<br />of th. Burircs a6d Pbfessio.s Cod.. r,i my licen{ is in tuU fom artd cffRl.
<br />c )(,
<br />7
<br />CAISIf,IJ.(:IIaN.LEIDIIG.AGINCI
<br />I hcEhylilmundcr pcnalry of F.ju!, rh,l nEc i\" cnintucrion kndi.s agcn.y ro. rhc p.irormn c ofrh. wort li'r which thh !6n l is
<br />issucd (S(.1097. Civ. C.)
<br />AITLICANLDE.CI.AAAIIA!
<br />I lteby hnuMor l,cnrlry olptrrtrryoN olrhc hll.wirg d(ldrdrtr)ns:
<br />Dcnnnlt,n Pcrnrih Aslf,no\ Norin. i,nl F.dcralRcsuhrnrnr(rirlc 40- Pun6)
<br />-Rcq!ircd
<br />llrrcr oa Noriri$ri0n
<br />l-r.nify Ihnr thc f.dcral rcBuhtions rgordinS ashcros rcmval arc mt 0pdta$h ro thn pmjcl.
<br />-l
<br />ccniiy lnd I n2!e rcad lnis .r,plklrion !d $atc rh ln. .bovc i.fo.nErion n coret I lsre ro @ddy *irh rl! Ciry a.d Counry
<br />ordi.imcs rnd Sr.re ljwsrchriu ro hcrchyrurhoriT. rcprcrndnts of rhis Ciryaid Cornry
<br />ahovc m riorcd nmpcny lor inspdio
<br />,\pplir nt nr.\,rnl Sianaltr
<br />rrV C 44rLa up:
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondino / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Flough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />l\4eter Release
<br />Rough
<br />Service Meter
<br />FINAL bzd I /tJ/(r(,'9)
<br />Notes, Remarks, Etc.lt
<br />Site-Work
<br />Under Slab / Floor
<br />a
<br />t, n,tc, \ aJJ,c\3
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