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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNES BUILDER DELCARATION
<br />I hc(hy afirn undcr lcMliy of pcrjury rh l am cx.mfl riom thc Conrroclor' Licensc Llw for rnc folloti.g rc{son (Sfr.?011.5
<br />Busincl\ a Prof.ssion Cclc): An! City or Q,unry which rcquircs a pcrdn ro ..n{rucr. ,lrcr, improvc, {kmlnh or rcprn atry
<br />(ruciurc. lrbrro irs isuance, aho rcquncs rhe apolicanl for {.h pemir t, lilc r siEncd srarcmnl thal lEor she n liccnrd purudnr
<br />r. rhc rrovkiont olthe Contmctols Liccnred tj* (Ch!,rlcr 9. ComnEncinE {irh sc.'ion ?tx)o of oivisiotr :l oflh. Busnr$ and
<br />Prcfc$hos Code) or rh ncorshc h crcm0l lh.rcltr,maod rh.li,\is rdrh. llLgcd.xcmption Anyviol ionolsdriooT0ll tbyrny
<br />lpplicrtrrfor0pcmilsubjccrrrh.,rplicdnir.acivill.ndlryornormrclhanfivchundrcddollrs(1500).
<br />I. ns owtrn or rh. Ifolr y. or nry cmflores wilh srscs as rhcn mh compcnsdn,n, will do th. sork Jld rhc $MrN i\ tror
<br />inrcd.n or oflcrcd nr sb (Sc 7(lt-4. B sinc*and Profesions Cod.r Thc C.nha.!r's Liccns Lawdocsnoluppl,bLnown.rof
<br />rlEpmFny wh. builds or iqro!.s th.mn. md *tr d6 srch u)rt him*lfor h.rs.lror rhroqh hk ot h.r owncmployccs.
<br />pft,vidcdrhal su.h inllownrns aE mr inrcndcd or otrcnd for srL lt how.rer. rhe tDildir8 o. inllmr€tum is q,ld wirhin onc ,td
<br />ot on0Lri.n. tlE Ol mr Bui&a {ill lEvc ln. bonlcn oa l,.lins rhd hr ur sh. did mr hoild or in{'mw rhc pmFny {or rhc lxilb* or
<br />l.^oNrcrolrh.Ir,pcny.strrc\clu{ivclyrcnlh.rn!virhli.cns.d.otrtra.llnt,dnNrrucrrhcpR,j..r(S..7(ll-r.8trqncs\
<br />{t rhlc$iotr Cod. lhc(otrlracroisl-iccf\cl-asd.c\n larpltt),ioan( ollrotc yuho hnild\or imrrovc\ rhcrcon,
<br />r l \rh. $nrNr\ Lr such troj..ls wirh , Conrndo( s) lrcn\c(l tDruld ro rhc G)nracr.i \ l-i..isd b*).
<br />I ir.r.i, uitl.r Sc.ro
<br />Drr.: _ oqm.:
<br />WORKr.RS' COIJPENliATIi]N
<br />DECIIIIAIION
<br />I hcrchy otnnn !odc! pc.alryorr.rjuryoncor'h. t.lnlwn't d.clstrio.s
<br />I halc md will tuinrrin a Ccnifi. cofC.nscntn,Sclf.lisurcli,workcs compcnsxrn,n. rs pmvnhd f(rbySccrionlT0Oolrhc
<br />Llhn Codc- lor rhe pcrfom.cc olrhc Rork tor shkh rhc pcrnir n is\ucd
<br />I hak rnd will fr"inidin rork$l..nltlc.srt,on rnsuraRc. rs (quircd hySccri,)o37(l).frhc tihor Codc. br thc !.rfonnmcc oI
<br />rh. *ork for whi.hrhh p.flnrr is hsucd. My so.kss ompcnsrion i.suroNclricr a fx,lkrnumb.rdc:
<br />, ' 6"rqlf
<br />*^"n*l I Z/ t
<br />Couo,
<br />foql Zo) k Z'3t-/8
<br />-l
<br />ccnilylhar in lhc l}crlonlarcc ot rhc wort lorwhichrhL prrnir ii irs!.d.1shrrlnot c.rPloyany Pcrson in aiymmtur
<br />q, as k, trsi* subi.r k, rhc wo.tcn omprnsdion laws orC0litmia. rtu lsrec rhai ir I shorld h..oN sxbtd ro Itf,
<br />w.lkdc.onf.nqrn,npmvirionsofSc.lion]TOOoflhcL.lnCorlc.lsh!U.fonh*nhcodply*irhtho*forisiotrs..
<br />WARNINC: tailurc h ecurc wortcn oarpctr\ali{in .okflgc is dnla*tu|, ,nd shall suhtc.r !n cmtlo}er ro dminrllicn,lr and
<br />civil fircs un lo onc hundrc( lhousrnd dollur (Sl0o-00). i,r rJdiri.n t' rlr.os olconrnctrsorion. drro8c\ as p(,vidc rd lhc
<br />Sccl iofl 30?6 ol lhe Litnr Codc. iorcrcsr antl ulrorty i rcds
<br />o^",' 1-b:13 ^,,,,-^* rtCttKTPe=;IJ(IN$LrcNIIA(rcI
<br />D}:EIAM.TIQN
<br />I harbyaflirmund.rpcnshyorpcijuryrhar Iam lieN'd u cr lmrhion ol Chiprcr I (mmmn.inr sirh sc.rion 7m0) ol Div ition 3
<br />of lhc ltnsirc$ aid Pmtcsions Codc, anJ nry licLn* i\ in tull fd( ird ofla\r
<br />',."."".,"".. .],
<br />o",", q-b-t t_
<br />r.rcn.(\u!$.'' 11 237</
<br />c..r*"..!r dhj+?*+_
<br />ra! f,uculrNuiNluNciliDltr
<br />Ihcrctyafllrnrul(lc, |xnully ol pcrjury lhd lhcrc hu.a,n{tucrior hndin8 rtcrt, iorrhc Pcr,nrnurcc otrhcsork n whichrhi\ Fnnil i(
<br />,\sucd lSc.. l(D7, Civ. C.)
<br />LndclsAddr.lsr
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<br />AIILICANLIESSAAIPN
<br />I nmtry ofim undcr pen0lryofFrhryone otlhe followins dccldri.nr:
<br />Dcm,liri.. Pfimtu-Ash. os Norifi.ation Fcdcrcl RcBulations (Tillc 40. Prn6)
<br />Rcquir.d hncr ol Noili.arion
<br />_l .cnif, rhur rhc lcdcral rcgulari.nq Egading ash.eoq rcrmvur !rc n.r rytli.lt lc lo rhis pmjctl
<br />Llccd'ryrhdIhrlcrcudrht pplic.ronlndnarcrhorrhclhovcinfunErn h.onNl.IaSrNloconllywilhlllCilyandCounry
<br />okimrccs ond Srlrc ljws mhrins ro buildins consrodi.n. otn teEby lurhori& Epre*nrarivd ofthis Cily and Counlylo cnrcr !Ix,n rhc
<br />uti^c mtrr'on.d nn,nrnyfor n.n cnonpuqy'+t ,
<br />^,,,"*,",^r.'',,,*4,LLKfP*-,i orre'
<br />pemi,R,rh.,pr,n,,: t< Q, llq t E TH t a f< a,J le-
<br />?.1-/ K
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service lvleter
<br />FINAL Q-zt-r8 Z. z-.7
<br />Notes, Bemarks, Etc
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<br />Itileter Release
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