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ELECTRICAL-INSPECTOR RECORD
<br />DATE rD/srG.COMMENTS OWNER BUILDER DETTCAN ION
<br />I h6€by afli6 u.dr Fnrlt, ol pslury rhar I m cx.mfl F.rb thc Conl6.roh Lic.ne b* lor th. following 1.e. (3(.703 1 5
<br />Bcio6s dd Profsion Codc): Any Cit, or Couny whi.h t.qut6 a ponir ro coNruct. ahs improle dmolish or rc!6ir ev
<br />slrudu.. prior ro irs issuecc, a]lo r.qut6 lh. applicdl for such ,snil lo 6lc a sisn.d starcn nr rhat he or sh. i5 li.ru.d Pmxg
<br />ro rh.Ircvisiom oalh. Cont.clo.s Lic.nsed hv (Chapld 9. Coh'n.ncing wnh Se.lion ?000 ol Division I ollhc Busine md
<br />Poasions Cod.) or lhal & or sn is.idnpl lh@liod ed lh. bsi! aor lhc lllcs.d €rdFion Any riolalion ol Sdio. 70l l.5 bv anv
<br />applica.| aor a p.mn slbj$s lh. appli@ to a civil pcnahy ol nol no,c $d nv. hundred dolls (1500)
<br />fllk *.**rn *,*]. orm).mplo'6 s,h was6 6 rhet ele comp€,s3rion, wi do rh. work ud rhc slrulu. is mr* nhdcd or oficcd ntr sal. tS(. ?044. Bus$* dd PmfeioN Coder l ic Conn dois Licosc Law do6 ool applv to an ownd of
<br />th.unldy who hlilds or i6ptur6 tha6r ed sno dG suh w& hiffi.lf or hdklf or lhDugh his or hd os cmplov.6
<br />pDvid.n rhat such inpilvomls s. qn i.rodal or ofidld ao. el.. lf. hos-.d. th. biildins o! irprovffir is $ld whni. on. Fr
<br />of.ohpldio( th. owns Buil& vil! ha( thc btr&. oaFovins rhd he or sh. dil noi boild or inprorc th. prtFtv for lb. pttrl.e of
<br />l. 6 ormd o llhc Foadly, m cxcllsivsly contEcrins * ilh licmcd coitraclo6 lo coGrrud rft prcjd (Sc. ?o44 Busins
<br />od h!,ision Codc: ftc Conlra.ror's Lic.m. Law doc nol applylo do*nE ofprop€n) r'ho builds or imprcvcs lh66n
<br />.trd who $itEcrs tu luch Fojecls trilh a Co radd(s) Iicased Pusuanl lo lhc Conlraclols l-ic.N Lry)
<br />DECI.AIAI]OX
<br />I hftby alEm undd porlty of pqjury onc of th. aollowoe del,ratio6:
<br />-l
<br />havc ad vill minl.ln a cqlifidlc of coMr to S.la-lBm for wk{l onrPdBlion, 6 Ftvi& aor ,v sdlion 1700 of th.
<br />bbor Cod.. foi rh. Faotl@c. ot th. rc* for which lh. pdmt b isu€d.
<br />-l havc aod will naintain work.B conpcBation irsumnc., d r€lut€d by Sctio. 1700 ofth€ tabor Codq for $. pofoll1l@. ol
<br />rhc uor! ao. wnich lhir pdir ie iscd, My *orkm ronPosltion iBuroc. ctrid dd policy nu,nba a.:
<br />Policy Nunb.(-Erpires
<br />&f-.rrr,n^ ^.n o.^'nanccnr,heqo ror q hich this pEmir is issu.d. I sh.ll nor c,nploy any p.uon n, onv medd- $ a ro bdome subFt to !h. M*d cornp(MlDn laws otcalilomia, dd agre lhal ia l lhould bc.onc subjdr lo th.
<br />sortm' compdMl ion povisioB oasdlion l?00 oflhe libo! Coi.. I shall. todh* nh conplt silh thos provisio6 .
<br />\IARNINC: Failun lo surc work6' comFeltu. ..\dr. is !trlarful. dd shall subjd oplovs ro dininal pq'allB &d
<br />civil fines up ro on. hundrcd lhousad dolld ($lo0,0oo), in addirion ro lh..o$ olcomt Nlion, dmag6 6 prclidcd lor th.
<br />sc run llrTb otrhe Inlnr (-ode intsd dX,^".ulslx ^
<br />*ar
<br />U!.:\]II!QII!.( rQ!3
<br />IDCIJ8AITAN
<br />I hwby a0jm uidd lcrully of p€jury lhd I m li.ds.<l unda Provision of Chrptd 9 (comnmcins wilh sdioD 7000) of DiYisiot l
<br />oa lh. BusinBs md Prof*io6 Cod., ed my licN is in full forc. dd cfld
<br />CONSTRUCTION I FNI}ING AGENCY
<br />I hftb, amrm ofld6 p€.ahy of p.rjury rhol lhoe is a cotsltudo, lodins .s€ncy for lh. pdfommc. of th. worr tu.
<br />"'fiich
<br />fiis pssit ir
<br />i$oed (Se.1097. Civ. C.)
<br />I.das\.'.-
<br />I erdci \dd6s
<br />-
<br />ATTIICANfDISAEAIIQN
<br />I hd6r arm und.r p.nax) o I pejuq on. of thc follos rg &tld ions.
<br />D.molirion Pdireasbdos Nolificdion F.ddt RqlulalioN (Tnk 40. Pan6)
<br />Rmu'El Idirof N.rifi.ri.n
<br />I cdri rhar r h. f.dd.l re*ulllioc Essdrns st6ror rmoval e c nol q'pk.bl. ro thi, Pm,cd
<br />fffir, ,* ,
<br />^,,^,nE
<br />arprGr
<br />'on 'd s{€ rhd rh. !hov. i.tomaion i! corc.l. I .exc ro comPly wnh .u citv ed cou v
<br />l; ;e* md Stal. tiwsrclllt{l ro b(ildi.e corulru.lioc dd h@by.uthorn rcp,snalivB oflhis Cily srd Cnulv lo olE uporlh.
<br />Jbo!.msrionaj nropd! tor ibpdion purr.s6
<br />^opt|ciit
<br />t
<br />^Eqt
<br />sig.nature fu
<br />p* r,*^,,*tprtnrl 2 t'4,h b&s[.-,^,",ulsla
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltase
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding i UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Roush)
<br />Irileter Release
<br />Rouqh
<br />Service [t4eter
<br />FINAL t7/lf rQ /,4qtfit
<br />Notes, Remarks, Etc.
<br />_)<
<br />APPROVALS
<br />Transformers
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<br />Lic.Bc cts:-Lic.M Numbd:
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<br />D.t.'_ Conlnclo.
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