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ELECTRICAL-INSPECTOH RECORD
<br />APPROVALS DATE lD/srG.COMMENTS OWNER BUILDER DDLCARATION
<br />I h.Eby airm u,'d.r p.n y of p.rjtrry thal I dn r&nlpl ron rh. Conb{ro6 Ii.M tjw rn rrE followi.s Easn (Sd.7011.5
<br />Ausincs !,i Prol'{skn C6d.)r A.y Ciry or Coum, *hi.h nqrircs . ,s,nn h con(rucr, allcr. i,nprovc, d.mlish o' rcnrir My
<br />3roctor., ,rior ro iri isu.N.. allo rqu,Es rlE sl,l)lion for such p.m b 6k a siSrd srd.ftnr rhat lt or JE n [c4qd tusod
<br />b thc Favisions ol rhc Conr&ror's l-iccns.d lrw (ChNptcr 9, Commcncin8 wnh Sccrion ?mO ol Divnion I orde Busincs od
<br />ProlissioN Code) or rhd lI or slt t er€mrr rhrelroh d rll ba3ar for tlE .llq.n .rcn{'lbn. turyviohrionofsdrbnT0Sl.5brmy
<br />trpplicd lor, Fnnit subj.ck ih. appticdnttodcivilp.n.lryotnormr.rh8trfiv.nundrcddollaF($5U,).
<br />t. a owBr ol tlE [ro[rnv- or my .'ryhrcr *i$ wa8.r is rhcn arh .imp.ndion, will d. rh. qo* arn $c rldw B Fr
<br />i' .nJ.d or ofi.r.d for s l. ( Se.7(}14, B usin.s a nJ Prolssio ns Cod. Th. Contr.cror's l-ic. ns. ljl d@s rcr npply b an ownc' o f
<br />E lnqrdy wlD tlildt or inl0n,Es tlt6\ nl *lD doc! ffih rolt himxcll or lr.rlf or rhrcu8h ht d her ow enployeos,
<br />provid(d rh.l such imrNwm{s {c mt idcndci .r oficrcn ,or salc l( ll.r.w. 0E hrildioe or in+rov.m b $ld *irhin.rc }td
<br />oiconplcrio[ rlE o'rcr BuiLLr ]ill tsvc th. burd.n olrovins lhd lE or rt. did n buiu or invoE 15. p,lpdy lor tE pupo$ ol
<br />_1, asowErotrh.pmtcny, an).iclusiv.lyconretin3 wirh li..nsd cont ron Lo lrnitucr rh. pNj.cr (S.c. ?04-{. BusiEss
<br />ar.l FDli{h Ctd.: Tn. Contradof! I-iceDse Ln$ dcs not,III,ro dow*r ofpropeny sh4 burlds or inrDrovcs th.r@o.
<br />md uho conrr's lor such pmtdx wi'l' a Con(6do(.) lirNd purrMr k, ibc cotuacror's Licc e kw).
<br />-lmr.r.mo!u.rS.dion
<br />!a8rE!slq}lfExsal]9!
<br />DECIATAI|!)N
<br />I h.Eby aflirn undcr p.mky .f lsjury.m ol lh. lollovi4 dcchrartoN
<br />_lhrv.xJrlwillnBinrrinaC.nillcd.orCons.nrroSclf-Insur.IDrwDr*ds..mtEns.rion,0s lDvid.dlortySatiotrlT00ofdr
<br />hhor codc, ror rhc p.rroawc oI rh. rolt lor $hich rh. relnn is is\ucd
<br />a,kl will mlnr woll.$' .onrp.nsaxon insurarc., as EquiEd hy S(rion l?00 ot rh. tiboi Cod.. for rlE FrfoMtu. of
<br />N!'oc. cuEr and policy lunbcr ft:
<br />Cl,Lt,
<br />5 L7Z 6:'2 /.2-l
<br />I ccnrly rh! i0rhc l[rlo,numc.l rhc sork lu whiclr rlns p.rnit ir ssucn, I shallmt cmploy uy t.rson in any ninncr
<br />s .r h bccox vhlcd to rhc lorlcr' conD.nsrion bw\ ofcaLifomia. and agftc thai ifl sh.uld b..DrE subjccr r. rhc
<br />*0lk.6' .onrlEtrllr rcn pruvieotrs or S.rnon l?m oi $. Llbor (lodc. I duu, fonh*irh .omply *nh rbs pbv,votu.
<br />WAI{NINGT Fiilurc ro ccur. rork.r smp.nsarion cov.rig. is unl.*ful. snd sl.ill subj.cr dn .mpLyct ro aimiNlp.uhi5 od
<br />civil fiNr up ro .rc hu r.d rhonsnd dollaN ($100.0iI)), i! addiriotr ro rlk con or contp.,MriDn. dsu3.s $ provid.d for tlE
<br />ScciDr 3076 oI rh. lr1(* Crdc. inr.rcd ..d .uormyt tei.
<br />DDELABAI]IA
<br />I hcEby atrum un,lc, Fuhy ot p.'jury rhal I afl licnerl mdd plvisio. orchspid e {conrEncin8 wnh s.diotr 7000) of Diision 3
<br />or rh. Busrn.ss .nd P6f.ssio6s Codc, ind my lic.n* $ in tullloc dd cIT..r
<br />Cto c qf 6 7710 8 z-
<br />l/-tL'7,D
<br />I9NSISUEII9NJ.APDGIGIICI
<br />I hcnby .Ifinn undcr ,.nrlty or !l. jury rhd lncrc n a con(Dcti)n lnding lgcey for thc p.rlorl11ft. of rhc rork lor whi.h rhis psmn k
<br />iisu.ri (s{. 1097. ciY. c.).
<br />A.I!LTS4NL!ECLAB4I!9!
<br />I hoxb ,nm unds pc.ahy ot psjry oft or ihc l{nb*ins d4llldr ionr
<br />Dcmlitio. PdnIt-Asb.stos Notilicdbn F.{cEl Rc8lhri.N (Tnk 40, P.n6)
<br />_R.quirtd Ln.i of Noriftdnr
<br />_l ccdili ln, rh. tcdcr.l rcsularioN o8{di.8 sbcsos rcmrd (e mr atplic.blc o rhn projcr
<br />I cedilt rlDr I luv. r.i lhis alplicarion atu sarc nd nE ah,vc ilnndion n corsr I agm to cotrply enh uU Cny rnd Coutrry
<br />.rdininccs i l Srdc t:rs rcl in8 n) buildin8 c.n iurhorir rcpicsc arivc\ oI lhis Cny and Counr, ro.orc, uror tlt
<br />$o\. 'ftnrion.d pmp.n), fttr i'xp{//. /2- ")A,Dli..nr or r\gst Signrt
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service [trleter
<br />l.??'zt TL L$
<br />Notes, Remarks, Etc.
<br />Rev. 08-07-2015
<br />Meter Release
<br />FINAL il eh9 *2V
<br />L.(Lr's AddG*
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