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ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BTJILDER Df, LCARA'IION
<br />I hq.hy afiinn und.r pe.alry oa pdjury rhd I &n exehrr iid,n thc Conrados' Liccnse tjw lor lhc aollowiry rwn (Ss.7011.5
<br />Ausin6s and Prclsion ftde) Any Ciry or Counry rvh'.h r.qurs a pdnil m codrucl. .llq. imp.ole &oolish or ,€pon dy
<br />srnrcx(e. pnor to ns issuecc, ale r.q!n6 thc applicafl aar such pmnil lo file a sisn€d slalcmd lhd hc or sh. n li...s.d pNUMr
<br />ro rhc provisioB oftfi. ConlEcrois Lics.d hw (Chapts 9. Conoe.ci.g {irh sarn'n 7000 of Divisiof, I of$c Busin* ed
<br />Prcresions Codc) or rhd h! oi sh. is crunp rhd.arom md ihe bsir for nE allescd cxonption Any violalion oasdion ?031 5 by an,
<br />appli.anr lor r Frmn srbjec rhc applicartlo acnilpcmllyofnot mo,elhd lirc hundr.d dolltrs ($50o).
<br />l. 6 os.s orrhe Fotdry. or nry oDlot€s wilh q .8c s thcn sob comp.6alion. \ill do lhc woll and te endue is norl
<br />imdddl or .fioe1 aor el. (Sa ?044. BusinBs and h oasions Cod€ Thc Gntocr.as t-i.o* lrs do6 nor apply to u oMs of
<br />ihc pmrEny Nho hril& o, irpro\ 6lh@., a.d $ho do6 sucn $lt himsclto! heslf orllmusl his o, hs owo cmploycd,
<br />provid.d rhar such infro\ oMrs s. nor inrdd.d or 0,16ol for eL. I[ hosos- rtc ttrildinA or imFor.:Mr a $ld wihin onc ]s
<br />ofcompldiod. rhc ovn6 Buildd will havc th. buldo olpl olnB lh.r n€ or sh. did nol build or ihpor. &. pmpdy lor thc purp.& oa
<br />I, ar orn& oirn. ptupdt. ,n€rclusivclyconi,adinr $ilh lic€nscd co. ,ac1on ro codtud fi. Eojdi (S4. 10,14, B6ins
<br />and Pmlsion Code 'l h€ Coorracroas Li.€nsc La{ do6 .or appty
<br />'o
<br />u osnn olprop€ny who builds or impror6 rh6@n.
<br />and s ho .omr&ts for $.h lroldB snh a Conracro(s) lic€Nd pureurn to rhe Confactors l-ic6* t s).
<br />I dn€r€'npt undd Sdlion
<br />loaf,E8tcaMtExtarll]!
<br />PECIAEAIIOT
<br />I hdeby r,Iiiln ond.r p.nahy of pgjury on. oflhl followins d6ldliotu:
<br />V(har. dd { 'll mrmdn s Cd rli.ale ofconsl to SclHnsur. lor rvorkes con:l$,rion. ai providcd aor by S*tion 1700 of th.
<br />Lalbr Cod€. tor rh. polol)Mcc oafic wort ao. whicn fi. Fnn G isucd.
<br />!(ha\r a.d sill ,nlinrarn tr ork6 compoEar 'on 'suranc€. 6 r.qun d by Sat ion l70o of Ih. Labot Cod.. for lh. paaolr@cc oa
<br />rh. qorl tor*hrchrhE Dmrl ts 's.d M\ $0*6'conp.Bd'on 'mutu..cmi6 edpolt) numbae.:
<br />c-. ar.€, t\"r+k"d
<br />*,n,",^*, ?a!eJ€C.{,44{ f,}6 u,rr^ -:Vl/Zo
<br />Lf.nt't] rh{
<br />'n
<br />rh. ndfom.nc.olrh.$o for whrch rhis p6mn is issu.d, I shall nol @ploy ey pdsn in &y mmE
<br />$ 6 lo b<o'r. subj(t lo tfic w,IB' omFnsdion :aq,s ofcdiaomia. dd .gr $al if I should b.coru subitl to th.
<br />sorl6' comFNtion porisio$ olsdio. I700 of $c Llbor code I dBIl. fonheilh onrply vith lhoe FovisioN
<br />WARNINC: ltilurc ro suc *ork6' com!.nsrion .ormlc is unlastu!. ed shall subjd a! oployd lo dninal FM]li6 md
<br />cnil fin6 up ro onc hundrcd rhocdd dollm ($100,000), in addnlon to rh€ cosl ot comp.oslio.. da@8.s 6 rovid.d aor rn
<br />S(tn'n 1076 ollhc l.ah)r ( od.. i dei .nd atunlq."\ Ld5
<br />u(.IrsElll-ltNr-E loll
<br />Dl:( l,,rll,\lI(rN
<br />I hd.lly.mrm undr p€nolly oi p€rjury lhal I m lic€.s.d undq pmvilio. ofch,prs 9 (cormdcins \cilh Srlion ?000) ofDilisioo 3
<br />oa rhe BEi.e d PrulNioB(ode ind my lico* G in fullaor.€ d.,Idr.\wo
<br />I hftby artr,n und6 Fn.hy of pdju.y lh.l th6. is a onsrrucrio. Lndios aga., fo, th. Ffomdc. oaln. wt for whi.h rhis Fni i,
<br />isucd (Se.11097, Ci!. C.)
<br />AIIT.TCANLDX;IIAB lla!
<br />I hc.la.ubn rdn e-nally ofpdjury one ofih€ lollovins d(l&rions:
<br />Demnly. Pm{s Asb6rc5 Nor'fi.d'on rcd(il R+ularnm ( I irle,10. Pdrlo r
<br />+K,ya u"-.t n''r" t*,
<br />!!"'0, ',," rr,. r.a*r '.u"r"Fn\
<br />'.sd d.ns st6(('.ih.\ard. noranprnaok ro rhs pr r.d
<br />lzd
<br />'
<br />l) rhd I h^ . r6d rhi! applicirnn M $ ar. rhd rh. abov€ i.lomarnrn n .onsr. I a$e ro .onply wilh all c y and (-ouoty
<br />or&nanc6 ed sr.t. tis ! Elal r.s ro brildin*rqetucl iotr and hdcby aulhoriz. ,ert*rnaln 6 of rhis Cn, dd Counly lo ols upon tlE.*,". ",u(*& u
<br />*r**,*u^,r*,^"* ,/,W - ^,, Vfc(rlo
<br />p6nnmr.nc,pnn,): 5;^4,b' \1iltlq5t'tas:
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / 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 />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />tL^
<br />FINAL //za/zt ..*1X141 t)
<br />Notes, Remarks, Etc U
<br />APPROVALS DATE
<br />"""'-\tfiAo
<br />,.""*".**, !l-L
<br />"",. 111?(l?oService Meter
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