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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT]ILDER DI'LCARATION
<br />I h6cb] .mnn trnd.r ,ftahy oi p6july lhal I o. cxcDpl Fonr lh. Cont to6 Licme tiw for Ihc louowing Eeon lse.7oll 5
<br />BusnEs and ProlNion Codc) Any Cily oi Cdnd, whi.h r€qriiG a pamn lo coBtrucl. !lld, inpro\c &solish or r.T.n ,nt
<br />srrucruc. pno! ro ils islecq rlsr r.qun6 lhe arpli.dt aor such Forit lo ,ile a sisned slrldd rtd h. ot she b licoscd p6ul
<br />ro rh. prolisbG oafic Co 6cttr s Lic€nscd t v (Chapl6 9. Co'nm.ncin8 wnh Selion 7000 of Diision 3 oalhc Blsine 6d
<br />ProL$iotrs codc) or thal h. or shc is .r€mpt lhgefrom tud lhc bsb lor fic all+.d .xoption Any viohtion oascdion 701 L5 by my
<br />rpplic.nr lor a p€mil $rbjtrrsrh. applicant ro acirilFnakrolnot morcthan livc hun&cd doll&s ($500 ).
<br />L s o$n6 o llh. Fop.nr, or my mploy.6 unh wes6 s Ih.i, slc comp.6arion. vil do lhl $o* dd $. s{tucluc i! mt
<br />inldd.d orord.d for el€ (Sd 7044. B6inas ed Pmftssions Cod. ft€ Conlr.ctoas l-ic..s Lrw dod nor applylo oMnol
<br />thc pmpdiy who bxiLh or i,ry.ov6 tlErch, dd who dLB su.h *olk hins.laot hd*llor lluoush his or hd oM cmplo}!6.
<br />pmvid.d rhar skh impr.ldmE @ml inldr&d oro,to.d aoreh lI hd\66. th. buildi.4 or itrsm@l a eld*nninon
<br />'aofcompErion.lhcOsoa Build6 w n rcth.hmk ol po\ing lhd i. or sh€ drd nol b ild or inprorc thc IItrFry for tlE Fipos oa
<br />l, doMnof rh. aiopdt. n crclusiv.ly contFcl ins rilh lico*d co adou lo connrucr lhc prcj(l (S( 7044 BBi.s
<br />.nd Pmfsion Cod. The Conlractoas Licme La{ do6 nor apply b .n or nq of prop.ny Nho blilds ot improv6 thd@r,
<br />and $ho co EcG for soch Fojccis sith. Conlmclo(s) licasd puBlan1ro rh.contadois Lic.N tasJ
<br />I @.r.mpl undd sNrio.ll & P.C aor rhis r6on
<br />rroaxEBfloMflltara!
<br />I h@by afllm u.dd F,lry o.polu,y on. or rr'. rono*insffiffig
<br />-l
<br />h!!c &d rvill 6ai.6in . Cdific.t. of Co6ol lo S€ll-l Burc tor sorr6 .omP@rio.. s Fovid€d for by S6rion 1700 oath.
<br />Labor Code for lhc pgfomanc. ol rh. {srk for $hich (h. pmil b i$u.d
<br />LAff**o *u,."t t*o,t6 conp.Narion iNuBnc.. s r.quiEd by s<rion rTur oarh€ l-lborcodc. ror rn pnfommcor
<br />rhe$orlror$hi!hrhirD.rmirrLsu.dMvrrorlccrmpdsd'onff,ma.5i6mdpnlicynumb.a..*. / ,tl,,J A-.{
<br />potirN,-b.,7a dcGA*6 EGz- E pi*, //rV 2-b
<br />I c€rri! rhsr in rhc pdfoman.c oflh. wort lo. which lhis pcmn is bsu.d. I slEllnol dploy&yp4on in any msno
<br />so 6 to bdooc subjd lo fie sorh6' compcatior la\$ ot Cfllifomia. ed as@ rhat if I should t com. srbjel lo th.
<br />\0,16'conrqeioopmlisioNofSeiionlTCrOollncL{borCodelsh.rlaonhwilhcomPlyrilfilho$ptori3ioc..
<br />WARNINC: I,silue ro secure \ork€6 conrptualion .ovdtlc i.r unlasful. and shhll subi{l a Enpby.t ro ri,nin.lpomltis and
<br />ci\il tn6 trp Io ooe hundr.d rhouend d.ll6 ($100,000), in addntun to lhe cosl orcompcnsarion. dm.8cs 6 Provid€d lor thc
<br />Sdr ion 1076 o f rh. I-alnr Cod€. inr*6t 6nd .trome!-s ad
<br />I ho.by .ftm undr Fnalry o a Frjury thal I m licss€d und6 Fovilion ofch.Od 9 (comDocins Nilh S6rion 7000) of Divisio. l
<br />ol rhc Busi,s md Pof6iions c'od.. d my lic.N. is in tutl forc. ud ctt<r.
<br />,'*-*.,* B r 'cc* Numb.r /2 X37/,
<br />on" {3 er/z-o c-,,*." @t/<.. 1,.,.f l,ra
<br />corl]auquoN.lIlulcal;lNcf
<br />I hRby .rm undd Fnalry of pcrjury rhat rh6c B a .oBrtuclion kndinS .g6cy for lh. pdfomd.. oflhi wort for *hich lhis Ffil b
<br />issue{ (se. 3097. civ. c )
<br />AIEIICANLO&CIAEAIIA!
<br />I ^L-,r.* .Jr6n undd t6alr, ol Frjury on€ of rh€ followi.s d<l@r ions:
<br />D€nolirioo Pmirs Asb6rd Noriicalion Feddal Rqulalions ( Iillc 40. Pan6)
<br />-R.qun.d
<br />Lals of Notifietion
<br />I cEriry thal th. tu6rl rcguhlioB r.grdine stqln rooval e. rct applicabl. lo this prcj<1.
<br />Ui(6'1, rhd I h.'. red rhis rpphcarion od nareth.l lh. dhovc infomalion i5 coret. I agre to condywnh a[ Ciryand counly
<br />,6Ai;ims Md srr!. Ilws r.ldins ro burldDs conmdoG ad hd.b, aur6ort. rcpr66tsliv6 oalhis Cily ed Couiy io dl6 upon lh.
<br />aborc nBlioncd pr.pdy for iBp€rion purFs
<br />,rl,l,licntrr n' ,\[rtrr Si[nxtnr Z.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor lt t,
<br />Bondinq / Groundinq / UFER utq20il aniWA )
<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 />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)l I lr
<br />Meter Release 4t512{)ryailrilv
<br />I
<br />Rough II t (
<br />Service Meter 4WA wuilva#,,/,
<br />FINAL 4A1W DVitt,twn lab
<br />Notes, Remarks, Etc.rt
<br />/t^,r€y
<br />a)
<br />**, ,l,L<,/t -o
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