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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS OWNER BIJILDER DEL(]ARATION
<br />I h6eby amm uodq psalty of porury rh.l I @ cx@pt &on rh. conr.doB Lictrc tiw for ihc aollowins reNn (567031.5
<br />BGin6s ,nd Profdion Cod.), Any Ciy or Couy which r.qut6 a pddl lo coBtrucl. alt6, inprovc. dcftolth or r.9an uy
<br />sIrucre rmr to its is@c.. also r€{ut6 thc arpli@r tor such pcmir lo til. r sign d 3laldd that fi. or shc is li.ctrs.d pumel
<br />ro rhe proviiions offi. Conracroas Licmal L,w (Chaprd 9, ComBcncins rith Sarion 7000 or Division 3 olrhc BBinB dC
<br />Pbfcsio.s Cod.) or th.I he or shc t .xcmpt Ihmiod dd rh. bas6 lor 0r aU.gcd d@prion. Any vioLtiod oaselion 701 1.5 by my
<br />aprlidl aor a Fmil subjels (hc amlicet ro a civil p.miy of nol mo,. lha livc hundr€d dolles (5500).
<br />I. 6 oM6 olrhe prorEly, o ny cmplo,t6 wnn sas6 d rhor el. @,npdsation, will do th. $ort ud $e rII1r G mt
<br />i qded or o,I6ed ror elc iS€.?O14, BBin* dd Pl'oasioro cod.r Thc Co,lractols l-icos Lav do6 nol alply ro u ovn6 oa
<br />theIropgty *lF boilds or ihp.!!6 thsoq and *ho dG s.h st{ him.lao! h.Mll or lhreugh his or hq om dnploy.6,
<br />provid.J lhd such improvarcnls 6. mt inrdd.d or orq.d fo! salc. ll ho{do, rh. hrilding ot imprcvmnr is $ld withifl on€ ,@
<br />olconplnioi. $c ol*tr6 Buildd rill ha( lh. hda ofproviry th,l h. or sh. dil mi hrild or improv. thc Fopaty lor thc lJupor oi
<br />I. sownrofth.p,op.ny, m.xclusiv.lyconlradins with licdscd co ractoElo.oBrtucr (h.projel (Sd.7041, D6ins
<br />Md Pttrftssbtr Codc: thc Codrrctois Licose Lsw do6 @r apply to e owd oapbpdy eho builds or inpo!6 lhqon,
<br />md who snhds itr such pmj.ds wnh a aodnclo(, licm.d pEu.r'l lo lhc Co.tradols Lic.M ljw).
<br />I er exmpl utrd6 Salion , B. & P.C. forlhb r6on
<br />!oA&88[CAI!,!jNiAIjA!Drclaa4lla!
<br />I hd.by smm und6 r,aahy olpdjury onc olthc followios d(lr@lio6:
<br />I hav. rnd will mrinrrio n Cdific.r. of CoBml ro S€ll-lNurc fo. world @op6$.lion. 4 prolidcn for b, sario. 1700 of ltc
<br />ljbor Code aor th. p{aommc. of lhe work for which th. Fmil is i$ucd.
<br />xffri;and will naintai. woikss conpcGarion isurM..,6 rcquned by Serion l?00 ollhe tibor Code, ao.lh. pslomece of
<br />for *hich Ihis ponil ir i$cn. My vort6 com!.Mio. iNurMcc cei6 ud policy runbq d.
<br />,,,,,,., -Awtlrl Utr1 ZlncAwLs?4 tu o I3 o?2
<br />I cdliay lnal in rh. Frfoflmc. oathc work for which this psmit is issucd. I shlu nor onlloy y p.Bon in any nen6
<br />$ s ro beom. suber ro lhc worl6 @mp.ns.rion la* oacdlifomia, Md a8B rtri ia l should baorc subjet lo lhc
<br />wo (6' .oht rcarion provkioB ofs.dion I700ofrh. t bor Code I shall, fonhvnh.onply wirh rhospoeisioN..
<br />WARNING: Failure io *.trr. sorkc6' comr.f,salion \dase is unlarfin. and shall subj.d .. dnploF to drniMl pdeiie md
<br />.i!il line up ro one hundr.d rnousmd dollffi ($l
<br />Srli.n 1l)?6.frh.l.alrr Coda i'n
<br />u
<br />I h@by amrn ondd pdalry of pajury lhrl I a. lkctrEd und6 prclision orchaplq I (cotndcins wnh s..lio. '7000) of Dilliion 3
<br />of rh. Busbs md Proa6sioN Cod€, trd ,ny licdc is in full fore€ &d cfid.
<br />.,."*..* JJ.q_qnjvg?
<br />SO
<br />I h*by srrfln undd Fn.lty of p.dury thal lhdc G s codruclion
<br />issued (Sft. 3097. Civ C)
<br />a{ocy tu Oc pqfomec. ol th. woik for
<br />"1ich
<br />$is pdmil is
<br />AEEIICANLDECI.AB{IIAN
<br />I ho*y afrm uidd ,6alty ol pqjury o@ oflh. aollowhs d<ltrarioNl
<br />Dc'rclition Pdmits-Asb6los Norificar ion l_.ddol Rcsulatioa OnL 40. Pan6)
<br />_ Rcqutcd L-.rrd oaNori6cdion
<br />I cdiiy thd rhc f.d6al rcrulat io$ r.strdints sbcios rcmolal e not aprlicable lo lhn pmj<l
<br />4dlix*tt hav. .@d thi! applicalion &d slar. thal rn. ahv. iniomation is corel. I osre to coopl) Eit all Cny dd Counly
<br />rq,6mr.riv6 olthis Cilyed Counly 1o nt6 upon thc
<br />above moriorcd poDeny for i6p6lio
<br />A +?1
<br />Site-Work
<br />Underqround
<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 / 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 />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh
<br />F|NAL //Zt/zo ."A Van')
<br />Notes, Remdrks, 'Etc., c....
<br />Rev.0B-07-2015
<br />Service Nileter
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