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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/srG.COMMENTS O'WNER BUILDER DELCARATION
<br />I h6.by ailrm unds F.alty oa psjury lhal I m dofl &om rhc ConbadoB Lic€m bw for lh. lollowi4 r.en (SE.70l L5
<br />Dusin6s ed Ptuf*ion Codc) Any Ciry or Coumy which rcqunG a larnn to coNtrud. dlld. i6!rov.. d@olish or r+6n My
<br />sttuctue p.ior to irs isuuce, also r.qun6 rhc applicd lor su p.f,hil to filc 6 signd slatmnl thd tc or $hc b licclts.d pNdl
<br />to thc provsioB oat Co.tacrors Li.ms.d Ijw (ChaF6 9, Conmocins vith Srlion 7000 oa Division I oflhe BEire ed
<br />Proacsions Codc) or th.l h. o! sh. is crmpt lhdcliom and lhc basis for lh. all.s.d crdFio., A.y violtlion ofs€.lioD 7011.5 hy any
<br />applicd tor a pdnn subtcts lhc aDplicul ro a .ivil p.mny ot not nor. thu fivc hundrcd doll&s ($500)
<br />L 6 owns oflhc prcprry. or ny enployd wnn wa8e a lhcn st comp.nsalion. sill do lh€ uo,L dd rhe $!cr@ is @t
<br />i.lodo.t or ofiged lor slc (Sd 7044. B*in6s dd Prol6iom Cod. 'ft. Controclois LicN t2w do6 nor appl, to & oMd ol
<br />rh. DtuDdy wto toilds o. n prcvB lhqan. ad sho do6 such wo* hims.laor hNlaor rhou3h his or hs o*n 6ployt6.
<br />Fovid.d thal such imFor@rs e mr inrsxloJ orolr6.d aor sL. Il holsq,lh. hiuins or iryrold11d t ed *nhin oft,a
<br />oaco,npl.tion, llE o\,nd &rild6 will lEvc thc hlrdm ol prcvi.s lha hc or sh. dA nol bnild or nnprclc tn. Flpsly for thc puloe of
<br />.1, aow.6oirhe pmldy, dn exclusivclyconrmcrinr sirh liccni€d co.tracrouro coftrtu.l tic projrt (S( 7044, Auin6
<br />dd Asasion Codc: Thc Conlrd.rois Liccns. Las do6 oot applylo anoNnd oipror.ny who buildr or imp.ovB thd.or.
<br />a.d lho contmds for such prej4lswilh a Coor,lcto(s) licda.d luBUMi to rh. Conlraclo.s Licas La*)
<br />lrne\.rn trnd.r SRl,on . R & l)C nnrh* r.asod
<br />Dnrc otrnr.:
<br />laaEEll!:c9lltflsArlo.r
<br />DICIJAAIIO!
<br />I hcrcbyaflim undd poralry olpojuryonc of$c lollowin8 dclsalios:
<br />-l
<br />h!!c and q ill naibrain a Cdificatc oacomd lo Scla-16urc for work6 N'npdsnion, a F.vi.led aor b, sdio. 3700 o f lh.
<br />I-abor Cod., aor rh. pdfomtu.e o f rhc "od for rnich lhc pqmil is issucd
<br />I htrv.andwill mainlain worl6 .ohp.Narioo iBurd.c,6 r.quned b, Salion 1700 oflh€ Labor Cod.. tor lh. Ffof]@cc ol
<br />lhc Mrk aor *fiich rhb !.mi is ic$.d My qorh6 onpaMlion i@e.. 6iq 0d policy numbq e.:
<br />I
<br />r& llt ..n'rr rur
<br />'n
<br />rt. por.mancc oirh. -or[ ror which rhis p.mn h issu€d, I shallnor.mployaoy D.&n in any 66nd
<br />e a lo b<onc aubjd' lo rh. \rcrta' .onpdsation laB of Califomia. and as@ rhd il I slDuld b<om. subjel lo rh.
<br />world'comp.NrionpmlisioBofSElion1700olrhcLahorCodc,Ishall fonhwithcomply wilh thospmvisions..
<br />WARNINC: F,ilur. io su. vork6' conlPoetion cove,asc s mlawful. ,id thall stbjd m 6plo,€r lo oiminal FEtts ed
<br />.ivil fin6 up to on. hundrcd lhousdd dollm (1100.000). ih rddni.n b th. cost of comp€nsation, darEscs N ptovid.d for lhc
<br />Sdion t076.frh.l ahn Code mro6r
<br />T,,lut^tL^.,r(
<br />LtcllsEa.caNraacpB
<br />DECIdEAIIAN
<br />I hqtby afm undd p.adty ofFjury $ar I m U6ed undo p.ovitior of Cht 16 9 i@mdcing wht S*tior 7000) ol Division I
<br />ol rhc BBid* md PEfNiod Codq and,ny lic6F is in tull lore dd cltcr
<br />,"*."*, O-to I i...{.Ntr,nIE -7otl cttl
<br />12 Aoze ."^,,."r,Xldo,--
<br />COXEIAIGIIQN.LIUDINGICENCI
<br />I h@by afllm uidd Fnah, oa pdjory $d th@ is a codoclk'n l€mlins 6sdcy for lh. pofomMc. oalh. wort fot shich thls Fnit b
<br />isucd(S(.1097, Ci!. C )
<br />L.nddi \m.
<br />ABLICAUDECIdEATqT
<br />I hdtby a&r ondd p..olry of pdjury o.. oa th. aollowing ddldal ions:
<br />D.molirion PmirvAsb6td Norifi..rion Fcd@l R.gulali.N Onl.40. Pan6)
<br />-
<br />Rcquiicd lclto olNotindio.
<br />I(di6 rharrh. f.ddd r.!uhioB Exsdins dbBros rmordle r o! appl'. ablc ro r hi, pmjdr
<br />\dY'U *,,t*,*l,* apprratrnnud narcrh $cabo!. inromiion iscotr.d.I o!,a ro comply wnh arl cny dd counry
<br />ordi@.6 Md starc bws r.Lring ro building coErruclio^ ad hdcby allhorir r.FMialivB ollhis Cny od Cou.ty lo dl6 uDo. lhc
<br />alsre mmrioncd propeny for inspd t-
<br />4
<br />,,,", kJ. I 2ozo
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sians (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communicalions Cable
<br />Building
<br />Under Slab / Floor \
<br />Bonding / Groundinq / UFER ?-.-luzd )r#\?,
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Ir,4eter Release Z-G-Z VWlLi,
<br />U
<br />Rouqh
<br />Service [Ieter z-g'v0 J
<br />FINAL 7-,-5.21
<br />Notes, Remarks, Etc.
<br />Rev. 08-07-2015
<br />Sub-Panels
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<br />vJrl)
<br />,^.", (Lb b ,l-tto
<br />Applionl or Aeetrt Sign.lure
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