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ELECTRICAL.INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER O6LCARNTION
<br />I hcrcby smfln uMcr l,cn,lly of pcrjury th0t I m cxcnrrr fmm rhc ConlmcrnF Lic.n* ti* ror rh. folk,winB rc.so ( k( 1031 5
<br />Busin.s Md Prol!$ion Cndc), Any Ciry nr Counry which eqxircs r lr.mn b ronnrucl, allcr. inFrovc. d.nn,lhh or rc,3n lny
<br />sdcrur.. t,ior ro irs iisuarc. atb rcqunN Ih. arplamr ro. sudh lrrmi' b filc . si8red surcmnt rhar h. nr \h. h li.cn{d pur$,nl
<br />ro rhc proltions olrlE Conrricroi\ t,ieiscd Law (Ch!!'rer 9. Cofrturting wnh Sedk,.7xx) of oivision I oflhe Brsincs and
<br />l'mtcssion\Code)orrhart or {hc h .&nl,r rhcrcfrod rnd rh. lEsis t r lhc dlkecd .x.trptnrn. An,viohlionofScctior?0115$yliy
<br />,,lrpl'.d r lo.0 n r'h( \ubF{F rh. dtpl'rani ro r$rlt.ml!, nl no' nmErhln nvc huDdrcrldollu\ 'Ssm'
<br />//] l***,"""r.*,y.ormycn{r'!rc\*h$r8.*dlrh.nbhsfrpensltion.wirrdorhevorkandrhcdnrlmi\,7 rrlrg{prt "rorcrca r"r *tc rS( 70a,.. Buvncrsand Pmfc$ions Code: Tic CotrrEdois Liccn.c tls&,csnor.rplyro!flopnerof
<br />rhY lm)iny wh" h.
<br />'ld. "r n{,ru!$ rheNn. ld wts dms rmh slk hinscll o. hcNll or $DUs,, nis or h.r o*n cd{,k,rc!s.
<br />providcd rh.l such inu,!rcmnh e mr inr.,rl€d orotlcEn forsk li how.vci rlt hildinS or inpmtm is $h virni', onc FU
<br />.r.orglori.n. ttf, o,nfi Buil&, will hovc rfu burd.. ol FovinS thd hc or shc dil ml trild or irymlc lhc pR'r.iy ror rh. purr,* of
<br />I. $ownc.ol rhcp&pcny. amcxclusivcly.ontnctiry qilh li.ctrsd.o rucnns io $ndrud ihc l)liccr (Sc. 7{X4. Btrsincs
<br />mJ l1r'fssbn Codc 'l fic G,nra.t* c l-i.rns. Law du\ n r trrtly o an .wn.r ol pmpc y who buink or imp
<br />nn{r who onrruclsfor suchrmjcch wnh a conrraclo(9 liccn{d pururnr hrhcconka.(,! Lkcn{ Ltrwruttl
<br />I hcrcby rlllrr urdcr ncn lltof pcduyom.llh. bllowil
<br />-l
<br />hlve dr.l sillnui rha Ccn rrtrrc oi Conrcnr r., sclr'isulc ntr*orkc^ .o.l,cn!0rn,r. N poviJcd lor hy
<br />Lnhor Codc. lor lhc ,nforronce oi lhc wo for whkh the ,cnnil h is\ucd.
<br />_lhovcund eillmaintain oortc* comFnsarion insrmncc- !s rdquncd hysdri.n l70o oflhc bbor Cod.. forlhc pciaomrcc ol
<br />rhc *ork for which rht F,nir i3 i*nol My workss. .ompensalion insuid.c cmi.r ond policy numb.r m:
<br />:-ErDircs
<br />rhc tcrlonnrrc.frh. $ork for whf,h rhi\ r.rnrir h tsucd. Ish.llnol cnrploy rny pcro inrny
<br />suhFl rn rlrc no*cri comlcosfll6n hws olCalilornir- and rsN rhtrr irl \r,,uld b{onE \ubicl ro I
<br />ns0lion l,Dlhnnr ol Sdnnr .17(l) of rhc titDr Codc. I shnll, ndh$ir[.on1Ply $nh rh,c F'visions.
<br />WARNIN(; Frilu'. u *{rrc wrkc6 .o rtlcns idr.o!cr Ec,s trnhqtul. rtrd shrll suhicd an cnlPl.rr t,.ri'nirrl lrnrlri:s rtrd
<br />I hcrcby xlilrnr u cr pcnallyof!.rjuryrhrr Ia'n li.anwl und.r prcvision of Chrptd 9r.onnhn.i s..ri{)n 7(xxr of ,}irnn'n :l
<br />ol lhc Busincss Md Profcsio.sConc. d nry licc.$ is in rlll iorcc and elllcr
<br />CAISIBIqUANIINDINC.AqENCI
<br />I h.rchy lmrm undrr Fnrliyofp.rjur! rhsr rh.ic iq tr c.n{ru.ri.n hMiig nBcncy f.r rhc Frlornrnncc olrhc *ork f(x $hi.h rhi\ P..mn n
<br />isucd (Scc 3097. Civ C ).
<br />AIPLI!]TNfIDIIAAAII9!
<br />I hotny aliinn u ndcr p.nalry olpcrjuryonc olrhc lirllowing dcclararn,n\:
<br />Dcnblilinn PcnnirlAsbcios Noliliration I'cJcrnlRe3ulations (Tillc,lo, Panr,
<br />Rcquirld Lcrrcr oI Ndifi cdi,n
<br />l..nilithrr rtu lid.rrl '.guhn)is rsndd| (f,(oic i)uln'r tror t rli.rhl. kr rh \ nfujccrffi *ttL'*,'^'1,,;',,t,,1*,;xl{nr.rhd dr hvc inf(rrtri,fl is.oaccr l ngrcclo.onrly*irhill Ciryr d coutrry
<br />Md hc6hyrurlr)"zc rcrcsnrarivcs ofrhn C t
<br />abovc mnliorcd pmrcriy lor insp.dt'npurrnsc\
<br />Appli.anl or Ascnl skn,lorc
<br />A UU lro
<br />-il?L;
<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 />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release
<br />Rouqh
<br />Service Meler I I
<br />FINAL 'al1kl)B ruth\v-Notes, Remarks, Etc.
<br />Air Conditioners
<br />;:ry12Y#
<br />lrr(
<br />L.ndcir Addrcs
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