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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATrcN
<br />I hcrchy afirm uidcr pcndry of p.rjury rhd I m cx.f,pl fnm rh. (t,nrn loN Ltcnsc L!8 nrr rhc ftrlowihg rca$. (s{?031.5
<br />Brsin * rnd Profcsion Cdl)r Any Cily or Couniy $hth rcquiEs n Fanrit x' .on\rruL1, {116. iftriow. dc'mlnh or rctllt atry
<br />sruciuc. prior ro ns issuoncc, olw rcquncs lhe amliclnr lor uch pc,nir b tilc a ligmd tul.m lhal h.or shc h liccnsd purMnl
<br />ro rhc rb!(ions orlh. coita.rols Liccnscd tjw lch.plcr 9. ComnEncins wirh Se.lion TOOO of Divhbn I ol dc Busincss a.d
<br />PmtcsionsCod.)orrhalhcorshckcxcmplrhc.clmnandlhcl8shforlhcalkEdqcnnrbn.AnyviollrionofSccthn7011.5bylny
<br />lpnlicrtrr ior a lcrmir subccrsrhe applicani t, a.i!ilpc.alrror,or tu,Efid 6v. hundRal dolles ($Jm).
<br />-1.
<br />x\ owmr or rh€ rroFny. or my cntloFrr wilh wtrc$ as rh.n sb .ompcnsotion. q'ill do rh. worl ud rhc crmhm k mi
<br />inr.toL{ or offcrcd roi sh (sN ?()44. Businc$ and Pmfc$ions Codcr Thc Conrracxtr r Li.cn* tiw do.s nor lpplt lo an owrct of
<br />rhc pmleny qho hu ilds or inDows lhcpn, urd sho d@s skh wd( htnsclr or hc6cla.r rhmu8h ht or ,Er o*n employds.
<br />Fovidcd th0r such i.DoEmnraEmt i.rcrd.d orotrcrcd rorsh ll.lrscw( Ih. hildin8 or impmwrnr is eld *ithinok ru
<br />olcon{,lcri4 rhc owncr auini will harc rhc hor'lo of noviry th.l hc or shc dil mr build or i'ionNc f pbIcny ror rh. purJrs or
<br />I. iso*..r ollh. !mp.ny, mcxclusivcl, contructins wilh li$nfd conrra(ni^ h, str{dcr rtr l)rcjNt (Sa. ?1i14. Bu\inc\\
<br />nlxl thril\bn Codc Tlr Conrrcrols Licen\c LaB doe! nor aff,|, ro !n own.r or rrol.ny Rho builds or imrovcs thcrs,n,
<br />nnd who .untrc(lnr su.h pmrcBwfha Conrmroi s) liccnsd pnnurnt k' rhc Conrraclor's Liccn{ Ijw)
<br />-l
<br />amcxcmpt undcr Satio
<br />t!!4tr[&r:g]Mf[NliarpN
<br />D[CL n u(}!
<br />I lErchy rmrm undcr lEnollyolpcrjuryoic orrttr r(,lk'wtrg d..l&ii{trs:
<br />Ihsvcnideillmirtrin!CcnifrcotcofConsenrroSelllns!rc,o,sorkoi.rf,p.nerkr,rspDvid.dlorhyScctn,nITOOdrrh.
<br />Ltrhor C.dc. ru rh. r.rroamncc ofrhc aork lor which rhc pcrni is nsucd.
<br />I hrvcrnd willnrinlsin wortcrr compcns ion inslratre. f,\ rcqlied b, s(r bn 1700 oi lhc Llbor Codc- {(tr rht porornBn.c of
<br />h nsucd My *orkcs' conEnsln'n nNurdcc .dicr &i polty nutrlhcr dc
<br />(
<br />5
<br />I ccniftrh ir thc |x lornmncc ollhcw.rk l *hichlhi\ nermir ir isu.d.l \hnllnor c,nPloyrny Pcrson inany manmr
<br />so sro hcconE suhjcd ri, rhc workcG co'np.n\arn,n h*s.rCnlil.nriJ. Md l8ndhlt iil \hould hcorc \rbrc.r hrlr
<br />workcr' compcn\lrion lr.vnion\ of Scd n,. .l7m of rhd bbr Gxlc. I shall. i)nhwilh .onrply wirh rho* pxrvi\ions
<br />\YARNIN(: tilurc r. rcurc aorkcn compcnrariotr covc&Se is unlowtul, ad shall \ublc.r rn cmtlo)cr ro rininrl Fnalricl md
<br />:.:iilill'1".il.il'uffi.llll,;i:
<br />l(x).UxD, in oddnion lo rhc.o( or.ddures rs rrovidcJ fttr rhc
<br />IECI.d8dIx)N
<br />I hcrcby ofirD undcr lcnohrolpcrjury Uur I sn lie.$rl udc l,r,lision orch4rcr 9 (onmrcio-q wilh Sccrtrn Ttxxr) orDivhion 3
<br />of rhc Busircss and Polcssions Codc. {d my licc,sc t in 6ill forc aBl cfl.cr
<br />\oo11 oo1
<br />""" JUN t
<br />COISIAIJCIION.LENIIING.{AENCI
<br />I hcrcby!flirnru&r Fnalry orr*.jury rh thd. h!coiiruc'iotr lcndins oScmy for lh. por.r@nN of'hcwork lor which rhir lcrdil ir
<br />nslcd (Scc.:lO9?, Civ. C.).
<br />APEI.ICANLDECI,ABAUON
<br />I hcrcby ofum udq pcnolr, oapcrjury onc otrhc rou.wine dcclddions:
<br />Dcmrilion Pcrnih'Asbcstos Nori6carion Fcdclal RcE!htions (Tirlc 40. Pan6r
<br />-Rcquncd
<br />Lxltcr ol Noli,icalion
<br />_l ccaiiy rhDr rhc r.dcr,l rcgulrtnrns rcgddin8 asb.srosrcmvd!rc not atfltar,h ro rhn pmi.r
<br />-l]?cnify rhor I h,vc rcad rhls applk,rion.nd iarc lh,l lhc atrrc info,nulion is.orfur I nlre lo conply qnh all Ciry un Colnry
<br />ordinde\ a.d Sralc Liw{ rclsring ro huildinS construcrion. !.d hcrcbyruthorjzc rcrcrnrdiks 6frhir Ciryadd Counlylo cnrs upon rhe
<br />!h.ve rrnliord ptr,pcny ftn invd i{,n turyr,\c\
<br />Appli.anl or AEent Signnlurc:
<br />zr>4./r,,"\1 2018
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFEFI
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh tt/l?tlq <,\ tft
<br />Service ltleter
<br />FINAL t/zt/,c ,b8g
<br />Notes, Remarks, Etc
<br />Communications Cable
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<br />tJnd.r'( NJm
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<br />t tu.rc A.l&e\:
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