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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrchy rfin'n und.r p.nnlry of lcrj!ry lhal I o cxcmfl iiom rh. ConlreroF l-iet{ rjw ntr rtu folhyhs rca$n lscc.7ol l 5
<br />Bulincrs rl Prolt$ion Codc): Any Ciry or cou.ly ehi.h rcquncs a pont b Lsnslruct. olrcr, inPrcle dcmolth or Epan lrv
<br />sdcrurc. Eior ro irs hsumc.,le rcquircs lhcnppli. l tu such,,cmir ro nba siSncd sloL'Eor rhar heo. shc n liccnscd l)UBUtnr
<br />lo lhc nolisioD\ or rh. conraclols Liccned Llw (Chapr.r 9. ConnmEins wirh Sccrion ?mo or Divnion :l of!h' Busincs 3nd
<br />Prorcarion\C.rL)orlharlEorslEiscxoill)rrhcrcrion.ndrh.hasnlbrlhcalhscdcrcnprion.Atryviolarionorselbn?03l5hrrnv
<br />appl,c.nl fo!pcrmir iubFchrhc {tliconr lo o civil Fnolry ot rer
<br />'rcrc
<br />rhm nvc hundrcn &,lla* ($5{D)
<br />L N owncr of rhc proFnr- or m, c.DLyccs wilh w,gcs {s lhcn eh cotPcns ion, will do rhc wort dd lhc $Mrw k mr
<br />inrcrncd or oftrcd for slc (Se 7044. Busimss and Prefc$io.s C.dc Thc Conlnctor's Lkcn.c Il* (l1)$ nor arply lo sn owkr of
<br />rh. pn,l.nt wh builds or imrm6 dmn. and wrb des such wolk nimself .r bctulr or dmush hh or her 6wn cntlovccs.
<br />providcd rrEr soch inlmEmnrs orc mr hrcnd.n or ofid.d for sL ll houw. th. no iiinB or inpmENd t sU withib on. Fo
<br />ofmnpLlion. ltr Osner B!ild.. will hlw thc budcn of prcvins rhar hc oi sh. did mi hild or i'[,rc* ttr lmFly for ltE purl.c or
<br />-l-!so*n.rorrhcproFny.!mcxchsivclyconrd.ringwirhli.cnscdcontrrcxrloconnru.tihcPmicl(Scc
<br />?044. Busin.s
<br />ot R$nxsitr Codc: Thc Co.r,cror's Licc,sc Low docs not applyro &o{mr ofprcI)crly *ho builds or imProvcs ltcrcon.
<br />and who 6 ack aor scn Forcls snha ClntB.ro(t liccnscd PuGUonl ro rh. C.nr&roas Licctrc Lae)
<br />-l
<br />rmcxcmpl und6SNrior B &f C Lrrhisr.lqnr.
<br />woRxFrl.s' c(lMPr.Nsa rl()N
<br />DECI. aAIION
<br />I hcrchy!1fi rnrundcr pcdrlryrf Dcquryom olrh. folkr*iig d..lardioDs:
<br />-l
<br />havc ud will minrdn a CcnifElrc oi CoiEnr o S.lr- hsurc ror workes coq)..sdrion $ pmvidcd ihr bv Sc.lion .1700 oi lh€
<br />bbor Codc. lbr Ihc perlortuncc ofrhc wolk ror which lhc l,cnnil is tru.d.
<br />-l
<br />havc and *ill maimain workcr'compcns{rion i.rxrancc. as Eqnncd t, Secrio.l70o orrhe Lihor Codc. r.r
<br />'h. Pcrtonumc of
<br />rhc wort rrtr vhich lhis ,Ermil is is\ocd My votktn comP.nsalion insuamc cndicr dld Flicy numtEr dc
<br />-C./i
<br />t)(,2 o/ -01-201 q
<br />I.cniry rh,r in rhc pcraoflntrne drrh. sotk rbl which rhn rcrnrir n issucd. I rhrll nol cmploy nny p.ron in rnv mJn(r
<br />s .s n' bcc-nrc sul,J..r h rhc so*cn' .omNn\a! ion law\ of Cslif.rni( tnd aBB rirr if I should ttcotrE \uhicr t rlx
<br />qolkcrl coilpcnlar ion povisons ol Sdion 37(l) of rh. Latnr cdd.. I stull. lodnsirh conply wilh r&,c Pmvtions
<br />WARNINC: Fnilur i) s.urc *orkcn'comlrn\dnn c.vcraBc i\ utrhwful. md sh,ll subjsl .n crnpk'rtr r. dirnrlpcrulrir\ aid
<br />civil fine\ up ro ooc hutrdEd rhousand dollln ($lm,rDo). in rddirion lo rh. cod of.onDcnsltion. d!tugcs a\ pnvi'l'd for rhc
<br />Sal io. ]076 ol rhc Lnhn CGlc. inrctcsl ond alrntf,y s f(\
<br />o^",.Ocf r+/rg 4! n4ry Zttt*t C.
<br />uLENtgl,L]2NIn crA.B!ll(L trtruoN
<br />I h.rcby,frtr undcrF.ohyotrcrjlryrharIr li.cnst undcr Imlnioi oichaPIcr 9 (com*rcing *irh S*lion 7(})0) ofDilision l
<br />of lhc Blsinc$ a.d Pn,fcssions Codc. .Ii nry ltcnsc is in tull r.rcc lri cflccl
<br />? o1 1? t$t/, I "-,-"*!4 11 c 04 I 7u<2 (?, o 4
<br />CAIEIBIJqUQU!ENIINGIGEICT
<br />t hcrcb, drnrm und.r lEnoh, oa !.rjuty $ rhcrc is a .onslruclion E.ding ogcncy fo! thc Frfortune or rrr work for wnnh rhh Fmn i\
<br />hsued (Scc. 1097. Civ. c.).
<br />I ..nllvrlDr th.ltdcralrclularion\ rc!rdniA ash.n.s rcN,!1lrr. norrfPl'.ihlc ro rhi\ !roiccr
<br />lA,*nr|n, , *r" ^"u,nn
<br />am
<br />'cdrr.n
<br />md {!rc rh,r rhc lhrc inr,trmr'on
<br />I oRlmaRc\and Srolc Liq\ rbrrgroburldrne con\lructnn.,nd hocb) s,rhoria
<br />I
<br />rlsvc m.rnncd ercFdy r i*""." r*r*{l-/.,/
<br />I Appri(utorAsmrsknrruEr<' / Z
<br />| *-n**,",0n,,, *3n a'rv -(U t r'r' ' (
<br />h cotrccl 10srftr...trfly wirh allCiryrtrd C.u.ly
<br />rcprcscnrntilesorrhisCir, utrd Counry kr .nrd u|En r,r
<br />^,". orftc,(n
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh),l
<br />?6 (E(&Lxsl-
<br />Rough n.l ra Vrnf?-
<br />Service I\,4eter rI'- - -'
<br />FINAL fulnT*to -/r 1Notes, Remarks, Etc
<br />APILICANLDACLAMIIO!
<br />I hcNby onim udc{cnalry of lcrrury orc of lhc foll.wi.g d.clsal ions:
<br />Dcnblirion Pcrmits-Asb6ror Nolincalio. ftd.El Rcsllalioni lTnL 40, Pd6)
<br />-RcquiEd
<br />t rlrof Mnilrdion
<br />Sub-Panels
<br />Air Conditioners
<br />lt/eter Belease
<br />1.1 t'-
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