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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNOR BUILDER DELCAXATION
<br />I hcrcby aflirnr u.dcr llcmll, o{ pcrjlr, thar I am cx.nfl ,mnr lhc Conrocro^ Liccn* trw lo, rhc fnllo*in! ma$n (s.c.70.11 5
<br />Busi..ss lnd Pn,r.srt,n Cod.) Any Cnt or Coumy which icquir.s , Frmir ro co.stru.r. ,hr, irnpmvr, d!fl'lish or rcnJt m3
<br />slruclurc. prior lo ns hsuancc. !l$ rcquircslhe lpplicrnr for su.htrnnil to lilc 0 siSncd (otcnEnl rfial hcorshc is li..n\rd Frrunnr
<br />h rhc pmvkhns ol rh. Co.tr.lor's Li.cnscd ltrw (Chapr$ r), Co'nnrmirg wirh Sccri.n 7{xx) ol Divisio. .1 oi thc Busincs rnd
<br />Prufcsions Codc) or lhd trorshc kcrcmpr IhcrcliomiM lhc hdsh for thc allcBcd cxcm0lior AflyviolorionofSdionT0:ll5bran,
<br />rpplicanr lor a pennit suhj(ls lhe amlicul lo rcivilpenrhyofml mrclhanfivc blndrd dollffi(3500)
<br />l. N uwmr or rhc pmFdy. or my cmplo)rB wnh sr8.s N rtun v,b .omp.ne'io!. will d rh. qdkarn lhc sEtw is ml
<br />irlcd.d or oftarcd tu slc lsd ?044. Ausincss md Profcssnnx Codcr TIE ConlEclor's Lic.ns Law d.cs trot lpply lo !i owM oa
<br />rh.pop.ny sho huilds or nrpdwi !h.Rrh. ad who drE\ sd.h w,* hinxclforhcr.lf.rrhrough hii or hn o*n cmtloyc.s.
<br />proyidcd lhlr such nnlDErnh @ nor inrcndcil or olt'crql lor rb. I l horcvcl the buikline or ir{roremnr i\ sLl (irhin unc }tr
<br />olconrrlclion. llE Owncr Buitls will hrvc lhc hrncn ol proving tlnlt hc or shc did nol ttrild or i Dror thc pmFny for rhc puqb$ or
<br />-1.
<br />asowncrolth- lmt'cny. amcxclurively.o ftclinf arth liccnsd co.rrrcron lo s'n(Ecr ttr pruFcr (Sc( ?0.1,1. Bu\iR'r
<br />,nd PDf6\bn C.dc Th. Contr.ror's t-i.rn\. t-as docs N, rlpl, ro an o*..r of l()l.n y *ho builds or im[ovcs rhcrcon,
<br />a.d vho co rrmk for such pmj.rls wirh a Contmdon o li.cn*d lununr h rhc Conrrlcrois Liccns uw)
<br />-l
<br />ihexcflrpl undcr Sc.lion- S. & P.C. ior rhis rca$n.
<br />Dat€ Owner
<br />rioRl([Rs co[iPnNsattoN
<br />IIEII.AXAI]ON
<br />I lErcbyslrinnundcrlcnllryofIc juryomolrh.lbllowingdcchr n'n\
<br />I hrvc,rl sill uinrain a ccniltdc of con$nr ro sclfl n$rc fd sorkds .onD.isd ion. rs povilcd li,r hy Scclion 37OO of rhc
<br />llhor G c. n" rhc pelo,nurc .f rh. wo4 ft, which rhe p.nlir i\ hrucd
<br />rtu work larqhi.h rhn p..n,ir i\ nn'il IUysor[r^ comtrtr\iri{nr in!u,rncc crrid ntulx'li.rnun$rr dc:
<br />ir rhc ncn'oirNncc oilhc NoIk fffw hich lhi\!ernrir i\ i$ucd,l \h!llnoi ctrlPbyuypcrs,n i rny m,nmr
<br />law\ olCrliforni( itrd l8tor lhrl il l slx,uld bcco,rc sub/-(rtorhc
<br />rhr trhtr Cod.. I \hrll. iodhpiri $nrDly wirh rhoc rovniotrs
<br />subi.r h rhc wo&$I .on'!.nrrr io.
<br />\orkc^ co tt,ctr\xrtrnr pni!'\n)tr\ol Sc.rn lr(X)of
<br />WARNINC: liilurc ro surc *orteF omncnsllion corcruBc is unln$iul. and stull \uhicr d cntbr.r ro oif,inal Frahts Md
<br />civil 6ncs up to onc huodrcd thousond dollan {$100,000), in {idition ro lhc cod or con{icn\lrioi, dzm!.s rc ptuvidcd ld lhd
<br />Sccrion 3076 ol rhc L$or ('odc nlcrc( !nd !llarrcy\ Iccst \,uer _L lpptiunrra
<br />t,I( t,tNstl) (()Nt R'\( ll)R
<br />I)l!r.1.ts!l].(a
<br />I hjrby afrtrm udcr ,l.Mlry ol,Erjury rhar I 0m lie.sn u,ric. p$lision ofChlrtcr 9 (comflEncinE wirh Sdbo 7qx)) oroivirrn.]
<br />of lhc Ausimssand PofessionrCodc. ad nry liccnsc h i" lullaorce ud.[er..C (-)
<br />CANSIBUCIIONIEIDING.&GEICI
<br />I hcnby rflnn undcr Fn0hyofrcrjlry lhnr rhcrc is a con{Mlion lcndin8 ascncy fo, rhc ricrfo.roc ofrhc work ror eh{h rhi lxmir ir
<br />i\sucd(Sft .ltt97, Civ C.)
<br />L.ndci' Nam:
<br />-
<br />AIIIICjIXLDECI/.BAIAN
<br />l,ftbydnfl uft].r lf,nrlr!of prjurt oN olth. lolbwnr8 Jc.lmri(rrl
<br />l)cnn,lin,n Pcrnrir\ A\hcnos Norifi.rrn F.dcral Rcgrhri,nr\ ('lirlc.{}. Pfi6)
<br />Rcq!ft d ldr$ of Norifi .nrion
<br />{r*"
<br />*;xr
<br />iryrhtrr rh.ladc[lrceul0rions rc88dir8 Nhcnos r. r,vrl c norafpric$lc lolhntmjsl
<br />rhd' I hav. rcldrhi\ ar/i.atiotrud strlclhallh ah)rc inlnnn io. is coEccr l r8ieroonrplyrirtallCiryrnd C.unry
<br />nd Sht I rss rhrir8 ro |ruildirB coonrud h.ahy,urhorir rcprcscnlotivcs ollhh City d Countyro c.rc. olxlnrhe
<br />*xnt Nnrn,n.d lroli.ny fff in\
<br />-," ''j-)-\i
<br />Frt.tsVrr4y\
<br />nppr,.on, "" ,n*"n, a,*no,u* X
<br />r"-ir* nu."rp.ino,)(
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Itrleler Release
<br />Rouoh
<br />Service It/eler ,A
<br />FINAL t0-lc- lg h -tt{t))
<br />Notes, Remarks, Etc \:--t,
<br />1
<br />ID/SIG.
<br />c oB\
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