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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.rcby amrm undcr Fnahy {,f pcrhry thar I u crcm aflim rlr ConrEro^ Lic€n* Law for rhx r.U.win! rosn IScc 70-1 I 5
<br />Busin.s\ and Piotcsrbn codclr Ary Cny or C.unry whi.h rcquncs i tunit b .!n.lrud. allci nlrlrcvc, dcmlhh orrElxn nn,
<br />struciurc, pior ro ns hsuancc. oho rcqlncsrnc allliconl aor such peirni o lile. skn€n starcmnr rfilrhcorshc ir licenscd purilnr
<br />lo rh. rovhidnq.r{r. Conrhcroaq LiNn*d trw (Ch.fl..9. Commn.ing *nh S.crion 7o0o of Divkion 3 oflhc Ausincs lnd
<br />Pmfcsi.ns Codc) o. ttu! hc or shc t cxcmtl thcrcfror.nd lh. tusis for rhc trllcecd cxcmplion. Any viohrion ofScclion 70.11.5 hy any
<br />uprlicant for a pcmir sul,jcch thc applicanl ro a civil ncnally of tr(n morclhon nrc hlnd.cd dollds($5(n)
<br />a ", "**. t,* ,"*y, or rry cnlroyr.s wirh *a8cs ar rh.n sh .otrD.nsfion. will do rhc wmk $d lhc sltrtw k ml
<br />L cdct orollcL'd lor srlc (5(.?044. Busimssa.d Profe$io.s Cods ThcCo rucktr\ Lian$ L,w d.cs nor aprly to dn ow d or
<br />rhc tftFny wh hilrh or inqr.vcs th.6n. ffil wtt, 'llrs sh s* himrclfo. hcrsllorttrou8hin or hcr oun cryloyccs.
<br />pruvidcd rhar strch imlr)vcftnk d br i.rertitrj o' oflcrn for eh Il ho*dti rlf, t ihinB o, inprowmnr is eE wilhin orc )ea
<br />of cornpkrb.. thc Owrcr Euiucr wilt hure rhc burdcn of rovins rhor hc or shc did no' hlild 6r iq,6w dc pmr.ny for th. I,UqD$ ol
<br />-l.
<br />aso*trcr o, rhcpnpcny- (nrcicnxirclrconrrr.rins wirh li.cn*d contract,Ft,cotrd cirtrpn,Frlsc. T(}l-.1.8u\im.r
<br />i t\rfssirn()dc:rhcConrrmttrsl-r.ctrscLirdocsiorrt,tlytortro$ncrofnmprnywhohuildsorimprovcsrhrlcon.
<br />nnd who conrEcnro'\uchlr+crsqnhrConrEcr,(s) liccn{d orrunr b rhc Conta(n s Li.cnsc Ltrw).
<br />crcnn' unds SNrior-. B, & P,C. fo,lhh rcornr{bpltL V" \
<br />IIIBf,EBIII;!]MEBSA.IIOAx","
<br />DE(IAAA.IQN
<br />I h.r.ht alfinn trnJcr prnrlry.fF-rurvutu ofrhr f{rk,si'rg dNlfdnntr
<br />-l
<br />hrve t will mointoin r Ccn irtare of Consor ro Selfinsurc for wor[e6 conrcosari.n- rr rolidcd roi hy sc.rion ]?uJ orlhc
<br />bhor Codc. fo rhc p.rlormncc of rhc work for Rhkh rh. l).rnrit k hsucd.
<br />-l
<br />havc and will nrinrair worlcs comljcn\olion imumncc.0s rcquned hySc.li lT0Ootrhc IiborCodc, r(rrhc pdrrornu.c or
<br />Ihc sork for whichlhisrcnnil is issuci. Myworkss .omp.trselnn iNufuEc catricrudrricy iu'nhcr u.:
<br />,Gfcnify rhar itr dc Frrornune ollhc work lor whi.h rhir pcrnir is ir\rcd. I \tull not cnrpk'ynny pcNo.
<br />'n
<br />m, mdhncr
<br />. so a\ lo bco* subjc( ro rhc iort.B compcnerion hss ot Calilnnia. rsl aam rh,r ir I should b..onb subir o lhe
<br />worksi .o'nlcns t,n pn,vhionr.lSerion.lTtX)ofrh. tltnr C.d..lsl$ll. fonhwirh co.rrly Eirhrh.s tmlhions.
<br />\VARNINC: Frilur h wur. urkcr\ conrpcn\nnn' c.ktuCc i\ unlatrrul. 3nd drll $hjc.r !tr .nlrlols to dirrinal FDltics lrkl
<br />civil llncs !p k' onc hundrcd rhou\rnd dnllnF 1$ l(n-(XX)). in rddiri(nr k, ihr.oi of.d rFnsar n. d.nB8cs 3\ provnl(t tu lhc
<br />#:gpil(
<br />DECIJf,AIION
<br />I h.Eby lmrou.d( p€Mlry ol Frjurt rhd I !fl liftnsn u.d( povtion olCh,flcr 9 (onmmins wirh Stlhn 7000) DiDivhn'n.l
<br />ot rhc Busincss ond Pmfcssio.s Gdc. und ny li.cnsc h in inll lore and effccr.
<br />SONIIBICIONIIN!,NGIIiENCI
<br />I heEby l(lrm undcr ,,enalry or pc.jury rhar lhm is , conrdcrio. lcndi.S dScmy fo! thc Frformnce ol rhc h* fd whih rhh Fnn is
<br />hsucd (S(..1097.Civ. C ).
<br />AIPIIIANLIIIL/IAAIION
<br />I hcrny amm u nds rcnalry ofrcrjulr.nc ofrhc firk,wins dcclarurio.s
<br />Dcnx,lirion Pcnnirr^sh.{os Noirficliion Ftdcral Rc8nlirions (Tiilc40. Pun6)
<br />Rcquircd tr crol Norific ior
<br />y rh l hrk r.rJ thi\ 4Dlicrri{n, rnd nrro rltu rhtrh,vo i'rntrir: i( is.o|ccr I rFrcct,conrfly$irhrllCiryrnd (nunry
<br />xtr,lsrrr. I rs\ rohri"S t) hrliln,S.rr{nn,. od hrrchy adlhnr tufic{fialr.\ nl rhi\ Ciry dtul (i,utrryt, cnrcr r]rn, rhr
<br />n rc1)FO
<br />.1-t\i.*,,,,
<br />X,"," <[7"lt<
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment \
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />I\4eter Release
<br />Rough llt4ltr 7yfrD
<br />Service l\/eter I
<br />FINAL clt-dr9 t IV4 \\,L1il 4r?S)
<br />Notes Remarks Etc.
<br />Pole Bases
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<br />a,,ni.1
<br />Licc.sc Class: Li.c.sc NumtEi
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<br />Drr. Conr.*lor
<br />Lcnd.ir Nsm
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<br />Irndcr'. Addrcs'
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<br />ccnify thor rhe lcdcral rcBularions rcsarditrB astEsros Emvrl ffc frn aprlicahlc ro rht pR,jrit
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