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ELECTRICAL.INSPECTOR RECOBD
<br />()\\i\t,tR 8t lt.Dt,Rlr:!.( \lr.\ It{)l
<br />I hcrchy aiirm rndcr pcnrlly {,f p.rury rhar Lh €rcrnpr fom rh. G,nrEdon l-ic.ns. us (tr rhc follo*ing rca{,n (S..70.11 5
<br />Busincs .trd Prob$n Cclri Any Ciry or County which R+n.s r !.nnn tu .onnru( rlr.r. impn,r. denmli$ or rcp ,try
<br />stru.lurc. prior lo ns kuarcc. als requtcs thc lprlic.nl lorsu.h IErn l h filc r si8rcd nalcmnl lhil h.or shc i\ liccn*d l[suonr
<br />ro rhc lioliin)N .f rlr C.nro.ror's tj.cn*d lnw (Chnprdr 9. Connr..ing *irh S.cnon ?ofl) of Divhion:1 olrhc Busirc';\ snd
<br />I'mfc$ions Codc) or rhrl hcorshc hcxcNnl rhcrcfrom rnd rhchrsis ior rhclllc3cdcxcnt rion. Any viohtion olSccrin?0l1 5 hy rtry
<br />aPllicrir ior r pcmrir sui,i(r\ '!c applicanr ro ocivill)enalryof mlmrc'nan filc htndr.rldouosrs50o)
<br />-1.
<br />rs owncr of thc proFny. or my cnDloyccs with aoScs os rhcn $k .rmlE.sr nrn. s ill do lhc wori and lhc (nt1uE n iol
<br />i,n.ndd .r olltrcd {(tr src ISN 7(lil4- Boiinc\\ 3nd l\ofcrsn,ns Codc: Tnc O,nrrtn \ l-iccn* ll* docl mr rpdy k' ,n .*rcr or
<br />rhc pnt]cny sho trildr or improvcs rhcmn, .nl who docs {,ch e *hi scllorhcFcllorthmuBhhisorhc!owncmployccr.
<br />pn,vid.d rhar such impoeeft s ft nor inr..dd r olTcEi t, slc lL ho*ckr. rtE bui[i+ or ir{r.RnrN i{ sold withir' nnc JeJr
<br />oi.onplcrirn, rhc o{Rr Builds willhavc tlE htrdcn of Eovins rh,r lror shc dil mr hoild o, ifl{nrc lhc pFpsly for rrt put${ nl
<br />-n'a- e e
<br />-jl. asoww oflre rmpcny. !m.rclurncly$nredins wirh liccn$n o trroN ro con(tucr rhc Imjcr lS*. 7&4. Brsin.*
<br />0 Pmftssi Codc:rhcCo.hr.lofsLicc,r$l-n*docrnorrpplybnn.wroolproncnyphohDildsornnpr.vcilhcr.on.
<br />and who onrmcls rb. such !.oFls wirh r ConrEcro(rr lncDsL\l punuanr ro rhc Conrra.rois Liccn* L!*)
<br />^drpr hdcrs*rion_. B. & Pp(y G>€.>
<br />u[( L,\lL{]lo}
<br />I h.rcn!rllnrund.r n ulryof lf,rjuryotr. of rh fi'll,,s,i"r dcchrrri,)ns
<br />-lhavcudwillmrinrainrCcnificlrcofConsnr!oSclllnsurclorworkqlcomri.aerion.&srllidcdlorpysc.lrn'l7{n.rrh.Lllnr Codc. ,or lhc p.rformrc oflh. *o* for which rhc pcrmir h hsuct.
<br />I h,vc and will dainruin wortcra.ompcnsalion insuruncc, as rquirl{ hy Secrion l?oo oflh. t bor Codc, for rhc pcrltrnufrr oL
<br />thc work for whi.h {nn p.mjl is isuoj My *orlcB comF.sln,n i.suBre cnicr nnd polky nu'nh.r ac
<br />Policy Numh.r:JrnA-P Q-
<br />-..,1Llcciltyihd m rhc Fdormncc orrhr woA r.r qhrh rhis p&nir is i\sucd,I sh.ll mr cmtloy.ny tersn itr !try nunmr
<br />s s lo bcom subiEl k, lhe wntsi conrFnsar t,n hws of Califorria- and a8rcc lh{r il I \tFuld bc('m subjd ro trE
<br />workcn.rnFnsarionphrisi.nsorSc.ri,n3700orrhcl$orCodc,I\hall,r.nhwiihomplywirhrl$sprovisions..
<br />W RNIN(;] Failurc ro scurc workfiJ con[cDsdion .ovcECc is unhstul. 0nd shall subjd dr c'nplo]cr lo .ri'ni'rtrl !.itrhi.s and
<br />civil fincsxpt,on hundmd rhouknil dotliGlll0O.0OO), in dddnion tu rhc.o{ of.ompcnsrlion. damgcs al F,vid.d ntr rhc
<br />SccriN 3076 of rh. If,bor Codc. i.rcrcn a.d ormy\ f.cs.";:.1" (;-, /s' "
<br />^*,,, M'' r rcYis"n conrnlcnx
<br />nf,r'r AR^ n{}N
<br />I hcrcby,finm undc, pcnalry ofF jury rhar I am liensd udcr pmvision olChaprq 9(..m'mfting with Sdioo ?(xD) ofDivhion 3
<br />ot lhc Busircss md Pnfc$ions Codc, ad nry liccnsc t in tull forcc .rn cftct
<br />I:ANiIAJ]EIIAIi.IENDING.AGI,II.I
<br />I hcrcby aflnm undcr pc.alry olFrjrry rhar rhca n a con(rudion lcndins lscry a.r rh. n&romDn.c.l lhc work for whichlln pcmir t
<br />i$ucd (Sa.llr97, Civ. C.)
<br />AI]LICANI.DECIdM.IIQ!
<br />I ho$y 0mrnr undd pcnalryofp.rjury onc orlhc followi.C d&bfariors:
<br />Dcmlirion Pc.mirs A\tEsros Norificati.n Feddal Resllarions (Tirlc40, Pan6)
<br />-Rcqlied
<br />txn.r of Nnifiorion
<br />rcSuhrbns rc8rdins dsb.n.sr.rov luc n.rnpplic$lc b rhistr.J.ct.
<br />a_-his,I,Flicarhnr nrrc rhar rhc .trrc inr.nn ion nc.dccr ! .BG ro conlP wnn all Ciry atul Cdu.'y
<br />odin n.crrklsrlicLawsElirinstobuildiracon{rucltrn.r.dh.lcbyrurh.riT..eJnlscnrorivcsolrhnCnrandCou
<br />{b.vc nrDtiorcd nroFny ror iispccln,n
<br />^DD,nr
<br />l or,\s.nl Six rh'rr O
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fi re Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bondinq / Groundinq / UFER //-26 4p //lz)
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To p Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />[/]eter Release
<br />Bough -.1-
<br />Service lVeter //-28./E ,///'-21
<br />FINAL ,%.-h4',)
<br />Notes, Remarks , Etc/l ' '
<br />D1/9 c a
<br />Crfticri
<br />Liccisc Clff\
<br />-Licctr\.
<br />Numh(r:
<br />t!le: Contruclor:
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