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ELECTRICAL-INSPECTOR HECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEIi BUILDER DELCANATION <br />I turchy sffirn unds pcnahy {,4 lcrj <br />' <br />y rh,r I m crcnrpr fon r hc CoirncbB Licen* Ijw f rhc fouowing rcdmn 1Sc..70.11.5 <br />BusiNss ond Pmfcssn,n Culc): Any cily or Coun(y whkh tuquins r lEmn ro cotr(rucl, rlrcr, improw, dcnrlhh or Eplir 0., <br />srructur. Drhr to ns hsuare. ako rcquias thc !!,rlirant for such |]crmir ro tlc a sistrd sralcmnr rhar lE or shc h lienrcd l,Irtollr <br />to <br />'h. tmvkrns oflh. contrrdor's Li.cnscd ljw (ch,nrcr 9. connRrcing wih Sccrion 70{D ol Division I ol lhc Businc$ oid <br />Pmfcssions Codcl or lhor 1.. or shc is cxcrnpt lhcrefronatrd lhc h.sn lor rhc ullcscd cxcnDrion Any riolarionorSccri.n 70-l I 5 by,ny <br />amli.anr fornpcrmn slhjsrsrhc aDpliclnrro dcivill,cn0lryofnor moErhan fivc tnndrcddolldrl$500) <br />_1. ,s o*kr ol $c pmFny. or my cmpbyccs snh wrC.r as rh.L q'k .nm!.ns.rbn. $ill do rlr rnk onl tlE ,ltrNE n ml <br />inrcndcd or ofcrcd for \ok (Sa 7044, Businc$ 8nd Prorcssiotrs Cod. Tic Conlrlck s Lic.nsc t w des nor rtrrly &r $ oskr or <br />rhc lmOcdy who buildsor nnFmrs rh.r.ur Md who dds su.h w.rk himscllor hcMlf .r rhmu8h his or hcr own cmlloyccs- <br />p.ovidcd rh8r slch improkm.k m nor i cnded ollcrci l'or {lc ll fu)*Br. rhL h iHing or i'npn,Etunr is v,Il wirhin um }axr <br />ofcon!,lcriu lhc O*rcr BuiUq *ill hlw rhc hrdcn ol pmvi.g lhd hc tr shc dil ml huild or iqret $c nrFny Lr rrr pLqb$ or <br />-1. <br />as o$ncr ol'rhc pmnq ly. amexclu\ivclycotrlrucrirg wilh liccnscd c.nlr(krs r) .on{tucr rhc poFcr (Scc 70tr4.8u\i,tu* <br />,rl Ptuh\nn Codd lhECoitdcror'sLiccnrcLdsdo.snor3tplyrorno*rcrofp$lrnywhohuildsorimfove\rhcrotr. <br />rnd who cootradr rd such rorcts wirh a Conrflcro(n liccnscd,,usur.r ro rhe (t'nnlctois t.iccNc t w). <br />lxn,.r.m nfflcrSc.riLrr .ll &P( litrr[.r.r!n, <br />I)Hte ()rn.. <br />ITOXKEBS]COMPINIA.II!]N <br />DICIIIXAIION <br />I hcrcby llfirm hdcr pcnalryofFrj!ryonc oflh€ lolloqin8 dcc,Mlions: <br />Ihdvrtr'xl*illtuinrrinrC.nifi.ar..lC.nscnrhsclt'lnsurcn,r!6rkcr'.o tP.n{ ion.as pr)vidediarbtsc.riotr17fi)ofrlr <br />Uhor Cdc. Ior thc pcnbnmnce o{ thc wolt lor *nich rhc pc.n l n isslcd <br />I hrv. rnd *ill trrir xn, sdrkorr .onIf, sr.on nntrrr0cc. rs r*tutr.,l hy srlnr 17(Xr.f rrtr' I nhor (irl. nn rlr <br />n nsu.d nly worlcrr on,rcnsrnm i <br />I ccdili rhnr h rhc rrlnr ol th. uork ior whi.hrhis p.nnlt i\nnrJ I \hrl tr'{ un$1,,v in\ r{'\otr in rn\ nunn!r..rfi,\'r" r r.r,,,,,r.i^-.",* -r';-, r,rr"v' st' hcdnrE uh,.d ro lhc workcK .onrF-nsrrion hw\oiCrlirornir. <br />sor[cr( compctrsarion nmytion\ ofS(rnn] lT0Oofthc lihor C{xl..l hconplyw hrk)* orisn,ns <br />W RNINC l;.iluc t, s.'^u.c snrken'.otrrrNali,r covcnsc is unhwrul. <br />civil iinc\ u! lo orc hundrcd rhou\lnd dollurs ($l(x).Ox)r. in rddi'ion tr I <br />ll sxbj..r rn .mpkJycr r. dimiMl pcMltics and <br />or.ohr.ncation, danq.s ar rrovidcd for rh. <br />Sccrion 10?6 ofrhc lih.r Code inrcc{ ud nm!\ <br />I hcrchy rflnn unncr pcnrlryotperjurr rhd I Jn l'.cns.d udcr pro orChrprd 9l.onmkinS wnh Scdion 70OO) ofDivisn,n:l <br />or rhc &r\irr$ an,l Pdt\sioFC lnd my liccn\c h ir Inll lbrcc aar..lccr <br />6T <br />,""' f <br />I hcrcby rfitnundcr pcnalr, ol,lcr,urythar rhqe is a q,nstrcrhn lcndins ascrcy for rhc pdror@mc olrhc work lor whi.h rhh F mil is <br />iisxcd lscc.1017, Civ C ) <br />AITLICANLDECLAEAIIII! <br />IhdrbyrmmundcrpcD0lly ipcriuryorcolrhcfollowirgd(ldrations: <br />D.nmlnion Pcr.rirs Ashcsros Nobncarion FMcral Rcguhrnrs (Titlc t0. Pan6) <br />Rdquntlt Ir(cr of Norifrlrnnr <br />I ccrrilyrhd rhc icdcral rcNl.lions rclrudins ,1rc nor opnliQhlc b rhis pmrLrt <br />-lrnif) <br />rhrr I hrE rcrd rhi!lpplicarionand{rrd I M inrorndion h.om.'. I altm ro coorrly wnh aI Ciryaod G,unly <br />odiMnccs ond Srnlc tius rcLriq ro bui h.rchy rurho.tu rcprr\odrr*.\ u <br />nho\c Dc rrnrd F,Nny lnr i'r <br />i,/u <br />Appli.anl or Irnl Si*nrlur. <br />U.*n." n,." ,rnnt,, Y rp t+\l <br />rrh^c yrnd C.unlrro cntcr uFrr thc <br />.",. - ah/,rVrnttf'- <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Lite Salety /Low Voltaqe <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bonding i Grounding / UFER <br />Transformers <br />Torqueing <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinos (Hard & Soflit Rouoh <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Rou h (.,</1t46 )lr <br />FINAL r\s \q )' lil a'it) <br />Note-q ReMr(s, Etc <br />/12,) ehA ([- l,t r*^ S cz64l <br />^ou,lrw <br />-+ <br />Communicalions Cable <br />Sub-Panels <br />Service lvleter <br />(a- <br />t.ndt,'. AnJ,..\