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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTS OWNER BUILDEX DEI,CANATiON <br />I hcrchy lffinn !.der pcnalry of perjDry rhm l d.xcnFr ftom rh. Conrmclou Ltcnsc L.w lo,lhe follo*in8 tcr$.lsft?0.115 <br />Blsinc* lnd Prof.sion Codc) Any Ciry or Couniy which r.qurcs tr Frnrir lo conntoct. alrc.. inuruv.. d.frnnh or ml'n atry <br />srru.{urc, pior ro ns is\u,tr(, also Equneslhc alplicnnl tb. su.h pcrnrillo l-rlc ! siEmd rrd.@ni rhd rror shc h liccnscd puBua <br />lo lhe nrolisions ofthc Coirachr\ l.i..nsd Llw (Chapr.r 9. ConnBn.ing Bnh Scdion ?O0O ol Divhion:l of rhe Blsinc* rod <br />Pmlcssion\ Codc) or thar hc or shc i!.xcmpr rhcrcftom and rh. l[rh Lr rh. allcecd cxcmplion. Any violalion.lScdi.n 70115 byrny <br />appli.n turnlBr. rrubjc.B(h. .pplicanl ro acivilprnollyoa,or nrrcrhan nvc hundrcd dour\ (S50or <br />_1, N owtur ofrh.ItroFdy. rn ny cnplo)es wirh w.gcs rs rh.t slc.onrlcn$tion. qilldo rhc *ork and rhc ilmlm ir mt <br />iniclt.il oroficod for srlc (Se 704,4. Busincssn Prcfcsions Codc: 1hc ConrEcroi s l.i.ensc lis docs n.r trpply h an owmr of <br />rhcpmFny *h. bnilds or in{n)v6 th.6r. rhd wls dtui ruch $(lrk hnnsclfor hcr$lfor lhrough hh or hcr o{n.n9loy.cs. <br />nrovidcd rhor such inrmrcmnr @ mr inrcndcd or ollcrd for {k ll h.qch', rh. buildin8 .r inlpNEmnr is n)U *ilhin onc }ur <br />or.o.{lcr!,1$r own$ auiilf willh.rc r hunlcn ofoovi.s tnat iEor\hcdU no' l,!ih or iqmw rh. tmFny for E purtDcol <br />-1. <br />a\owtrcr olrhc nropcny. uorcxcllsivcly(o rrcrirswirhliccnscd.oitnr.^ro.otr{dcrrhcrrcj.tl(Scc.?O{r.Bunne$ <br />lnJ h.f6qionC.dc lh.G)ntrctn s Liccn\c Low do.s nor rtpllfu owncrofp()!crly$hohuildsornnpi.!.\lhfic.n. <br />.nd sho.onrmckforsuchpmjccrswirnoConrrocrons)liccNdlru6uMrrorh.contrdofrLicnschs). <br />-lomeremDt <br />undc. S(rion- B &PC io,rhi\tr$. <br />}ABXEES.!!}MfjNTAIIA! <br />DEqI,AEAUAN <br />I hcrcbyafiirn undcr p.nallrof pcrjuryoncof rhc lollowins dcclararioos: <br />I haw ,nd w ill flinl{in a Ccnifrclr€ of Consnr lo S.lf ltr\!rc f., *ort6 6n9en*rion, a povidcd lor by Sdi6i 3700 6r rrt <br />tjh,r Codc, for rh. FrromN ofltu wo* for which lh. lcrmil is issud. <br />-l <br />hor ond will mainroin *ortciF conp€nsarion ioiuraee, {s Eillied bt selion 3700 of lh. t bor C.dc. {or lhe pcrro.Mc ol <br />M,sorkc( c. rFnui,n, i surxf.c.rnicr xl Nli.y nunrhqnrc <br />/w1 <br />z <br />-l <br />ccnilyihar ir rh.I)crLrnuNc ofrhe *or[ for whichrht pcrn,ir i\ isucd.l shdlltror cnr/oyany Pcron insnl 'nrnnsd a1ii, hL{otu \ubjc.r k, rtur workcs conDctrs{totr l0vs ofCrlilnnia. nnd lgB rMr ifl rhuuld b.com subJcr ro lnc <br />wolkciJ rc p.nsnriotrF)visionsolScdion-U([)ofthcL,tnrCodc.I\hru.fonhwnhconrtly*ilhtho$pmlhions. <br />WARNINC F,ilurd r. r.urc workcr co |xnsiriotr covcnSc is unlartul. and \hxll rubicr an crDl.)tr k, ni riml IEnahis lnd <br />cilil finc\ ull n' otu huftlr.d rhousnd dollars ($lu).fiD,, i..dditmn tn. drnu!.s rs !'rovidcd tu rnc <br />Sc.ri{)r l{)76 ol rhd l]hn :lx 'H"v <br />DECI,AAAI]ON <br />I h.dby 6mrnund& t,.Mlry of pcriury lhal I am liansn undcr Fnvisi.n orChnpro 9 (omm*in8 *nh Sc.lion ?0()1)) olDivisn,n 3 <br />of rhc Businc\r and P6r.$nrns co&, an my lkcnsc is in tull lors lrd cfIal <br />L5 Ioz oz )tol'+/ <br />colulllcuoN.LElDlNc-AaENcr <br />I hcrcny rn]fln undcr pcnrlrrotr.rjury lhnr rhcrc isa.ons clionhndinSoscncylorrhepcrf.rtunccolrhcworklorwhichlhhlErmith <br />hsucd lscc 1097, Civ. C.) <br />AIIIIIANLITESIdBA:NAN <br />I lElhy lllm under p€nrhy oipcrjuryonc.fthc lolbsing dc.ldalions: <br />Dcnnnnion Pcflnils-Astcslos Noriliclrion Fcdc.al Rcgxhn,n\ (Tirlt.lo. Pd6) <br />-Rcquircd <br />Lcucr ol NorifHtbn <br />-l <br />ccnilyitur Ihc ltdcral r.lrrlarionr rcg.rding rsb. osrcmvdlurcmtot tatklorhisrojccl <br />l(.nirydfu I hrvc rc l rhisn|tli.rln arxlslrldlr llh.{n,vc ii,lnnnxri(r n corfrr I aErN ro .omfly Birh ill Ciry od A'ody <br />rcprc{ninrivcrof rhisCny. Coutrlyhcnrcr uIx,nllrf'dnrn..\xf,lSr rI x*\ 'chr U n) <br />rh.rc DEnidrn nmpcny in <br />.," 51'It,\ppli.ani.r laol Signolu <br />D4 V.\Vl&ea+!ar <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Salety /Low Voltaqe <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq i UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Rool Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouqh) <br />Ivleter Release <br />Rough 5-v-tK W.$dt <br />Service Meter <br />FINAL lo/a/r*€rrarn /o2-- <br />Notes, Remarks, Etc. <br />APPROVALS DATE <br />Communications Cable <br />/^\ <br />1- <br />L.ndcis Addresr: <br />- <br />t---+---f-------T------