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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNDN AUIDER DET,CABATTON
<br />I hcrcby rfllrm undcr pcnahy ol pcrjury rhur t m crcn{,r fro'n rhe Cont,.ro^ Liccn* bw fo! llE follo*ins eN)n (se 70.ll 5
<br />Busincs and ltofc$ion Cod.): Any Ciry or Counry *hich r.qnncs a tr.mir to con(rucr. llrcr, ioprovc. dcmlish or rcpan any
<br />ndcluc. ritr ,{, irs i\\!r@. ,l$ rcqutcs thc rprlica for such Fiinil h nh ! siBtud dncmnr rh,t hc or sh. k li.etrrcd puNurni
<br />ro rhc pmvnions of rhc Co ractois l-icc.{d law (Chaprcr 9. Conncn.lng wirh Scclion ?000 ol Divhi,n.l orrhc Bu\inc$ and
<br />ProfcsionsCodc)orrhat hcorshe isexcdpr rh.rcrrondnd rh.t{sir ror rhc alLScd crc'nptin Anyli.lntion.fsccriotrT0ll.5l,yany
<br />omliconr for a t rmir suhjdB rh. iptlicanl to a civil F.altr ol ml frm lhatr file hundred dou' (S5{x))
<br />l.asowcrolrlrnrorcnv.ornrycnrn,yc.\*irh*as.sa\lh.irv,lcconr.tr\nlinr.willdolhcForkudlhcnmrurui\frn
<br />inrc cd or oficrcd ttr qL l So 704,1. Aunmss rnd Pmlcssi.rs Codc: l hc Conrrlcl{r'\ l-i.cn\c kw doc\ n.r aml, h !tr .s'rr nl
<br />lhc tmrrcny Nho builds or ifin orcs ihcrn. d$hodessuch*r)rlhim{lrorh.rsclf.rthft)rghhi\orhcro+ncntrn,yers.
<br />,n,rid.drhrrsd.himpn)vc'mtrrsmfrrLcnd.doro(.y.dluslrllhd$c\!r.rhcii,iliirAori'noft,vcnrnri\q,ldwirhnr.ncrn
<br />olconUtri{,n- rhc Owm! Iluiklcr wilLhak rlk burdc. offn,vii8 ihar lf or shc dil nor ttrikl or iq)mvc rhc nn,tcny ror rtr PUqx,$of
<br />l. xsowmr ofrhr pml,.ny. rdcrclu\Ncl, contm.lins {irh liccnscd conrrrkml. con\ltocr rhc tn'rNt (Sc..7U11, Au\im\r
<br />ond }\nlBrirD Codc: 'I hc Conlracrols L,iccisc l-aB docr norrpplyro unowncr of otlcn y wh. bulld\ or imfro\ti rhfi.otr.
<br />a.d who .unk .hfor such lrojcchwnh0 conrncron 9 ltctrsd purluanr brhcconh.tn \ Li.cnsc Law).
<br />I lmc$md u.dq Serion . B & PC r.r rhs rc0scn
<br />Dlle Oener:
<br />woRr(r'es' ()[!PgNsliroN
<br />I2ECLIBAIIa!
<br />I hcdb, nfln undd r.n,hyofpcrjuryonc oflhc followins dccltrr.lion\:
<br />Ihrvc ld will minrrin a Ccniiicrtc ol Conscnr h Sclf.nsurc hr aorkcN conpu\rriotr. ,s lnrvid.d lor hy S(li,,n :17{X) .f rh.
<br />tf,bor Codc. ao, rhc r.rfonn tuof rh. sork lor*hich rhc p.anir is is{cd
<br />-l
<br />htrr otrd sillm.intoi. *.Ikc6 c.mprnsnn,n in\urrncd. a\ rcquiftdbyScclionll00oath.lihorC.dc,ibrrhcpcrlonmmcol
<br />rhc work n, whichthis pennii i\ nskd Myworkr^ co rpcd\ nnr insurancccmicr r p.licy nums.rdc
<br />Policy Nunrbcr:-Erp
<br />I ccnilyinar nr rhcr.rfohBRcofrhe work for shich rhk Firnil is i\$cd.l shalltror cDPloyrtr! l[rso! in lny manncr
<br />s' sroh$om{h]cdr(,rh.scrlc Lannpcnsrnrn hwsor( rlir,nni.. md l8ncrh0r ifIshould h.c t $br.trbrhc
<br />workc.s onDcnsrrion trovi{i,,ns ofSc.ri(,n lT(x)ofrhc tih.r cldc.l sturll.lonhsirh con,!ly oirhrho$ fiovilions
<br />WARNING: Frilurc ro $curc woikcr'onrltnn ion covcrnsc is urh*rul strd \hdrl ubiccr 0tr cfldoltt t, omin.l Fnnhics rnd
<br />.i!il finc\ up kr om hundrcd rhous0nd dollan (Sltx).000). in uddirion r. rhd co{ orcomPcnsotiotr. domaEcs u\ lmridcd ror rhc
<br />SNrbn.1076 of$. tjh, Colc. i.tcrcsrond afiorrcr\,tcs
<br />IICENSED.CONISACIQf,
<br />DECI,ASAIION
<br />I h.reby {lfirm xnd.r p.nNlty of p.rjury I hat I n liensn undcr I,DlnionofChaptd 9 (smmNin8 wilh Sarion 70Oo) olDivision l
<br />of the Busircs\ aftd Pro{c$ionr C.d., rd my lrcnsc is in tull for( .xl cft(|.
<br />l,icenrc Numh.ri
<br />AI2LICANLDEII.AM:UA!
<br />I h@by armr lnds pemlly oi pcrjnry onc of rhc rollowine d(Lral ions:
<br />D.mlilir. Pdmirs-Asb.{os Notincation Fcdcral Rrsllrions ll nt 40. Pd6)
<br />Rcqn ind lltr.. of NdifHtion
<br />I ccnilylhrr nr td.rrlrcsrLrn,i\ rcSnil S n\ltro! 'r tr,vrlrt. n.r q'l,li.rhl. ()rhn n()r!.1
<br />-l
<br />ccrr i{y rhor l havc had rhis amli. ion rntl sdt. lhal th. 0}[vc infornulion is .o@r l ,sie ro co rdy wilh all Ciry a.d C.uily
<br />ordinames and srlre Liw\ Ebri.g lo buidinS .onstru.iion. uLl hcrchy aurhoizc rctretunuriv.s ofrhn cilymd colnryxr.n'.r ug'n tlr
<br />oliolc mnrioncd prepeny for inspccr ion nu 4sss
<br />Applicant or Asenl Sknnlurc:
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundinq / UFER 1\vo\r*/4,/41 tl/
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)I
<br />lVeter Release 1\qg ,t-t-a'/t tic)
<br />Rough
<br />Service lvleter
<br />FINAL -1Ur\(9 /,u4.fl,)
<br />Notes, Remarks, Etc.
<br />Under Slab / Floor
<br />COISIBICUAN!ENDINS.AGENCI
<br />, hcrchylmrnundcr lEnuhyoarcdlryrh (h@ h n cdnnftrion lcnding a8cmy lor llE pc,fomr. or rhc *or* lor which rlis lEdir n
<br />hsu.d (Se. l{1s7. Civ. C.)
<br />tind.r'( Nim: _
<br />t ndn s Addrcs:
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