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ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG COMMENTSAPPHOVALSDATE
<br />Site-Work
<br />Under round
<br />Pole Bases
<br />Li ht Standards
<br />S FountainsPool
<br />Si NS monument
<br />/Low VolLile Sa e
<br />Fire Alarm / Dam ers
<br />Communicalions Cable
<br />Transformers
<br />uernTo
<br />Sub-Panels
<br />Air Conditioners
<br />Roof To UI mentE
<br />Facto Wired Unit
<br />Walls Conduit
<br />Walls Rou h
<br />Ceilin hSHard & Soffit Rou
<br />lvleter Release
<br />Rou h
<br />Service l\/eter
<br />FINAL
<br />Notes, Remarks, Etc
<br />I hcrchy ufi.n on .r p.Mlry ol p€rrury rhar t ur cicnDr flrnl rhc Conrraclon Lic.ns ti* tu rhc lollowiig rci$tr rscc7)ll5
<br />tlusincsr an{l Profc$iotr Cqlcl A.! Cny or Coury whi.h rcquircs a Ilcilnn r, constdcr' alr" im[l''rc d'mlnh r rctltn 3iv
<br />srrucrur.- prid r, rls nsuldc, ako Rqutcs lhc Jlrplt! fot such rmir ro lilc . sised qrdcmnl rhal hc Dr sh! n liccnrcd pusurtrl
<br />ro rhc ptuvisions orfic conlffcror'\ Lic.nscd La\'(cfiaPrct 9 co'nnrrcins unh sc'rion 7
<br />'o 'f Divisn'n I 'tlh' Busi'r's and
<br />Pi(nassions Codc) or rhnr tEorshc hcicmpr rhcrcfiilm snd lhc hash t'or rhc illcCcd cxcmprion Any violulionolS'di'n70ll5byany
<br />applic,nr ror a !.nnir subiccls thc {ppliconr Io { civil t*f,lryortror ntrc rh livc hundrcn dolls\ ($500)
<br />I. ns ow.cr ol rhe IroFny. or ny cntl.yNs wilh wases a\ rlEn vre compci\dion. Eill do rhc wo* ond fic sltu1uc h nor
<br />i'.frId oltircd rd sl. rss ?Or4. BusnNs.nd Profesi(,nr Codc Thc C.ntacrois Liccn\.I-as docs nollnplv
<br />'o
<br />!n ownctol
<br />rhctmFny {ho hoilds or irynw. ihcmn. snd who drcs Mh *olk himsclf.r h.Fclf'rlirough hn or ncr own c'[lovc$-
<br />pn'id;d rhlr.r.h inllsEnrnri u. nor inr.nnd .. ofieEd t n er.. It hoqc\.i rh. huildinB o, impr,vcmnt k sU q irhin onc Fr
<br />;r.-fkri{,L EO*n;r Buildd pillh.ir rhe lldcn orptuving lhal lE or \hc dd nor buiE or impmvc lhe rnFnv hr rhc l]uqn{ ol
<br />l. asos.croilicpmpedr. imcxclusilcltcontrcrin8 wirh riccnscd .onru(Js !, (nNru.r rh. tm,:.r(S!t. roJ4 8unrc\{
<br />.ft| l'iorissbn G cr ThcCotrrracktr s Lt.trsc LaRnoes frn lrPlyb rtro\ncrorlnrN vwho huil{k or iDprovc\ rhc'con'
<br />ntul sho conrn sror su.h pmjccr( wirh r Conrhcrd n li.ctrsd nursurir hrhcConrtick,\ Li.cn\c Lasa
<br />()lvNIaR Bt:ll,l)IiR lrlr,c]\R,t I lo\
<br />I anctcorpr xndcr S(lion-. B &PC lorthisrcr$n
<br />Dat.: - O*ner- TVOR(OiS!'OMPENSATION
<br />OES.AN{IION
<br />I h.rchy .flirn ondcr n n,lryol!.rj!rroncofthcfollowirydcclr iDns:
<br />-l
<br />hrv. 0nd will minlrin Ccnilrcatc ofco.\cnl ro s.lalosure lnr workcr'onp.ns ion.!s Provid'd ror hvSccrt'' lT0ooirhc
<br />tibor Code, fM rhc pcrlolmnce of lh. wrk tor *hkh rh. pcmit h hsu.d
<br />-thav.,nd*illMi
<br />lin{ortcscomlcns,rioninsumncc-osrequir.dbySdion:1700oltneLlhtrCodc.forlhep'rronmnccof
<br />rh. work forwhichrhn n m l is isscd. My*orkcs .omlEnsulioo insufl..c carif drl Iblicv nuBhcr e:
<br />D"r",'f1 :lO !L^
<br />a^t
<br />r,,," ' lO'?l: tt
<br />' CAK ?'v C2- \r'<a-
<br />lo \ -t*
<br />--"-
<br />o,," t 1. o 't?
<br />eai.yr,.*. - oFLs f *D 3q rt-l
<br />I ccn iiy rhrr nr rlE pcrrbrmme .r rhc wotk rbr $hich rhic l. nir is i\sued.I\h!llnol cmpk'v trivP'ron in&vn'n'ncr
<br />n * o rrconc ot,rci r. rre ro sl conPcnurnr hws ol California. rnd,8Nlhal ifI shruld hccoE bi'd
<br />'o
<br />rnc
<br />solkcis .ompctrsol io! prvisions of Saiion .l?(x) or rhc Ltrtrt Cftlc. I \hnll. fonn*irh .o llrlv tr ilh rh's ll risions
<br />WARNINC: Ftilurc lo $.rt w.rk r conP€n\arn .ov.trsc is unhvtul. nd shau s!bj..r rn cnlllovcr r' diDirrl pcrulrics d
<br />ciril fine\ rP k, oflc hun.lrcd rhors.nd d.!lr\ (Sl(X).(XXr) iI rd,lirirnr
<br />Sc.rnnr.l076.rrhcL xtr(ixlc,tr crc\ludtrror,try \lcc(
<br />DECI.AMIION
<br />lhcrbyarfiirnundcrpcnellyofFrjurrlharlmliensdundrpovisiono{Chaflr9lco'nnEtuingvirhSslionTmO)orDivkn'nll
<br />of rh. ausimss ad Pole$iions Codc. and .ry li.d$ h in tull forc and cllsl.
<br />. Wllq?'L
<br />,-,*'* X- ? \2aa e t
<br />(](}NSTRIJCTllTN I FND!N(; A(:FN(]Y
<br />I hcrchy aninnudcr Fnrlryofprjury rh l hsc h o s,n{ ru.ri.tr lcndins 4ckv tu lhc psnn d{c oi rh' $ork ror trhi'h thn Fnnii k
<br />i\\ucd (sN l(I)7. cir c.)
<br />APPLICANT T)ECLAAA-T!oN
<br />I hcNiy al'm !tolcr Fnally ol'pc,jrry on. ofrhc lhlbwins dd.ldtrrbns:
<br />Ocnbliliotr Pcrmil\ A\h.(os Noti6carion Fcdcral RcBulnlions('I'irlc 40. Pin6)
<br />_Rcquircd Lcrrd of Ndifrllion
<br />-t
<br />.rrl ily ihd rhc lcdcrat rcsllartu ESdinB ostcslor rcmvdarc no( aPllicnblc to thh Poirr.
<br />-l
<br />ccnitt rh.r I hav. rcad rhis 0mlicalion tnd sl{tc rhal thc !bo!c inlomtion n crrel. I tr8rc to compl, wilh aI Cn, lnd C'unr,
<br />slnccs;nd Slalc llws plnlini io buildiis.o.(ruclion..nd hd.by aulnorizc tlr.snblivcs ofthir Cilvtnd Couorvro c d upontlrc
<br />rh.\. nr rotrcd |[,|trrJ- 1o' trN|ccrknr
<br />ApplicMt or A8enl Silnuturt:
<br />e"-,lr* n,-. rduo,X cA
<br />Buildinq
<br />Under SIab / Floor
<br />Bondino / Groundinq / UFER
<br />Ceilinos (T-Bar Rouqh)
<br />I fflJtll -l{'> ---tltn *
<br />!.ll.l\z
<br />L,{J{ s A,Ur($
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