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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcrcby aftrnr uftl6 p.nrky of pcrjury rhd I am .xcn!, rm'n rhc conhros Li.chsc tjw for lhc followin8 Eorn (S.c 7031 5
<br />Bu\incss and ltotc$ion Code): Any Cir, or Colnry whicn rcquirc\ ! pcnit lo consltocr. cltcr. improvc. dcmlirh nr iFt y
<br />slrucrurc. nrior ro irs suancc, ako Equn.s rh. ,tplicrni r'or su.h f.rnn r. nh r sigftd {dcmnr rhd h. or sh. ir liccns.d puNar
<br />b rhc F,visi6n\ ofrlt Conrra.tr\ l-iccnsd tjw (Ch4tcr 9. Commmin8 uilh Se.rio" 70(xl ol Divhion 3 ol rhc Bnsinc\\ lrd
<br />PmLssbns Codc) or $ar h. or rhc L\.xc,ri,r rhcEhon rnd rh. b!\k nn rhc slhs.d.xrfrpibn. Ant viol,riod olScclion T0ll.5 by any
<br />applic!trr ior opcrnrir sub,.xls lh. rrrlicant lo aciv'lpcnalryolnot nn,clhon fivc hundrcddolh6 (S5(l()).
<br />-l,
<br />as owncr ol rh. pop.ny. or my .mplorcs wnh w.8cs ri rh.ir $L .omprnelidr, will do rh. worl at rqlmrc n ftn
<br />i.rendcn or oittrcd for st lS(.7044. 8!sinc$ otrd Prcfcsions Codc: l-h. Co.tmdoa s Liccnsc t3w docs nol !ppl, ro 3n owtur or
<br />rhc pmp.n, wln bxild\ or imptuEs rh.mn. ud wli, &{\ luch $brk hin&lf or hrr*lfor rhrcugh his or hcr own cmlloyccs.
<br />,rovidcd rhar su.h impmvcnEtrh orc not inrc(6 or oficrcd lor $h lt hoscver. thc tuildins or imrmremnl h n,ld {ithin ,,nc ,!rr
<br />.rcoDphrion, rhc Own.r Brildq willhnlc rlr hurdcn of pmvinS rhlr tt or she dil mt tdiu or inlhr lhc F,p.^ny for ttu Nrf{sof
<br />l- a\osncrofrhc nmpcny. a crclusilclr.onhcri'rg*ir[]i.rnulcorrxct)nk'mn{tu.rrhcrn,jccr(SLr 7{Xt. Bu\inc$
<br />anl lt'li\\hn Codc: Thc Contrictor's l-iccnsc LrN docs troi.t'!ly ro rn owncr.l prop.ily sho builds or impovcs rh.rcoo.
<br />rnd who .onrncG au sdch pn)jcctr sirhrContncbn\) licc.scd pu^rnnr hrhcConkr.kr'\ t-iccn{ tf,s)
<br />I nnr.kn,pr uidrr Srcri,r .ll & PC lnrrhisrcrvnr
<br />Dal.: Own.r:
<br />wonxr"rc' corrPl,'rvsliiirlr
<br />PECIdS4II!,}N
<br />! hcrcby drfinnrnd.r Ftuhy.tp.rjxry.n. orrhc r.llowin8 n(lurtbns:
<br />lh.rrandwillhrinrrinaC.nrfi.rtorConscilroS.lalnsxr.f{trworkr^(omp!trsitknr.!srrovidcdlo.byScclion:lTlDolrhc
<br />Lf,h,r Codc, for rhc pcrformdcc ofrhc worl for whi.h thc psnir i\ i$ucd
<br />I harc
<br />"nd
<br />will m,i,tain wo*cn conF..salion i.sur.k.. as mqniEd by Sdion l70o ol lhc tibor Codc, for lh€ pcrfomncc of
<br />lhc work ror which rhk p.rdt ir hiuM. My eortc^ compenqrion i.strdm. mir orn Fliy nufrbc. uc:
<br />.,*.,, sa' dw<st Cag I N S
<br />EN\IWC I bdta10 l-i-lq
<br />I..dify rhr i. rl[ p.rformn.c oithc sork foi shich rht Fnnn is issucd.I \hr frn cnploy rny rcRon in iny manmi
<br />s s k, h$om subicd b llE rorkcs con{,cn\alion laws oicaliforni0. lnd a8rc hnl ilI shruld bc.orc \ubjd ro rhL
<br />wo en' conrFnsor ion fmvisnrns .l'Sar ion l?00 ol tlE Lrt ! Gnq I sholl. fon hwirh .-mply Nnh rlr,{ pdvhbn\..
<br />IV RNIN(;: Frihrr n, {cur workc^ co ,pri\rri{tr, covrrJ
<br />, rit,itr.. ut 1 .,trt. hu.,l'cJ r\i.u.Jn,l J,i[.j\,{'ryr ^niSccrnn, :ll)76 ol rh. trtxrG)dc. irncrc{md onry \ lcc\
<br />!c i\ udlxwliil. md \hall \ubrrr an rnfk)ycr
<br />i'r rddirion r) rhc co! uf.orr|r
<br />Br0z 9I -l0f no,,.-,
<br />DTCI,AB{IIQN
<br />I hcrbt afltn trnd& F.rhy of,rrjury rh0r I rm lic.nrd Dndcr Ftuvnion orChaprcr 9l.ommmi.8 wilh Sation ?O(x)) ofDili\trn:l
<br />of ihc Ausircssuo Potussn,nsCodc. dd'nyliccnse h in flll lorcc atrd€arccr
<br />B to@qqaq
<br />"''5[ rf 2019
<br />.-"*"., F,qrl.a.,.t----
<br />IANIIAIqIIANIENDINGJ(iENI]
<br />I hcrcbt anirnr undcr lEnllly of !.rjury rhat lh* n a con(Mlhtr hndinB oScncy for lhc pcr{.rmie olrh. work for which rhk psmil is
<br />hsucd {Se :1097. Civ. C.)
<br />a.PrucaxfD[cldBArlo!
<br />I hcrcby aninn undcr pcnlll, of pcrury one of rtE follo*inB dehrll ions:
<br />Oc,n ilion P.rmils-Asb.ios Nolificatnn Fcdchl R.gul.!ions (Tnh40, Pd6)
<br />-Rcquircd
<br />L.tlcrof Notificlli,,
<br />-lccnilythd
<br />rhcltdcrllr*ulf,lir,tr\ ruaMling !\tic\los rcmovil rrc norrppli.rhh b rhktr.i.r
<br />bki,n,, u*","uu,nn,nn,i.rrn a {rrr rhrrrhcllnt i'narmrtion i\comcr I Jlrs ti.oq)|, sirh dllCiryrnd Counry
<br />ivcsolrhi\Cir,and Cou ry ro cnrn trtxJrrhcordiratrcc\trtrJ Shrc Lrwsclnlirs ro buiknr8
<br />ov. rciii,fud ptr)t*d! tur i rF.r
<br />Appli.anl or Agenl Signolum
<br />remiremntrpano, DClfl\t
<br />,",JiJll 1R
<br />''',i{o
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Bough)
<br />Rough '?12*z/r SLgS
<br />Service Meter
<br />FINAL T /zsl t >\ 6.6
<br />Notes Remarks, Etc.
<br />APPROVALS
<br />It4eter Release
<br />Ari c")
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