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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS OWNER AUILDER DTLCARATION
<br />I hs.by arm undr rEElly oa p6ju'r lh,r I d cx.mpl lion lh. co.lrtclos Lic.nse tl* aor
<br />'hc
<br />aollowins r€Nn (Ss.?011.5
<br />B'sin6s d P,ofsion Codc): Any Ciry or County snich reqri6 a p6hn to en$rucr, alts. inprov., d.molish or rcpot M, ,
<br />sttuctu€. lnor ro its sudc. also cqor6 rh. applicet lor su.h pcmi lo nl. a si8n d ahn6( rhrl h. or shc is licos.d puMt
<br />ro rh€ provisions of rh. Conrractois t,i€cns.d kw (Chaprs 9, Commenci.s with S{tion 7000 of Division I oarh. Businss md
<br />Pmfsions Cod.) or lhar h. or sh. Ls .tmpr thg.from and thc bsis for rhc alLg.d €rdprioi. Any liolalionofSelion 7011.5 by dy
<br />applicant for a pqnir subjcc rhc applic l ro acivilpcnalryolnol noErhd fivc hundEd dollds (!s00).
<br />I.6owhdofth.piop.ny.ormy.mploy6pithwasB6rhcn$lcconp.nelion.Nill&lh.so,.dth.snElu.ismr
<br />inrFiLd or offr€d nn eE (Se 7044. BBinB dd Pof*sio6 Codo Tt. ( orlroclors Licdsc I s' do6 nol apply ro d o$nr of
<br />rhc pNpsly sto hilds or imprer6 rh@r md *ho do6 such sorl hins.lfor hmcllo! thur8fi iis or hd o*!.'nployca.
<br />prolid.n rhar such impm\EBrs e mr i od€d or o,I6€d for sl€ I L ho*6d, lh. trild,ns or i,Ilrovamt is sE wnhin on. )@
<br />ofcomplclion, rhc (rnd Buildd wil navc th. htrdo of poving ta hc o. shc did ml build or nnprovc lh€ Fopoq fo, 0. prDoe ol
<br />I.6o*.d ofthe prcpdy. dncxclusiv.ly conlr.dins wnh licosd codmcloBlo connrucr lh. rFjd {S4. 7044, Dusin€s
<br />dd I\oBsionCod. Th€ contrctor s Lics. Las do6 .ot apply 16 M ovns ol prcpeny lvno builds or in,prov6 rhftmr
<br />.nd *ho conr.cts lor suchprojcrs wirh r CodDdo(r lica*d pusuur ro rhecontr.lor's l-ic@i. b$)
<br />ltun.i.d|]ru idscrrn . B & P C lor rhis rc6on
<br />Di(r o*ner
<br />.v!)a(E8l(ar!EE!lal!ll!
<br />DCC!AaA!A!
<br />I h€r€by amnn under p€nahyolpejuryone oflh€ follovin-! dsl arioN
<br />I ha!. md \rill mannain a Cdincale olcongl ro S€lf'hsur€ for wdrldt mnD.n$lion, s provid.d ior by S6iion 1700 o I lhc
<br />bbor codq aor thc psforruc. olln wort aor Nhich th. p€mit is issucd.
<br />l h.reandwill maintainworkera compcnsarion insu.ance. d requtcd bySdrio lT0o ol rhe bbor (-ode. lor lhc p6fomec..r
<br />thc work lor viich this pmir is issu€d. My woikdt compcNalion insuld.€.mid tnd p.licy oumbs dc:
<br />-lcdilyrhar
<br />i. ih. psLrntrc. ofrh. work aor whichdisp.rmn is issu.d.lshlllnol {rpbyalypd)n ihanrndner
<br />so 6 ro bdo,n€ subjai b rhc rork6' coop.nsaion latrs of Califomia. ud aard lbar if I should bdom. bi6' tolh.
<br />{ort6s'compasalionpmvisionsolS..lionlT00ollhcl-ahorCod€.lsh.llrodt*nh.o6ply$i$rhoseEovisiom
<br />W RNINCT r{ilur. lo surc sorkss ompcBation covl
<br />civil fin6 up to one hu r.d lfiousnd doll6 (5100.000
<br />sdrion :1076 ofihc bbor cod.. im<61md !fiomey r fc
<br />dasc b unlavful. md slBll subjel o @ployd to aiminal FEllis dd
<br />). in addirion to rhc cost oi coqE.nd6n;678, provid€d ror rh.
<br />,","i10v I 5 2ot8
<br />DECI,AIAIION
<br />I hdelyarfim u o p.nah, ofpojury rha I m lies.d und6 Fovision oachspl6 s (comm.ncins with Sc.lion 7000) olDivision l
<br />ol lnc Susins d Prclsio6 Codc. ed my lt.@ is in tulllorc€adclldr
<br />,-,**..,'*, f' .i".*" *,,'b.' LsA?14?
<br />-.ilovj lj{l& (.n,rs.,.r ?a t ".ro'
<br />qNua!cuo!.1!;!lu!!lc!!r.I
<br />I n@by amd und6 poahy of Fdurt rh.r rhr. is , cododion krding sSocy for rhc p6fomdc. of th. \orl aor Ntich lhis p6nn b
<br />issued (S(.1097. Civ C.).
<br />AI8IICANIDEIIABAIIO!
<br />I nod,y aliift undd poalty of pGjury o.. of th. follorvinB d(ldatios:
<br />D.ho lilion Pmirs-Asb6ros Norificarion F.i-.1 R.sllarioB (Tn|. 40, Pan6)
<br />R.aun.d L.rrd of Noi6cdion
<br />I.enirylllal lhe l€ddal rcguhl io ns rcgeding Gbctos rcrnovalde nor applicablc lo lhis prej€cl
<br />4^,,++,t tt^"*^a't
<br />6rd'nxncs,nd Srrr. I atrsrld
<br />sapplicarnrn edsrarclh.r rlEabole intonnation is.ond I aBre ro condy \rilh oll CU and Counry
<br />'ng
<br />ro huilding coisrncrion. md izc r.?rMrarive o I $is cily Md Couoty ro are upo6 th€
<br />abo\ e mdrnr.cd prop.ny lor iNp€ct
<br />,\ppli.nntorAgenl Sigmlure Nqy" I s 2018
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si gns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<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 />Ceilings (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service [Veler
<br />t7,41,A I ^- -1, /)o rl-4i,1114t6)
<br />Notes, Remarks, Etc.I
<br />Communications Cable
<br />Under Slab / Floor
<br />FINAL
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