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ELECTRICAL-INSPECTOR RECORD J
<br />DATE ID/SIG.COMMENTS OWNER BUILDET DELCARATION
<br />I ncrcb, omrm undcr pcnally of Frjury rhd I no cicmpt iiom rhc ConrEctof Liccns LIw for lhc follori.g B.$n i Scc 70:1 1 .5
<br />Businc$ uftl Profc$ion Codc): An, Cily or Coxdt whi.h dqltc\ a tf,rdir to .onstu r, ahq. imtrovc. dcmlnh or Etlon flny
<br />sltu.turc. pri)ltu irs hsumc. !l$ Eauircs rhc atplicer fo. su.h Fhnir h liha silncd dar.tunr rh,r h.o, \hc n lic.nscd p *uant
<br />ro rhe Folisions of rhe Coniro.rols Li.cn*d t,,w {Chapter 9, Conmencins ,irh Scction 70OO of Division I olthc Busin.s and
<br />ProL*ions Codc) or rharhcor shc h cxctrrpt rhcrcfiom dd rhc b*h nr rhc rllcsed.xcnlJjri.n AnrliolarioaorS6tionT0ll t hy rny
<br />rpplicrnr ror a p.mn slbjccr\ thc applicrtrrkracivilFnohyofnor.rorcrha.fivchu.drcddollust$500)
<br />L as oRtur of rhc lrolrny. or my cmployes w h wrgcs .s rh.n vre .om,cnsar ion. wiU do rh. work srd rhc dtud@ is nol
<br />inlcndLn or oricrcd ror sL (se.701.1. Busincss and Pmfessions Code Tlrc Cotrtri.roas Li.ctrE Las docs nor applyto anowncr ol
<br />rh. tmp.ny $ho builds or improrcs rhemo. ad who des such wr* himsclror hcr{lfor rhmu8h hh or h$own cmt,lo}rcs,
<br />nrcvidcd rhd such inp'umnB d. fr i.rcnd.d oroncqr hr sk ll hoNcur rlr hlildinsor iqmvcmnt t$klBirhin.nc,r
<br />olcoryLrkr.. rh. Owhcr Bril&, will hovr llrc turdcn ofl)roving rh,r h.or {hc dii to t iki or inp(rlr $e porEl, tor rhe DurrDsc of
<br />_1. n owmr ol rh. pmp.ny. r r.xclusilcly coniridils wirh licnsd cotrtrrcron r(' on(rud rtf, l)()j.cr (sm 7044, Busncs\
<br />lnd h,hsskn' Codc: 'l he Conrador's Licctrs. L.w doB no! aptly ro !n owncr.rpropcny who l,uilds or nDpnnrs ricrcon.
<br />snd who onrdck ror such tFigcrs wirh a Conrmcro(, licc.sd pursur ro lh. Cotrr{.ror'( Licctr* trwr
<br />-l
<br />anrcxcnw undcr Sccrnr
<br />-.3
<br />& PC lnrrhh rcrstr.
<br />D.t€: O$nrr:
<br />wonKrRs coirPmsaTIoN
<br />tl[ct a.SaIluN
<br />I hercby.ffirm undn !.n.hy or ldjuiy o.c olrhu {dl'wins dcclaftti()n!
<br />I hrw dd will .Binrin r C.n irrlrc oa Gnr{nr ro Scllhsurc lor wort.n ronlrnslrio . ar lor idL{ lor hy S(rion l7m or rh.
<br />Iihtr Gdc. rn rhc perlormne oi lhc {ork for whi.h rh. Fcd is nsucd
<br />_lluvcondwillroinrainwork.*.omFnsarionin\lrumc.asrcquncdbySccriotr3rmofrhcLrborCudc,rorrhepcrrorm,n.cor
<br />rne $o.k for whichlhispcrmit is issucd. Mywo c6 comp.nsarn,n insuoEe caricr ond policy nunrhcr !rc:
<br />Policy Numhcr: _F\pnc.
<br />I ccnify thar inlhc nerf.rronccoflh. work lrr whi.hrhis p.flnii is i\sucd,I shr!llor cnfbysnrrc6oi in rny nrnncrs s ro b.&nf subF.r b rhc *orker' d,nncn\lrion laws of calirirnio. rtri rsEc thd rf I should hcrom subjccr ro rhc
<br />wolkrc'cotrFns,rb.prrlisn,nrors..ri.nl?(xlofrhcl,ho!Co<le.lshnll.ionhwilhcomplysirhrhosproviions.
<br />WAiNIN(;: FrihB xr rc!rc srken omtEns0rion corcm8c N unlawrul. and shrll srhjor n. cnDlorcr tu aiNirnl p.Mht\ rid
<br />.ivil finc* rt ro.ne hlndrcd rh.lsand dolhn (SlUr.oU)), rn Nddiiion ro thc.os ofcotr1p.os.rio.. dr Decl {s provid.d for rh.
<br />,*iiG{LeiS ^.^.,,,k,,"*_.,rkfuN& le-
<br />DEqI,AAA.IIOI
<br />I hcEby arr$ u6dd p.naxy or Frjury thd t !n lien$d undcr t'ovniotr oIChofls 9 (omnrmins *ilh Sccrion l00o) ofDivnion l
<br />or rh. Busiic$ and k,l'cssinns Codc- rDd my li.ensc is in full roN ed tfi.ct.
<br />b(r.^:o1
<br />.-,*"-,X= -tLLEh+4e
<br />co$trBugllaNff!.Dllc-a ji.E!l;I
<br />I hereby ulltrnundcr Fnahyofpcdury ltul lhm k a oniruc'irn Lndin! agcky rorrhd p.rr.r.un d.rrh. {. rff whi.h rhk p.nnir t
<br />issucd (Sa.3097, Civ. c.)
<br />AIPJ,ICANII'ECI.AXAIIqN
<br />I hcr$y olInn unJcr p.n,lly ol p.rjury o* or rh. follo{inB d(lrarions:
<br />D.mlnion PcrmirsAsb.nos Norificark Fcd.Dl RcsUsrions frnt.l0, Part6)
<br />-RcquiEd
<br />L.tr.r of Nditicarbn
<br />_l ccriilyrhd ihc lcdcral rcBuhriotrsr*ud ! s\t nosrcnrvtrl!r. nor aprlicahk h rhn nnjccr
<br />I &difyrhrr I h^crc rhhlpplicalionanlnrlerhitth.ahorcinionndioni\.urNr.Ingmk,.onDlywirhrllCiry.ndCounry
<br />ordimE-cs.nd srrrc liss rcllrins ro huiidins conNru.r iNl hcrchynurhoa?crcfcrcfkrivc\oflhN Cir! dtrd Counry h ctrlcr uF r)r
<br />^rr,,"rn,
<br />o. n*"n,
<br />",*rr,u* )(
<br />e"*r* nr.. , prnt,, )--dv Ntr r
<br />,,.,"ortlg Ire
<br />Site-Work
<br />lJnderground
<br />Pole Bases
<br />Light Slandards
<br />Spas, Pool, Founlains
<br />Life Safety /Low Voltaqe
<br />f!1e Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundi ng / UFER
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Facto Wired Unit
<br />Walls (Rough)
<br />Ceilings (Hard & Sollit Rouoh
<br />Ceilin s (T-Bar Rough)
<br />Ivleter Release ql%lcltTn ?u
<br />I U\
<br />Eough flt7ltK ryx\n0L l'2.\)*ain n r^&rJt,ffi)^
<br />FINAL blt'l9 L J-1D)
<br />-+
<br />APPROVALS
<br />Siqns (monument)
<br />Transformers
<br />Torqueinq
<br />Walls (Conduit)
<br />Service lvleter
<br />Notes, Remarks, Etc.I
<br />L.ndei\ AddEs
<br />rk,!d rEDrioned proFny for insDsrionpu4n*s
<br />I
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