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ELECTRICAL.INSPECTOR RECORD t,F
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATION
<br />I hcrct! aflinn x.d.r FinXy (,f p.rj!ry ihd I @ crc.llr lmm th. C.nrd.bE Lic.ns be for rh. foll.*in8 rcasn (Scc7011.5
<br />Burincs !d Profesion Codc)r Atry City or County which rcquncs ! IEnnil lo onstrucl. alts. iflrprcr. d€mlhh or qut ony
<br />srrucorc- rritrlo ns nsu0n.c, aho rcqlircs rhc ip,'liconr ior such Fcln llo filc a stncd storemor Uar lEorshe is li..d\cd llx8nanr
<br />lo thc pmvnioB ofdE Conlm.lols Liccnsed bw (chrplc.9. Conmcn.ing wilh Scclion 7uD.i Divisio.I oi lhc Businc$ lnd
<br />PmfcssionsCodc)orth0lhcorshcisexcnr/lhcrcliom.ndthcbnnforlh.lllcScdcrcmptiotr. Anyviol b,ofSalion7011.5h,atry
<br />aprlicanl lor s pcmit sutlccts lhc amlicanl ro 0civilpcMllyolnor mrclhln lirc hundEddollors($500).
<br />I. * owno of rhc tmFdy. .r nry ..lpl.)Mr wirh srSc\ us lhci, *,lc ofrpcn$lnrn. will do rh. wfk nnd rhc srMhrc i\ frn
<br />inrcdcd or ofrcrc{ aor sh (Sc. /o14. Busincss !.d Prcfc$ions Codc: Thc Contudol s l-iccnrc ljw doc\ .or apply h an owns or
<br />rhc lolEny wtxl bxilC\ or iftprorcs lhcmn, md wlx' d6 ruch $t,* hinr$lfo. hcscltor rhnu8h h( or icr own.mpbr{cs.
<br />lnlidcd ilDr such impmunEnrs m mr inrod.rl or oficrcd lirr $k lt ho${!.i rh( hrikling or nni&rc'nnr h $h withh onc ,s
<br />ofco.Ihlton. rh. O*rcr Bnildcr will h0vc lhc burdcn oitmvirB tlnf lL or rhc did ml hild or impmre rhc pmlcry ior rhe puqnc of
<br />-l
<br />!mcxcmfl unacr Seli
<br />TI}Bf,E8SJ!]M8INIAIION
<br />DFCI ARATIoN
<br />I hercby atfi,mhdc. p.nallrofpcrjury oie oaltc folhwir8 dslirolions:
<br />I hrvc el will nrinrri.. C.nifi. c of Conrnt kr S.la lnsur nr w.rkc '.otrrFctrsrlion- $ prlvidcd ior bySdn,n:1700ollhc
<br />Iihitr Codc. br rhc lirformmce of thc *uk ibr *hi.h rhc p.rnir is i\srcd
<br />_l hlvc lnd will mainllnr workcn comFnsrlion irsumrcc. is rcquncd by S(l ion .17fi) ol rhc I trhor (1 c. n, rlt p.rrornMc. or
<br />rh. sork iorwhichrhh pcmril is hsEn My workcr' orycnsrrion nsumnccotricr !ftln licynuot'.ruc:
<br />\Zl !cd'ryrhr rrhc rcrrqmn.currh. *'tr|rorshilhrhk pcflnn k i\sucd,I sh,llnor crploynnt,Eson inotrymunncr
<br />'h s h hc.nnf, subFr h rhc tr.rlfts, c.'nl'cnsrrion lJwr of Ctrliiorni( ond o8rcc rMr if I \hould txcoft subj.ct b lrt
<br />wottcr'compcnsllionpovisionsofScclionITOOoflhctitrrCodc.lsholl.lonhwirhcomplywirtlho{pnvnionr
<br />WlltNlN(; Iirilurc r) {.urc {orkc's .. rfc \di,nr ro h unldsrul. and sh,ll suhrccl .. crllllorr lo cirninalpcnallics rtrd
<br />civil tincs ut to otrc hundrcd thousand dollrs (Sloo.fl imddiri, ro rhc con ol conf.nsrion. dunugcs a\ pn,lidcd tnr rhc
<br />S.cri,nr 1076 ofrlr tnbot
<br />".e 69l,'t h.\G L'
<br />t)E(.t,/\RAlt()N
<br />I hcEby amrm unds I'cnohy ol pdiury rhlr I om liensd ud.r [ovision of Cn prd 9 (commncing wirh Solhn ?00o) ol Division .l
<br />of lh. Busimss and PbLssions Cod.. ad my liccn$ n in tult lor rid cfaer.
<br />e6,hftlre-$r-rN.-tP
<br />I hcEby dmm undcr p..ah, ol pcd!ry rhlr rhc r @i$rudion h.ding lgcxy ror rhc p.rlmmc of lh. vo* for which lhis pcrmil h
<br />issu.n lss. 1097, Cir. C.).
<br />APIUIANIIJiCLA.BAIIO!
<br />I tf,rdry rmm und.r l.nali, of Frjur, ort olrhc follosing d.claarion\:
<br />Dcmlition Pcrnits Asbcstos Nolificolion Fcdcral Rcsllolhns ( rilb.l0. Pan6)
<br />-Rcquircd
<br />btrcr ol Notiarcalion
<br />_lcnilyrhxr rhc LdcnlrcEllurion\ rcrMli'rg n\txsrot rcnmlalrr. Nr rfp i.rhlc n) rhn !m]..i.
<br />Icdlfyrh l hnv. r.rd tht.ptlrdbn dt *!tc rh.rrlk.bvc itrf rmrion i\ cor.cr Ialtccl.clrnplywirhallCitynndCouDiy
<br />iklin8 con{rucuon. aki h,r.h!.uhoirzc rcprcsenrdiv.s of lhi\ordinrnrc\ JtrJ SrJrc tj*(rcL illlo
<br />"h". mo,,,*,i l,.r*it li" n.fi
<br />Appllcdl or Agdl Sipn uE,/
<br />P" tt* "t "tp;rrrt /Sur=tL A.6 ""*iQt
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER ahAlnT*Ur,-r^/9->)
<br />Transformers rl t /\
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Bool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />7t3,6tW-n t>)tl u l'
<br />Bough
<br />Service Meter 7l2blt2 T;-x\tt cD,dt)
<br />FINAL
<br />I p lrJ,oti ^l*-l.e^.t 5)
<br />Notes Remarks, Etc.
<br />It/leter Release
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<br />l. 6 owner of rhc pmlcny. um cxclusivcly conrrrcrins wilh liccnrd conlacron lo condocr rlE f,oj(r (Ss 7oil4. Bxsim!\
<br />and Pft,fcssbnGdc:ThcCo.k0cttrsl-iccnscLrwdocsnornptlyk,&.snd.frnrpc ywh. buildsorimprovcs rhcrcon.
<br />lnd uho e nd s ror such pnjccls wilh s Contmdon s) liccnFd pusuitrr ro llE Conlrucktr s Liccrsc Law).
<br />PolicvNumhr:- efiir*,
<br />Lnd€i. Addrc*:
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