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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />_1. 6 ovnq of lh€ sDp.ny. o! ny cmplolc wirh !aa6 a rhcir elc conp.nsalion. ruill & th. {ort anl $. end@ n oor
<br />inrddql or offdcd fo. sE (Sc.7044, Bsin* ud Prcl6io6 Codq The Conradol3 Licc6c La{ do6 nor apply to d o$ nc. oa
<br />lhc propcny qho tril& or nryiore lh@a dd *ho ilti6 sch \wrk him.lf or hdsclf .r (h6ugh hir or hd oM mplor6.
<br />provd.d rhar snch inpmvdmts ft nor imai.d or off6.d for Fle I I ho*6s, lh. bildiry or imFqvo,El ir FH *irhin on. )a
<br />oaco'trpldion, fi. om.r Btrild6 *ill h,ve th. htrd6 oaFovin{ lha h. or she did el tnild or imarov. rh. p@pdy ror rhe ptrpo$ oa
<br />l. 6 ownd oflh. Fopsly, dn qclusivcly conlmcrine wnn licasn .onl.a.tou to conslnci lhc projd (Se 7044. BbiI6
<br />ard t\oissbn Cod.: Thc Conradof ! Licdsc Law do6 not apply lo o o*nq of p.opqry s,ho buildt or inprov6 rh6@..
<br />rnd who conrds for su.h pmjats wirh. Conra.ro{, lic.nsed pu^@r ro rh.Conrractols Li.dk ljw}.
<br />I n er.mrt undcr S{tion .a &PC aorrhis.cdon
<br />Drr.: O*trq:
<br />.EAB(E8l.c9[ttErSArq!
<br />[EC!AaA!!O!
<br />I h6eby afinn und€r rBahy oI psjury ofle ollhc lollowir8 deldaliosl
<br />I hav. ad will n:aintain . Cdlifcrtc oaconmr lo S.lf lNurc ior qorlns' cDnrposrtion. 6 prcvidql tor by Sed nrn 17C{ o f lhc
<br />bb.r ( odq for rh. palomdc. o f rh. sor{ for {6ich lhc psnil is issu.d
<br />_I harc and Nill nrainlain wo*e6' c ation insu,ancc..\ Eqtrted by Sdion 1700 ofthe libor Code. for lhc perromdc. ot
<br />k6t conlp$erion iBurmc.dicr dpolicynumb6se:
<br />()
<br />Ir.nilrirhal,nrhcternn ancc.flhe \uk for shichrht lrenn s 'ssucd.I shillnor enrpkl y nny Dtcon ,n any n'mnd
<br />$ ato be.omc subj.d lo th. Mr{ds comp@tion la* ofcrfifomia. ed 6s@ rh.t ilI should tE om. subjer to thc
<br />Lvori6' conpssl io. provisioB oasdtion I700 of rh. Labor Codc I 3h,ll fonhtrilh .o,ndy wnh tho* polisioE..
<br />WARNINC Failu.c ro su. work6' compe@lion covraCc is orloye b dnnin.l Fnahb dd
<br />bn, d,mag6 a !ro!id.d lor rh.rhousd dall6 ($100,000),
<br />'n
<br />-,. J I K
<br />!rct.!!uua]
<br />I hd.br amn. und6 p6ahy ofpdjury rld I dn licaE d ond6 Fovisiod oacn.pG 9 (coomdcing $nh Sdrion 7000)ofDilisionl
<br />oa rh. a*in6 and Pdl6sions Codc, dd ny lictu. is in tult lorcc e'd c,I(r.
<br />Ci CL
<br />I hd.b, altirm undd D.n lty ol pojory lh,l rh6c is a corsrucrio, L.diis 8g*y for $c p6hlr@cc of rh. $orl lor trticn $a Fnir !
<br />i.su.d (s6. 1097, civ. c.)
<br />ATTLII:ANfDICIAAAUOT
<br />t hmib aftim unds p6ahy olrErjuryoncollhe lollotrinlr dEls ions:
<br />Dcmolition PdnriG-Asbdtos Notificarion F.ddal Restrhtun! (Tnk r0, Pan6)
<br />Requned L.tln olNolifi cation
<br />-l
<br />cdrilyd10t nE Lderal r.Sulalions rc8.rdinr Gbenos rc'noval . not arplicahlc to rhis ptujcc!
<br />V lcd'h,h, I hae,..1d,hs,n.li.
<br />/F.m$ d sHe Lais,ctaiu; bli
<br />oho\\ c mononed prcFny lor Gpdnn
<br />),
<br />l(
<br />^ppliccnr
<br />or
<br />^smr
<br />shmrurc,K
<br />"*.r**.",0n*,, EK
<br />Site-Work
<br />Unde rground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Roug h )
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Itileter Release
<br />Rou gh
<br />Service Meter
<br />FINAL Z,-l-19 tLcz)
<br />Notes, Remarks, Etc
<br />-.{
<br />OWNER BUILDER UELCARATION
<br />I hdcby amrm undd p.mlly ol pdJury lh.l I m cxcmpr 6om thc ContracloN Lic.ns. tjs aor ih. followinS rceo (5<.703 L5
<br />a6in6t an<l P.of*ion Cod.) Any Cny or Counly Nhich r.qun6 a psmit lo con$ru€1. .116. inpmva dcmolnh or'rqan &y
<br />sd.rr., prin to ils isuoc.. also r.qon6 $c agpticd for such rEoil lo nlc a sis..d srar@d |har hc or sle b licds.d pusBln
<br />ro rhc provtions oflhc Co.tra.lols Licenled Lsrv (Chapt€r 9, ComnEncin8 with S€clion 7000 ol Division I ofth. Busin* dd
<br />Profsiotu Cod.) orlh he or sh. is .rcs9l rh6etioo dd rh. bais for rh. all€s.d .r@fl'on. Any violado. of Sdlion ?01I 5 b) any
<br />applic.m ior a p*on subjdrsth. applice' ro a civil lBalty of not Dorc $d nv. hundrcd dollds {$50o)
<br />, fSOlk\)
<br />o*", . ll q .*,.*".,(
<br />l,eDde' s Addrcss:
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