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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DT]I,CARATION
<br />I hcrchy ifllim undM p.mlry ol t'.riury dnl I m.rcnp! rft,n rhc Conradon Liccns Lou rbr lhc hllo*ing rcayrn (s( 70-11.5
<br />Busincst rtrd Proicssiotr Cdc) Any Cily or County uhi.h rcsuncs a p.rmir ro dJn\r .'. alrcr. i'Iprovc, d.nrlish or EPtn 0.t
<br />{ru.rurc. pri(n ro ils issuore, oho rcqdnc\ ih. aprrltlir lq ruch rEnnir ro fil.a ri8trcd sarcmd rhal hcorsh. n liccnsed ruFurnr
<br />ro rhc trevirion\ .rlh. Conlr&ioas Liccned tjw (Chrprcr 9, Commcrcins wirh Sccrion 7(m of Dienion I oflhc Busnrs otrd
<br />Pmicsions Codc) or thnl hcorrhc hcxcmpl rhctirono lhe bnsn ior thc lll.gcdcrc.$bn Any!t arionofs(lion7031 5hya.y
<br />erli.r ru a pcnnir sul,jftc rhc tDli.,nr r. a.ivill,cnalrlornor drcrh,n livc hundrcd dolltrs($50t|)
<br />_1. !s owmr of rhc I)IorEdy. (n ny cmtbttcs wnh wasc\ i! r hct $h comn nsrn,n. will do rtr eo mnth. srnr]lmt nor
<br />inrcndsl .r off.rcd f.i sh (se 7(xt, BusiRss dnd ft.i.ssi.ns Cod.: Th. Conlrcdois l,iccns ljw dcs nor anpiy rJ d owncr or
<br />rhepmF,y who hilds or nq'mrs rhcMr ard sho des su.h qork himscllor hcrsllo. rhtrro8h hi( 6r hcr dsn.n'ployecs.
<br />provacd rhor $ch imlotrmnrs arc mr inlcnd.d tr ofiNd rbr slc It howEr. lhc buiklhs or inlmttunl is v,u wirhrn ,,ft ,tt
<br />ol snlshlbn. rlEOwncr Buil:rs eill hrvc llE burdcn or provin8 rhd tr.r shc did nor btrild or in{rcrc rh. pDFny for thc lurrneof
<br />_1.Nowncrotrhcrrop€ny,aorcx.lusivdlycoor,,.ringwirhli.!{dc.trkr.toFtomnslrucllhcnroj.rl(S(7{x.r.Busrm$
<br />.od Aofclsion cod. Thccontrror'sLiccnsctiwdocsnoraptlyrortroqDcrollll,pcnywhohuildsornnprovcsrhcaon.
<br />lnd sho contmcls l'or such projcts wnh a Conr,!cr.r19 liccnsd puFuunr ro rbc Cont&'.is Ltcn* Lrwl.
<br />-l
<br />omerchtl ondc. 56r A & IC r{rrhis rcr{)n.
<br />Ivaartrf,lraMtliNi]!1]N
<br />DECI,AX6.IIQN
<br />I hcrcby nfln'n und$ Dcnihy ol pcrjury orc ol lhc loilowirs dcchrlrt,n\
<br />-l
<br />hr\c oft will minl0in a Ccr liiEarc oi Con*ni to Scl nrurc fu porkca $mpcnsa'ion,!s In,lidcd r.r byScrnni 37(10 olrhc
<br />tib.r Codc. for rhc ,crfmdn.c .r rhc work for which rlE Fmn is ksucd
<br />Ihrvcrndeillf,rinrait*.rkcr{.omFn.rrio.i'Nuraft..rrcqundbySccrionl?00ofrh.l,oborConc.forrtcFtlo.nbn..ol
<br />rhc *ork f(trwhichrhh pcmir is issu.r! Myworkm c.np.n$rioi in\urituc .onicr ord Nlicy nu l,o uc:
<br />-l
<br />ccnilyrhd ir rhc rcrlormrNc ofrhc Nolk rbr which rhn Fnnil t issucd.l \hrll nor cmploy rny Pri<,n h afl, minncr
<br />$ r\ h lrcom \ubtcct lo rh. *ork^' .onlTnsnt tun hw\ of Cnllfomir. nd d8(r rhd ifI stuuld bccotrE suhid rorlr
<br />workcr{ comp(nsarn,d prcli\inr or Sdrirtr l7m of rhc Lahtr Cod.. I shrll. lonhwirh mry,ly wilh lhos prcvi\ion\
<br />WARNINC Failurc io *curc workcn compcnsolion covcmse is unhtrtul. ad shrll srbjccr rn cnployci ro oi,niNl Fn.his lnd
<br />civrl fincs up b onc hundrcd rhousind dollam (SlO(r,(rO0). nr.ddiliotr ro lhe cosl ofcofrFnsarion. d,.Egcs as [ovidcd hr lhc
<br />."wliTs
<br />I h.rchy rffirflr lndq pcnllryoircrjurr rhar I rm li.anwl !ndc! EorttunofCh.prcr 9 (.ommNitrB wiih Sdion ?0m) oiDivi\i{,n l
<br />ol lhc Bu\iNs ond ProlcsiorN Codc. md nry licctrrc h ir lull lorcc orxrcrt cr
<br />f+!r1 ,..'.""'",(t9
<br />CONEIAT&IIONI.ENDIN(;}GINCI
<br />I hc(by ntnrm u.df Fndlyorp.rjuryth,t rhcrc is a.onirucrion hndins o8cmy forlhe pe,fommc oflh. *o* ld rhhh rhis Fnnil is
<br />nsucd(Scc 3097, Civ. C.,
<br />AIILIIANLDECI,ABAII!]N
<br />I tmt') lim undcr ,'.nulry o,pcrjury orc oIrhe folb*in! dmlrari(inr:
<br />Dcmlnbn PcinnsArhcsros Nolification Fcdcrul Rc8ulrlions (l'nt 40. Pan6)
<br />Rcqutcd klrcr ol Notiliculion
<br />ifyttut I havcrcadlhisapDlicolionond{trlclhrr lhc atnvc inrirmorion iscorccr Irardro.o rrlywirhrliCil
<br />s md srar. Lrqsrcltllinsro huilding
<br />rh)vc,mnrt *d pml.dt f(r ms
<br />Appllconi or AaenI SlatuluE:
<br />Prmile. mm. ( prinl ):
<br />"x*rucrion. r hcrchyrrln r rclrc{nurivc\ of
<br />;)l{T_LB
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor />\
<br />Bonding / Grounding / UFER +-26-tf [.U(r0
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solf it Rouoh
<br />Ceilinos (T-Bar Rouoh)z1
<br />Meter Release +-27-ry W-W:10)
<br />Rouoh
<br />Service I\/eter +-z-b-l l v.u/Fo
<br />FINAL l2-11-r\"q.)L$o
<br />Notes, Remarks, Etc U
<br />Transformers
<br />l.dilirhJrrh.lidcirlroguhriotr\r.grJi',Sn\Grno\..fkrrlnr.n.rat)tl(rhl.r,rh\ftr+.r
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