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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CNNAIION
<br />I hcrcby arfin lndcr pcnaliy (,f p.rjury rhdr I m cr.nfl fmn rhc conk,cfuu Li.cns tn{ lor rhc lollosin8 rer$n (s(.7011.5
<br />Busin.\s r.d Prorcs\ion C.dc)r Any Cil, or Counly which rcqutcs 0 pcrmn ro consrrucr- alrcr inp.orc, dcmlth ot rcpan lny
<br />dflcturc. ,)rior lo ns issu,ncc. rlh rcquircs lh. applicanl ior such [Ennit h rilc r sisned nar.mnr rhar hc or sh. is lianscn Pr{rnl
<br />ro $e polhions otrlt Conra.bcs Liccnki be (chrrrcr 9, Comnrmins Nilh Scciion 7OO0 of Divirnn I ofrhc Businc$ lnd
<br />Pmrcssiotrs Codc) or lhal hc or shc is excmpt lhcrcfromand lhe basis fo. rhd alltg.d.xcm,,rion. Any viohtiotr of Sdi,. 701I 5 by any
<br />,pllicrtrrrorxpcnnir$bjcckrhc,tnlic,nrlor.ivilrcnnhyorRn'mrcthlnfivehundrcddollas(3500)
<br />-1.
<br />m owncr olrhe l]rolenr. or ry cmpk,rfts wirh saEc\ !i rhct $L onprtrs0rion, will do lhc work und lhc ddm h hor
<br />inrc cn or ofcred to, sl€ (58.7041. Busircs d Ptur.s{ons C'od.: Thc Coftacloir LiccnE ljw docs ior ,tPly to ,n o*ncr ol
<br />rhc l,nltry elt) 6nild\ or i.pn,hs thcmn. dwhodcssuchrorlhnnscllorhcrclforrh u8hhicorhcrowncmployces.
<br />pR*i rd rhat su.h imnurrDh uc mr incRldl or oflcrcd l'or $lc lt noMlci rhc bdilding or inlmwmnr is $ld within orc Fr
<br />olcotr{lclion. rhc Owncr Auiucr *illhave rtE htrdcn of pmvia8 rtd hc or shc did frn boi[ or irrvmE rh. pmtEny aor llE purlrs of
<br />I. o*ncroirhclrn,pdy,m.x.lu\ivoly.ontrcrir!sirhli.cnscd.onlricrosIoconnru(lrhcprcidlsc.701,1.0umc$
<br />Md Pnf.\si c{ c Th.Onrlrnclu s Liccnsc Lrs docs nol Dlyrortrowncrolrn)nt y*hobuilds.rimtrovcsrhctcon.
<br />rnd $ho conrracrs ttr \uch pn!.{k wnh , Cdnntun, li..i{d pu\umt k, rhc Conhchis l-icctr{ ltrw)
<br />-l
<br />rmcrc0pl undc, Sccrn qLUN
<br />D.ICLABAIION
<br />I h.rcby ilfinn nnd.r n nrlly oipc'jurvonc ofih. f{nlo*i',s dc.laBri{,ns:
<br />-l
<br />h.v. d uilln$intrir.CcniarcdcolConscnrr.scltlnsurcntrsork.r'$nlpcnsarion.as prcvidcd lhr b) Sccri,n.lTmorrhc
<br />bhor Codc. for thc pcrfornDnc. ofrhc wort ao! shich lhc l)crmir i! hsucd
<br />-l
<br />llrcnnd will rminllir sltrkc co'npc srrn nNrrrn.c. r\ r.\ttrn.d hySdion lT0Oollhc LrhorCDdc- rrrtu p.rr.nmncc ol
<br />thc $ork,brwhi.hrhnlcrmil is i\\ucd Mysorkcrr conrcNkrion in\urm((dici dpolkynuftcrarc
<br />I c.niryrh,r inrhc p.rronMn.colrhc work lor whichrhis pcflni n G$ed. lshrU no' cntloyriy pcson inany mnncr
<br />b a{ lo hGoE su$jsr la lhc workes @mpcn{nn,n h*r.lCalif{nnia. and 4N rhd irl sh.uld beonE suhJc. o rn
<br />qorkcrs c.nrtcnsrrion tmvisions olSeclion:l7tx)otrhc hlnr A)de.lshnll, ronhwirh.onrlly qilh th)r provi\ion\
<br />WARNIN(;: FIlrrc b \cc!r lorkc$ .otrrt{trsaridr ..rcr !c -{,,cnrtl.ycr h dirinil pctrrhics ud
<br />civil fitre\ !p ro otrc hrndrcd rh.u\rnd dollrs (Sl(x).oul)ion r u8c\ i\ tmvidrd nlr rhr
<br />Sccrn,n.1076of rh. Lf,htrCodc.n dcslandlllntrrcy!lccs
<br />?4LP
<br />DECI,AB^IIO!
<br />I hcrcby srfird udlcr pcnslryorF.jury rhal I !m lien$d Dndcr pmvision ofCh4rer 9 (fl,@nci.g wnh scction ?00O) ofDivhio.:)
<br />of lhe 8usirc$ md Pofe$ions Codc, aJrl my li.cn* is in tull Lr.. ,nd cffccr
<br />TNSIBUCUQNIINDINC.&GDI1;I
<br />I hcdhyamr u.d.r Fnrlryofpcrjury Ihar rhcrc h 0 on(rudion lcndins ascicy ror rh. pciroflrutrcc ofrhc $ork {in which rhii rrn'ir is
<br />i$ucd (Scc .1097-Civ C )
<br />AITUIAILDECI"A8AII()!
<br />I h.Etry afim undcr p.nllly of perjlry ok or rh. rollo*ing d*lr.i{bnsl
<br />ocmlnion P.irniis.Ashcstos Notiliorion Fcdcrll Rcsuhtions (Tirlc 30, Pd6)
<br />-Rcquncd
<br />L.lter oi Nolilic ion
<br />_l corify rhrrrh.lcdcr.lclul.rions rcAnJinE ashcnos rcnnrvrl ir. nor4plicrhlc b rhi\ !k+.r
<br />ihcrh'rr irforrorn hcorcd l oAre lI c.rrnv rh l Ilr\e rc rhn)ml'.rri,n,
<br />,{,1'1 tr-. 1\r,rcl r$\rclrr ngr,,h l+
<br />.,1{\r nr irtr rLl fr,tdrv ,{ nFgg.rrn/'
<br />^n,hsnr rqr \i*tr utu fY=
<br />lu"-,r*.,.",nn,,,
<br />.rotrrfl,Nirhrll( 'ryr d C,irit
<br />rhn C tr rnd (i)unr} !) rtrd nt{rlr
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<br />Transformers
<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 & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lVleter Release
<br />Rough
<br />Service Meter
<br />FINAL Ittln/i4 5L1A
<br />Notes, Remarks, Etc tr-
<br />Site-Work
<br />Policy Nurnhcr:-Expncs:
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<br />l.ilrnsr ( h\\: l,rcNc Nuorlu
<br />Dirr Conr,a! ror
<br />trndci\ Addrc*:
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<br />tl
<br />tt
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