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ELECTRICAL.INSPECTOB HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUII-DER DELCARAIrcN
<br />I ficrchy arfirm undcr p.nrlly of p€rju,y rhnr I m cr.npl fmn thc Co.rru.ro^ Ltcnsc tiw fo. rhc foll.wins rctr$n (scc70.t1.5
<br />Busihcss ond Pnicssion Codc) Any Cily or Counly which r.qxirs a lsnrir ro .on{ocr. dlr.r' inyovc. {hmlhh or rclln onv
<br />(tudu.c. prir t, irs issuurc. also r.nut.s th. arplic|.r tor such pcmil ro lilc i siBftd rtrtentnl rhs' rEor shc k liccn*d purua
<br />b lh. pmvisions ofdr Co.ka.iois t,ienscd liw lchnpr.r 9. conrrncitrg wirh sccrion ?u)0 of Dilhi.n I of'h' Businc$ 8nd
<br />PmtcsioorCodc)orth0lhcorshchdemflrhcrcfbmandth.bashl{trihcall.Ccdcxcmplion.Aor!iol.'io.ofSNlionT0ll5hvdnv
<br />rpnlicJ lo' x r'cn \uhj(h rh. rplltrinrro 0.trr ncnrlrl otn.! rnnrc rhan r c hur.lddolla,!t$r(io'
<br />/hA, ""*, * t" ,-*.y. d my cnrluree\ wirh * asc\ * rh.L s.k conrl,cnsar ioo. will do trt $o* ord rhc rrBrm is mr
<br />7 #nait "r .ncrca r". qtc r s( 7u44. Busincs Md Pmrcssi.ns Codc ]ltr Conh.rors Liccrt L{s de\ nol qDlv r' rn owmi ot
<br />rh nDncny wlo hu'ld\,tr i'q'rnv.( rh.mn. and whn dies sEh $o* himsellor hcrslfor rhmugh hk or hcr oq.nlkty.cs,
<br />Irovidcd rhsr su.h impmvcmnk d nor im.ndcd or offcBl n, sh ll ,F*crcr. rhc huildi.s or irtetdsr is sld I ilnin ore ttar
<br />oto@krbn, rtE OqNr Builds vill h!ft rh. t dcn ofPovitr3 rhul hc or she did ml hoiu or itqrew dx l,oFnv ior rnc Pn+ot of
<br />I. r\osn.rorlhcrorcny, rmer.lu\ivclyconhdirs qilh licer{d .ont,.ror\ k' con(dcr rh. pqccr (Ss 7lx4 Bustrc$
<br />dxl Porif,si'n Codc:'l hc Coirrr.tois Liccnsc l-as dfts norarnly t, rn owrcr orln'lcnywho huilds or impi(,vcs lhctcon.
<br />and wh. conh.r ld such prcFr sNirhr Cb in.rrr\) licctrr,l,rurnirnr r.rhc('qrlrrcnn s l-icci\c LN)
<br />;:- u{ial
<br />I hcrcbyJ,ftmu cr ncnnlry l ,rjury onc .l rhe lollo* ilU
<br />I hrvclM will nEinllin a Ccdirf,alc of Cotrsnl ro Sclflnsurc tr workcs- comlcrsstion. n\ providcd for bvSccridll?U)ol lhc
<br />ljtrr Gdc, tur rhc rcrforMncc ofik work for th,.h rhc Fnnil i\ i\\ucd
<br />I h.!c rRl u ill mainrain wo*cn conpcnslrion iNuratuc, .3 r.quncd hy Secrnrn .r7m ol lh. Lnhor a)dc. ror rh. lcrfo'mncc of
<br />rhc vork for which lhn pcmir is hsucd Mylork€n .onPcnsrrn,n insunncc clFicr dnd lFlicy nunrher ec:
<br />Pcl'.vNumhcr
<br />-Erplc.
<br />frM,nfrt,^,**u",nEnccorrh"workra,wh'chrhisp.mirntiu.d.lshallNrcmplovtnvp.ronin!n,mdncrh tr\ r. bcrom subrrl !n lht *o*di (nmncnsal nn la*\ of California. rd 08N lha' it I should tE om slbj.d ro lh.
<br />sortcr' mn{Enslion pmvhions of Serion :}?m of lte Lstbr Cd<tc. LrEll. {onhwi$ onlpty wiln lb* ,rovniods .
<br />WARNIIG: Fi,ilurc Io suE workc^ conF.salion corcmse is unlnuhrl. and shrll slbjdt s.mPlovtt lo oEiml
<br />'ri
<br />ln!\xd(l (lollnrs rSl(xr.olxrr. i', rld nnr ro rhc.orr or conpc.sari
<br />trl
<br />,qrcq JrlrEky'\ ri{\b *^,**.a
<br />I hcEhlrfilnnundft n.hyol prrjtryrhrr l3m licc.{d undcr i ofClrU.r o r.onnmn.i'r! tr{h
<br />l-iccns. N0n'rrr:
<br />-
<br />CANiISUCIIONTEIDIMICEdII
<br />I hcEb, rmrd undc, lEnllly of ldjury rhd thcrc h a con$rucrion lcnding r8.rcv ao, rhc l.rrormB of lhe work for shi.h rhn Fr'nir is
<br />i$ued lS€. 1097. Civ C )
<br />AITI.IIAILIIECIJAAIION
<br />I h.rc6y altnn uMcr ,.nrlly of ncrjuly one of lhc followinS dclarar ii,ncl
<br />t)cmoliiiotr Pcrmirs Arb.slor Nolilicolion ltderal RcguhrnnN (Tirlc40. Prn6)
<br />Rcquircd l.llcr of Norirslion
<br />-t
<br />ccnilyrhrr rhd fcddrJl rc8uldrrns rgrrdin8 r$.{os.crovnlurc nor +pli.iblclo lhG Pn)cci
<br />ifyrhar I halc rc rhhlpplic ionrfrl{arclhst rhc al$v. inf(mrr i iscotrr.r l rgr( ri (inlrly wirh rllCirynNl
<br />ro huildint.on(rucrion- a.d hcrcbyaurhtrizc "iT,';inh,vc mcnri{)n.n pn,!.ny Lr in{Iisrion IUiIx
<br />Appliunl or Ascnt si,tnnloR
<br />I
<br />t,
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />I\4eter Release
<br />Rouqh
<br />Service lt/eter
<br />FINAL 6-27-/9,/)Jot;6 (rr)
<br />Notes, Remarks, Etc
<br />Sub-Panels
<br />Air Conditioners
<br />of rhc Busincs,nd Pn,rcsionsCodc. and nylicn\c isin full irtr c ffil eff..r.
<br />t nd.r! Nam:
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