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ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BUILDER DOLCARATION
<br />I hcrcb, trmirn u.dcrycnnlr, of t'erjury rhar I sm excmpl &om rhe ConrEcro6 l-ien* llw fo hc aollowin! r.,$n lso 70:rl 5
<br />Businc$ ard Pro{esn,i Gdc) Any Cny or C.xmy *hich rcquihi . Frn r ro con{fl.r, nllcr. nnpmv.. rlcmlish or rc,'on lny
<br />sirudue. Fior ro ir\ iqsuon c, aho,cqnnrs rhc ,l)plher for su.hFmi r. tilc 0 siemdslstcmnt ltul tEor shc is liccnscd puNanl
<br />to thc Imvhions oflhc Conlrrclors Liansn Lrv (Choflcr 9. Comrcncins wilh Scclion 7000 or Divi\ion I ollh. Busin.s $d
<br />Pmfc$ions Codc)o, thll h. or shc n cicnfl lhcrcfrf,m lnd th. h!\is lor rhe alk8cd crcfrprion. Anyvid(rio.ofScdnnr0ll.5 by,ny
<br />$tl'.dnrrNdt'h \uhJ(h rh. rmhrnr ru rcr'lprnrlr) nlnu( m'crhd l^c hundrcd d.llor rS5Ur'.
<br />/r{l[ * ,,. *. "t'n" n-*"y. ur ny cryr,'yb]\ wirh lr8cs as rhci' $r. d,nFns,ri.n. wirr do rtE w.'k md rhc lrxrm is mt
<br />'Ftu*.a6r.ff.rcdror$hrs(704-1.Buqm(andPFfisio.icodcrTh.ConlrrrolsLiccnscL.*docsnolamlyhuoorcrof'rhc nmFny qhn hnrkt\ or,tr{rnws rJirtr ui }ln dms sch sA hinselfor hcr{lfur rhhxSh hh or h.r o*n cr{loyccs.
<br />provaed ihlt such inDmrcmnt m mr int.nded or ofi.En tur $L It hor$!r- rlE tniHiry or in{tuvc'Enr k s,ld wirhin .nc fd
<br />orconpldion. tlr owmr Buildd *ill h,w rlr h)rd.n ol provinB th,t tr or shc dn mI hih or inrl'mE thc pmFny tor llt Plrlb* or
<br />-1.
<br />!s .wncr .l rhc !opcn]. am cxclu\irc ly ronlmcriry wirh liccnscd conracroG ro co.drucr rtr prcjc.r (s.. 701.1, Bnnn.*
<br />anl ADfcssiinCud.rThcConrr.ror'sLi.rns.Lrwdo.snorlpplybanowncrolrrr.pc y wh{' buildsor ir.fovcs rhcrcon.
<br />and who mnlm.ts ntr luch rmjccts wirh a (bntmcbns) liccnsd pu^ua ro rhc Conl[cr.as l,iccnsc lrw)
<br />;: "ryi,
<br />I I'r'chy xlli'nr und[ JInrlryol t).'i,ryotrc ol rhc lalk
<br />Ihrvcatrdwilln!'i'rnr.Ccdin..rc.lC.trknrbScll lnsurcforsorkds..nDensrrion.aslr()vidcdiorhySccri,.l7O0orth.
<br />Irhor Cixlc. itr rhc llrrlhnuRc olrh. work f{r whih rhc Frn,ir ii h\udd
<br />-l
<br />havc ind qillnroiNrin workcr'conrpcnsorion in\urrncc.0s rcqutcd by56..rioi l7m or ihc ltrhtr c.dc, for rhc P.doirnrncc ol
<br />lh. wolk lbrwhi.hthis pcrnrir is nsucd. Myw.rtcr'c.mr.nsolion in\urancc urid dldt,li.y tru $cr m:
<br />ily rh in rhc Frfonun.c olrhc work lor phich rhis pcnlnr is isucd. I slx,ll n.r cmpk,y lny p.rnn, in ant iffmr
<br />d* comr.n\dion lrws of C! lifornii. and rgcrh.r ifl should hccorm rubtcclro rlrc
<br />,lSccrn,n:l70O.rrhc lihr Gxr.. I \hnll. rodh*nh mmpr, *nh rho{ tmvkions$or[crs .un|En$lbn p&vtinN {
<br />W/{RNINC: :rtrilrm t, {cur. workf\ confen\arion 6rdBE. i\ unhsrul. .nd \hall subj.rt nr crplotcr k) qiminol lf,naki\ and
<br />irtr k, rlr .od orc.mpcnqlon. drnuScs !\ provnted ntr lnc
<br />lFli
<br />i' crc( rnd rrhmy s fc.\
<br />V t
<br />I h.rcby rrm undcr rcn,lrrorpcrjury lhat I0m fanrn undc. provision ol Chlplcr 9 (co.n*ncins lnh Sdion 7000) olDivnion 3
<br />6f rhr Busituss !tu1 Pofc\ri.rr Codc, rrld ny lic.ns is in tull for.r ld cft'st.
<br />CONSTRI'CTION I I.NTIIN(I A(IENCI
<br />I hcrcby ffrnxndci F.alrt olpcriurr rhd thcrc is. snsrucrion L:ndire l8ercy lor inc pc,i,rnatc oarhc w.rk ror shich rhk lErmil is
<br />nsucd lscc.l0)7. Civ. C.)
<br />ArfITANIDECI,AIAIIO!
<br />I M,y arnn u.dcr pctrlhyof p.rjury om orthe fouo*ins dslMrn,ns
<br />Dcmlirion Plrmns.Ash.$os Nolification Fcdcrsl RcBubrn,ns fink 40, Pa.l6)
<br />Rcquncn L.llcr of Ndilicalion
<br />-l
<br />ccnilirhalrl.c ltdcrul rcsu ld ions rcsrdins rshcdo\re.oval c nor,tPlir lct, rhisln+cr
<br />A4\,(Ir, htr, rcir,hFlff,Ea,,nn m.r (n,c,hi,
<br />'od$!ftc( rnJ srsrr Lws rclor,nE ro hurldrns!otr{ructn
<br />rtl. urnt,"r"a pn,prny r" n\N.rmnnnnnes
<br />rhc.txtrc inlonn ion is.omcr I agrr k,rotrlPlywir
<br />ApDlitn l o.,\xulSi,rnhltrrr
<br />T?b
<br />b
<br />Counryro ctrrcr uIi)nlh.
<br />lwlrc
<br />Sile-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fi re Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab i Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service [t/eler
<br />FINAL ,a1vrflg -1-N7 .dtfir/41
<br />Notes, Remarks Etc.
<br />APPBOVALS DATE
<br />Meter Release
<br />civll llnc\ u! t, onc h!ndrcd ihou\rnd dollrrs 151(x).(X[)). in
<br />bndcrs Addrcsq
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