|
ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNUR BUILDER DELCARATTON
<br />I hcEhy afinn uoncr Fnrxy oi l.ijry rh.r I m crcnrlr fm.r lhe Conr.acnr^ t-ic.ne Ij* lor rhc lollowins rcasn (scc 70rl s
<br />Businds id Pnrt \.nr Cdcl Anl Cily o! Counry snich rcqun$ a p.nnn to conrrucr, lltcr, imProvc, d.mlhh or mNir My
<br />(rucrurc. priorro irs issuancc, also r.qutc\ rhc aF licnm ror\uch Fnni lo filca sisncd iarcftnr rh h.or shc i liccnsed IDGuanr
<br />ro rh. F,virbns .rrh. Contracft s Li.cn*d lj* (Chapicr L Connr,f,i.8 wnh Scction ?(l)0 of Dilirn,n -l orrhc Businc$ ond
<br />Pml!$n,ns Codc,orth.r lEorshc iscxc'npr rhcrcfromdM rh.hsn for lhc ollcscd crcr{,rion Anyviobrionofscctio.T0ll5hrrny
<br />!pplicont lor r Frnit subjcc(rhc npflicant ro acivilpcnrlryolnol nbrclhan five hundr.ddolldr ($5t10)
<br />!. 0s own$ ol rhc pmp.ny. or my cn{loyce\ wirh wascs N rh.n vnc ..nPctrdnnr. rill do rhc aorl uri irE $Eturc h ml
<br />inrcndcd or otlcrcd I'or sale (S( 7044, ausiftss dnd Pi.Lrsiohs Cdlc: Thc Conr@lois Licci*c bw des ml omly to an own.rof
<br />rhc ptuFny who hoildr or in{rc6llL]mn. !d uho d{E\ sNt hrl himrclr o, h.rslf ot lhDuah hn or hcr owo tmplotcci
<br />providcd rn,l such inpmrmrk m n inrLndcd orofimd fdsnL li howc!.r rhc lldilding or i,llmrcftm is srh snhin orc F{
<br />ofcoq'tlio". tlE Ovncr Bliklr sill hrvc rhc boni.n of povinB rhd h. ot shc dA mt $oild or nr{rolc rhc tFP.nt aor lh. puqnc of
<br />-l-
<br />as o*rc! of rhc pmri.ny. rnrrxclurivelyco ract inS w it h licc n scd colr rud.n ro .onsrd.r r tE ltoj.rr ( S.c 704.1, 3 u\ioc$
<br />on'l PrdL\snn Codc: Thc Conrra.ti, s t-i..n\. L,u docs nor arply r. an ownc, offlopcny{ho builds or imtovcs thcrcon.
<br />snd who $nrtucrs tu such rrcj.rh wirh a Conrracrorlr li.enscd ,'r r(unr ro rh. contaclois Liccn$ ljw)
<br />-l
<br />rcxcmlr undd S(r
<br />OPn.r
<br />]TOAtrE8.'IAMT};NSAIIIIN
<br />I)IIITIBA.IION
<br />I icrchy lmfl! undcr FDaxyorr.rjur! uN ordc ioll,'$in8 dcclmri,)n\
<br />-l
<br />h.vc un Bill
<br />'Mnrllin a C.nificrrc or con*nt ro sclil.ruE lor *orts odpcnsrion. as Ptuvidcd lbr by Sccrion l70o or rhc
<br />Latxr Orlc. fttr lhc t rfonMme ol thc work for which thc ,c.nn h issucd.
<br />-l harc rnd uillmuinlain sorlcr'.onl*nsario. nrsur.rEc. os rcquircd hy Sarion :l7m or thc titDr Codc.lor lhc psrornMcc uf
<br />Dcrnir is isssd. Mywoittrs o!np( ns,l io n i Nullncc ca cr dl I.li.y numbct m:
<br />-l
<br />ccnily lhur in lhc l)c.torrotc orrh. uork nx which thh Fnnit is nslcd, I \hrll mr .mploylny !cr$n in any manrcr
<br />$ s ro l,ccom s$icd ro rh. workdc conu'cnsar ion hws of Crl 'ornia, dnd agm rhor if I should nccom s$icd ro rhc
<br />*orter' comF.o$rirn ,mvi\ions of Scclion 3'7(D of rhc LrtE Codc- I shzll. rodhwirh mmJ,ly wirh I h.s Pmvi\ions .
<br />lurc ro *curc qo*cn conrrcnsarion covcmsc i! unhwrul. d !tull slhi\r an cnpk,ycr h 6inin0lJEuhies 3nd
<br />h. tlh{ (iklc. i'trc..n rntl rr(trm} \ tce\
<br />1 1 2018 ^,,,,...,,
<br />,,dUN
<br />DECI.AEA.IIO!
<br />I hcrcby atftrm unds Fnalrrotrdhryrhar I am licnsd undn povision ofChllrd 9 (m,nnrRifl8 Rilh Scclion 7000) nrDiviri.n I
<br />or $. ausim$ and Polcssions Codc. a.d d, lkcosc Lr nr tull roN and clf(l.
<br />Li.{T
<br />',dAJ
<br />l9qat q"t
<br />V ft ruN.
<br />CONSIBIJI]UOXIEIDINGA{iINII
<br />I hcrchy arfiirn trndcr Ir nnliy ol pcrrury rh3r lherc n a onitucri,n lcndinS !8cR-.y f.r lhc Pcraormancc ofrh. wotk li,r *hich rhis Fnnir i\
<br />issucd (Scc .109?. Civ C )
<br />AITIICANfDEILAAAIION
<br />I h.rct! ufrinn un&, pcnllry or Frjury orc ofrhc followin8 dslurarions:
<br />D.rmltion Pcirtrits.Asbc(os Norificlrion Fcd.Bl R.Eulatio.s (Tirlc 40. Pan6)
<br />Rcqurcd r.rrn of Norifi clri{,.
<br />-l
<br />ccnily lhar rhc fcdcrll ree]ll,riois rcEddin8 asbcslos rcmvalnrc nor apnlic0bL ro thn Pmjcct
<br />h.rniryrh, lhrK rcnd rhi\ 0l'nti.rlionrfrt dr(c rdnurion is cord I (sre k, .o.Dly wnh sll Cny lnd Colnr,
<br />ordi.sicc\ rrd Srdc trw\rhing r) huil{ll yaid Counlylo cnrcr !En, rh-
<br />rlx'v. trrnli,nr.J fR)p.ny,,, irN
<br />Applionl or AA.nl Si,tnHl
<br />:?aP'tat-- A+JAa
<br />!!Jry1'119
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Satety /Low Vollage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rouqh ,\J#l
<br />Service Meter
<br />FINAL
<br />Notes Remarks -f1.-^(ta nZB
<br />1 L0 J
<br />APPROVALS
<br />Communications Cable
<br />b/t,t /ic^
<br />ilatl/lLt z\s 6V
<br />Etc.
<br />(.1 .\q.
<br />ttrl'dc' \ AdJrc$ _
<br />----+---------r-----
|