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ELECTBICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNOR BUILDER DELC RATION
<br />I hcrcl,y ai6rm !nde, pcnalry or rcrjDry rh0t I dn cxcmpl fmnr lhc G'n!rucb^ Li.cns llw tor Inc follo$ins r.a$n (sd 70115
<br />Bu\incs\ lnd Pturcrsion codc): Any City or Colnly which rcqui(s , Fmn ro onslocl. aho, idPmvq dcmlish or q,an lny 's cru,c, lrhr lo irs hsumcc. rl$ rcqniEs rhc {pli., lor such Fnnir kr filc a risncd (rcmnr rhol tr or shc n licc.\cd puBU!
<br />k, rhc pmvnions ol rlr C.nr,clols Liccns.n L,* (Chrptcr 9, CommRing silh Secrion 7(x)0 ot Divkion I olthc Busincss rnd
<br />Pnrrcssion. Codc).r rhal h.orshc hcrcmpt lhcrcf,omlnd rhc basir ror Ih. rl lcScd cxe m0ion. Any violarionofscclionT0:ll 5 by d.y
<br />aml'.n lbrapen lsubjcchlhc amlicanr ro tcivilp.nahyofnor 'mrcthrn fivc h!.dEddollus (S500)
<br />-l.
<br />ar owncr ol rhc rop.ny, dm .r.lusivcly rontacrins with liccn{d co rracrtrs ro conrrud rhc pojd l Sc. TN4. ausrm$
<br />Md lrlDL\sir Codc Thc Contncror's t-iccn$ Law doos nor ryply ro un os ncr o l tn)pcny wlx, builds or imnrovcs rhcr.on
<br />trnd who conrrads tu su.h pml.cB wnh a Contlclorln ltcnrd prFunr k, rhc contracrois Liccnsc lrw)
<br />I mcrcmpl lnder S(l
<br />WoRKFRS' CoI!IPENSAA(IN
<br />t2Er;ld&lrlllN
<br />I hcrcby !firm undcr pcnrlry or pdjury oR ol I hc lolb$inB de.^hrllior:
<br />-l
<br />h!!c exl will nuinraii , C.nitlc{c of Consenr ro Scla lnslrc ld workm mmpcnsatn'n. as F,viddd ror by Salion 37(rO of lhc
<br />tihor Codc. tbr lhc I'crforromc ofthc to* ror uhhh rhc i,.imit n nsEd.
<br />-l hrlc undtillnBinrrin workcrJ .ontlcNilion ir\uturcc- r\ rcq ncd hysc.rh 3]u)oIrhc lrborCodc. rot rhc teifonmncc oi
<br />pcnn is s\en. M, * orkcr' oDa.nsrr ion insurr..crricr JPlicynunrh.rtd
<br />l st^ f-n5 .qo
<br />I..rlili rhlr in lhc pcrbrmanccolihc worr r{tr whkhrhi\ pcnnn is hsuct.l shau nor c'nr,loy ,n, ,cGon in any m.rcr
<br />so !s h bcconr sub,icct lo rhc *orkcr .omPcnmtiotr hws ofcalilomia,6d +rc.ltur ill should hcc.rtu subis l. ihc
<br />wolkcm conDcnstion prcvnions or sc.rion lru) .I thc titor Codc. I \h,ll tunhsilh .oryly wilh rho{ Pturki)ns
<br />WARNINC: Ililure b {.utu uorrcn onlpcns.ttun covcru-qc is unlawrul. rnd shdl subicr un enll{,)t k, ri'ninal lEnahts od
<br />civil incs !D Io one hlndrd rhousrtrd dolla^ ($luo.l)oo)- in rddirion ro rhc c.sl ofcotrr,Etrelion, dnruecs rs ri(,vidcd iq lnc
<br />Sccrn,tr 3076 ofthc bh.r C{xi.. inrcmsl and arlorrcy.s fcc
<br />,.,",JuN 1l 2018^,,,,*.,,
<br />LICENIED-CONISA!:IOA
<br />DECI,If,AIION
<br />I hmby afirm undcr p.nahy ol pcrjury rhar I am lientd undcr Pmvision of Chaptc,9 (conmfting with Sdion 7000).rDivhi..1
<br />ol rhc Susincss and Pmfcsions Codc. and ny lic€as n in tull fod and cfiel
<br />{3.oo1
<br />,.,",JUt*** XSfS c-,-"*, 6.'.t<-ra^. ,
<br />CoNSTRIICTION LEX\N!N{I A(iENCI
<br />I hcrcby rItuD lnder rEnalry or t rjry lnar thcrc t a connrudiofl L.dine rScmy for lhc I,crfolfuc. .r rhc work for *hich rhi\ trrn h
<br />hsucdls& 1097, civ. c.)
<br />APILIIANLDECI.ATAIIQN
<br />I hettry affm undcr pcnalry olp.rjury orc oflhc fouowi.g dcclamrions:
<br />Dcmlition P$nirs AsbesrG Norification F.dcrrl R.ruhrio.s (Tirl.40. Pd6)
<br />-Rc{uied
<br />lrtrer dr Norifrarioo
<br />-I
<br />..nify lha! thc fcdcEl rcgulalions rcs{diis e\b.std nmval N ml sppltabk ro thie !mj€t.
<br />Lr *niry rrur t m," ,*a rli. 4tlic ion sJld slrtc lhal lhc ah)ve inlotrulion ir .orol. I t8e lo otrqiy snh tll Cny rnd Counrv
<br />ordinorccs and Shlc l,uws elrtine ro bo
<br />itr,vc ftnrioncd Imp€ny lor in\pdn'n
<br />ivc\ ol riis Ciry and C.umytu cnlcr rlof rlr
<br />,\pDlitant or Alonl SillnoiuF:C"n "7,'//A;--:,IJffit+@
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />It/eler Release
<br />Rouoh
<br />Service [/]eter
<br />'{/o.ttlls 5b4x
<br />Notes, Remarks, Etc '?c tS loIa
<br />L ds owtur or rh. i)roFny. or my crnployccs wirhwa8c\r rien $h omPetrslio., willdo lhcwo,kD ih. strudurc h nor
<br />i c cd or olicrcn for slc (S€ 7(x4, Buqircss and Pmfcssions Codc: The Conrra.lois Liccns. tjw dms nol olnly ro an uemr of
<br />rhe pollcn, *lnr builds or impmB thcNtr. ud who d(s sh hrt him\clro. tEsclfot rhmuBh his ot hcr ow6.mplottcs,
<br />Drclidcd rh.r such inDovemnh m mr inrcrH or ofic,cd fttr uh ll h.Mvcr. rhc hoildins or imntukmm i] sU sithin ,,nc )cs
<br />ol con{rLisn. lh. Owmr Bui!.rsillhnve rhc hudcn of ptuvin8 rhd h. or shc did mr tDild or in\Tok th. FoFny for rh€ I[qrE of
<br />L€ftld r N,mc
<br />-
<br />Site-Work
<br />Transformers
<br />FINAL
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