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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hcEhy affi.n utulr pcnall, of pcrjlry rhdt I n cxcnrt fmnr lhc Coita.roN' Liccnse l-trr ntr rhc rollowin8 rcar. (Scc 70.11.5
<br />Brsincs ,.d Pturcssion Cdc): Any Ciry or Cou.ty which rcqun$ | pcnnil lo conslrucr, ,hd. nnProvc. dcmolish n mFn JDv
<br />{ructurc. prior to ns issuancc, ils rcquncs rhc ipphcrnl for skh Frmil ro filcr sisncd s,r.ncnt lhal hco.she is li.cnscd puNuanr
<br />b rhc Frvisions orihc Contraclu\ Lic.n{d htr (Chaplcr 9. Connncncin8 wilh Scclion 7fix) or Division :l ofrh' Bn(in's ind
<br />ProltsionsCodc)orrhalhcotshciscxcmptlhcrcfromrndrhcbashrorrhcrlhgcdexenrrion.Anyliolarioiorscclion?0:ll5brlnv
<br />rlplic.nIlororemirsuhj.cNlnc.Dplicrntloucirilpdnnxyornolmorclhonnvchutrdrcddolltrs($50o)
<br />-l-
<br />as .wno orrhc pmpcny. or nl,c !r.)Ns wnn Baecs.s thcn vnd.onr$N.tion. will d{, rh. work md lhc ntururc i( tror
<br />imcndcd or.il.rcd lbr elc isc.7041. Busincs md ltolt$iois Codcr Th. Contmcroi\ Li.cnsc Los docs nor q'ply lo an osnerof
<br />rhc propcn, *h(, huilds or in{raves lhersJn. arxl who docs such sol( iinsclfor hcr$llor lfirorgh hk.r hcr own cnIk,y..s.
<br />Ir.vidcd rhai srch inrpmvc,Bns m nor i cndcd .r olt'ercd fd {lc. ll howcvcr. th. btildira ot innmwnrnr h bld $ilhin oic vcr
<br />oiconDlction. rhc Ower Buildcr Billhavc rhe luden olF.vin8 ihar hc or shc dil nor huild or inPrcrc llld psrdv lor rhe Furl{t.f
<br />l. Nowncr ofrhc !x,pdny, amcxclusivclyc.nrtNrins *irh Iiccnscd conlracttr\ to.orslrucl lhc Pmjcd (SLt.,l)41- BrinA\
<br />lnd PrnbssionC.d. ThcConnacroisLi.ctrsc Ldwdocs mr nprlyn, rn.ancr ofPropenrwho bxildso, i pnrvcsrh.rcon.
<br />.trd qho .onlrrcrsi{rstchpn,lccbwith{Conrr!.tn(\) licctr{d nuBunnr loihcCont ttrt Liccnrc ljw)
<br />I n.x.frt, trnJ.' sr(ltrr .11 &l'( rdrh\'.r{nr
<br />(hrn.r
<br />\1()RKITRS', (l)\lfliNS,\l !{)N
<br />L2rtL lidllar
<br />Il'.'rhynlltr r nD,L.r t).nrLrt.ll)r'lur!.m uT rl[ ],'ll,n\ir,3 (L.rLr.rrit \
<br />I ;rl\r ( ,r1..1,)r thc r('ltnrrr r...lrhc uorl li,r \hr.lr L r prrfr I i\ su.ll
<br />My\ork.n comFnsdrn[ insunrcc dFid and Policy numl,cr r.:
<br />\[\l
<br />/t
<br />-lccniiyrhrlinthcl.rroirnrtrccollhc*.rkntrshi.hrhtpcfln
<br />n is\u.d.l shrllnol cn]PkrrrivP.*on inonvtunmr
<br />s. k, trconf, suhjcl lo lhc *orkds .onrFnsolion hw! of Calif{,mi{ dnd.src
<br />'har
<br />irl sh.uld hccome slbi{r lo thc
<br />workcri cotrfcns io.povhn,nrdrScctiotr l?0ooflhc tihtr Cod..l shdll. lonh!irh.. Yly wiln thos provi\i{'ns
<br />WARNINC l.r'iLrtr. r. {.urc s.rkcr!' con,Fns ri(,, covcrdS.n unh*rrl aM shrll {,hic.i an c.rloycr lo ai'ni'd Ntr.hics.nd
<br />ciril lincs uf ro o.c huMrcd rhauslnd dolhi\ (Slu).()(XJ). ir iddir
<br />?.\,oDar€: I r
<br />Ih.rcbyaflnNDrdcr |rnnllyorn rjury rh IdDr licnsc(l vin.nofChnprcr9(rortrDcNirrS*ithSc.ri{D7UXr)oil)ivi\t,n:l
<br />of rhc Busin.\r and Ptufc$ions Codc. rd ry li...t is in iulliorcc a efr..r
<br />{3 Oo1 b
<br />4-1.1 O t.nr,u.r,.
<br />Lrndq's Addrcs
<br />-
<br />APPLICAN'T DECI ARdTI(TN
<br />I lEEhy nrm undcr pcnallyol pcrjury.nc ot lhc followin8 declulln,nsl
<br />De.Dlirion Pcrmih Asr.sos Nolificrrion Fedetul Rcguldions (Tillc40. Pd(,
<br />Rcquircd Lctlcr of Norifi crliotr
<br />-lccniiyrh,r
<br />rhc i.dcr.l rcsuhrlons rcgddnrS,sbcsos tcnDvrlarc tror iPrlic lcro rhisnmic.l
<br />Q:r-rcn,ri rhd r hrvc rclll]rhi\ irpIt.r ion rxl sr,rc rhd rhc rbv. inftm id, i\ conccr. l .Are lo comPly wilh rll Cilv u Counry
<br />o thi.cs.nd Srrlc LrwsrcLri',! k,bu
<br />r'lrvc nrninnd ttuFny tu ir\pccri(n,
<br />oirhh Cirydnd Coutrly lo enrcr uB,' rlt
<br />AppliuDlor \!ol Sisn iurc *,"J.L-lt-
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monumenl)
<br />Life Safetv /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rouqh {/Q)*>aal )
<br />Service [t/eter
<br />'6/?//q,7Wf1 a)(;1
<br />Notes, Remarks, Et c C(}NSTRT]CTION t T'NNING AGENCY
<br />Ihcrcbyafrmundcrpcnalryorpcrjurylhalrhcreta.on{.lionlcndirPa8ei.yfo,thcFrfollMceofrh.wortforwhichlhhFnnnn
<br />issucd (Sec 309?, Civ. C.).
<br />l.n lcr'. Nrnc
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<br />Pemiiee nrn. (printl:n,0/
<br />FINAL
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