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ELECTRICAL.INSPECTOB RECOHD
<br />APPROVALS DATE ID/SIG.COMIIIENTS OWNER BUILDER DELCARATION
<br />I h.rchy ailrm uiJcr p.nalry of Frjury rhal I am cxcmpl from th. Conlmctor' Li.c.sc tis lnr dc follouin8 rca$n lscc 70ll 5
<br />ausituqs and Prorcs\ion Codc): Any Cily or Counly which rcquircs ! F.nir b .on(d.r. ahcr. inpmvc- &mlhh or qEt dy
<br />srfl.turc, prior ro ils t.uotrcc. !l$ rcquncs rhe rrtlicdl aor suchFmirt) lilc, si8ncd (utemnt
<br />'halhcor
<br />\h. k lkcnen onBu{nr
<br />ro rhc rhvisioG ot rh. Conractors Liccnsd tjw (Ch!!lcr 9. Cornmncing wnh s.crion xx)o of Division.] olrh. Bnsin * nnd
<br />Pmrcasions Cadc) or rtul lEorshc iscrcmllthcrclromand lhc hr\i\ rorrh.alkE.dcxcmplion AnyviollrionofscclhnT0.ll5byrny
<br />applicrtrr lor a p.rn t subjcch rhc amli.a.r k,a.ivilr.nahy.rno! nmrcrhan rivc hundrd dollor ($5m).
<br />I. as ovmrorrh. l,olErly. or nry cnl,lo]es uilh *ases as rh€ir s,h co'nFns,'nnr willdo itr sork ard rlE dBrm n ior
<br />intctucd or oFcrcd for \rk (SE 7(,'14, Brsincs and Pr.rcsion\ Cod. Th. Cotrtrrclot s Liccns li* doN tror ,pply lo an ow cr o,
<br />rhe Imrcny wtu bxild\ or in{,r.ves th.mn..nd *ho dcs such wir iinNlf or hcr*lfor rhiouah his or hcr osn enrPln)ccs,
<br />F)vidcd rlDr ru.h iuDmBmtrh rc
<br />'xn
<br />inrcndcil .r .ficrn li)r $lc. Il ln*c!.( rlE trildin8 or imfloknEnr is $ld wirhin . . ytdr
<br />of conplcion. thc Owncr |tuits will hsw rhc burdei orF,ins rr,n hc or shc dtu nor huild or nnpow rhc It6Fny ror lhc NlTnsc ol
<br />-l.rso*ner.frhcpopdny,rr.x.hNivclr.otrtr.lirBwilhliccnsedcodrrcr{xnr.oinr.rrhtrolc.r(Sccr04r-Bu!trcl!rnl Arfcsi.n Codc lhcConlri(nn s Ltcnsc I-r* docs nor trml!n) o! rcr ol Droli.ny *ho bl ild\ or in9tuv.s lhrrcotr.
<br />$J $ho c.nrrckror su.h tnoj.ch Nirh 0 Cotrlrrdo(\r liccnscd !ur{ nr t,rhc Gnnrdcktr s Liccnsc tj*)
<br />-l
<br />u'ncrchpr undc, Sc.riotr
<br />n-o8KE&::roruENJ rl)!
<br />DEEIA&III9Ii
<br />I hc.ehy allirn]undc. |Enrllyolpcriuryomof rhc n)lbtrinJr dc.lrr ri(N:
<br />I h.vc arilwillrmint.i,raCcnificBrcolConscnt b SclalnsuEn, worldr' cotrrFns.linn. ns pmvided tor bySftridn:1700orrh.
<br />l$or Codc. for rhc FrtordDn.c orlhc wor* for ehich lhc p.irn insucd.
<br />-l
<br />h0vc and will mainlain workcn cotrycnsdn nNur,ic.. a\ r.quircdbrScclion3700orrhcLalxJ,Codc,rorlhcpcrlornnnccor
<br />rhc wolk iorwnichlhh ncn.il is issrcd. Mywo.kcn conrpcnsdnn nsurun.c c.tricr u lrolicy iu rhr m:
<br />.944{. a^d,.^^',+l + Lr4b.l:1, (.
<br />\OoOOt" \\3L i\' ac+ ->4\g
<br />l..nifyrharirrhcpcrlorntrRTofrhcworklor*hichlhnpcrmir t NUrd. I \hnll mr cflr oy!tryPcronn,i yn1rnrcr
<br />$ slo tEcoiE suhtccr ro
<br />'hc
<br />virrcr co'npcnsarn,n hss orCalirornia. inlnsEc rhrr ir I\l'!rold trtom b.jcd ro lhc
<br />wolkLr(.onrFnsnrtotrrirovtion\ofSr.rn,nlTlDofrh.LihJrC.dc.ldmll.li)nhwilhconrPlywirhrho{nmvisions
<br />i{ARNING: Failun ro ccurc worlcB sn.Fnslrion olcBsc is unlawrul. alxt shrll suhjct m er.plortr rb Ltmiral F* ix !trd
<br />civil 6ncs up lo otrc hundrcd rhousand dollan (Sl(x).O(x)), in tddirion ro rhc.osl of omPcnsdrion. danag.s as [ovidcd lor th.
<br />s..rbn 1076ofd. Lnbor Codc, inlcrc lndlnotuyifes
<br />q -/^q\ - Zt,\L appn*tt.-t (?e. l' l 2,
<br />LI$ASEDJOIiISAT.&B
<br />DICIABAI&N
<br />I hcrchy rinm undcr pcmhr.lpdrjury rhnr I trm li.cnsdl undcr flovhion ofChlprcr 9lmnn]kncine wirh scclion 70(()) oI Dirisnnr:l
<br />of rhc Busi.cs md Pofc$ion\ Codc. and rny licd\c i\ in full f.(c dnd.lllcl
<br />B Glo *-tc
<br />9.1" . L,t -pa,, - Zi. t<!
<br />IaNEIAIIJ](III.TdDIIGAGENCI
<br />Lrre$y umrm undfi Fnally of r.qury lhol lhnc C o mnstruclion Lnding actfty ror lhc Frfomarc oa rlE wrk ror whf,h lhis JEmir k
<br />irsucd (Scc.109?. Civ C.).
<br />ATTUCANIDLCLAS TN
<br />I hcrc$y anim u ndcr lcnally olrcrjury om orrh. rolh)win8 d..tffdn rs
<br />Dc'toririon P*nirs Ashcios Noriiicrrion F-Lncml Rqrlarions ('l-ir l. 40. I'M6)
<br />Rcquncd t.trcr ol' Notifi cdion
<br />-l
<br />cenifyrhal rh. fcdc..l og! hr ions Egfdiog Ntr os rcmval sc nor applic lc h rhli poii1
<br />@l ccnify rhd I hak @d rhie {dk{rhn &rl $arc rhar rhc ahore inforroibn h corel.I aSre locornplyvith iI ciryoftl counlv
<br />6rda.'m. ard Sra(e bws El ing lo buildins conndclio.. ud hercly aurrhti* t Ft*ntalircs oa rhis Cny,nd Counly lo cntcr upon lh€
<br />dnv€ rntioftd lloFny tor insF3ion purposs.
<br />Appriont or Aaenr siaNtu*: L:Ela J't>o,n' 1-A!l
<br />l'e.n ree nsn,s(pnno: )'- C.''' L -()-
<br />'z 5
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Sbh./Eloot-
<br />Bondin6(QroundiddV UFE R ,z(-tq KczT
<br />Iranstormers
<br />Torqueing
<br />Sub Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />I\4eter Release
<br />Rouqh
<br />Service Meter 94-/1 Ecz2 /-\
<br />FINAL 7zt-t3 Pcr/4 zn5@, )
<br />Notes, Remarks, Etc
<br />..",^",",* (-,t'I7"
<br />tr'ndc''\ Nrnr
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<br />trnJ.r'.^Jdrc\\
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<br />Site-Work
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