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ELECTRICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I h.nhy rrfirn undlr pcnalty of pcijury lhlr I m cicnDr tiom rhc Conrreros Lhcnsc taw ior thc followins rcasn ls.t70.!l5
<br />Blsiness and Profc$ion Codc): Ary Ciry or Counry whi.h rcqxn.s a Fn t lo con(rucr- 1116. impmv.. &frrirh or rcJ'oir any
<br />sltu rurc. prio, ro n\ nsu,ice. rho r.quncs lhc r!,plicanl for su.h IEm l ro lilc a sisEd {dcmnr rhat tE or sh€ Ls liclntd puNsr
<br />lo rhc Folirions ol tlE Contraclols Liccnsed Lxw (Ch!pr.r 9. conmncin8 rith Seclion 70(n ol Divisi,,n I oi rhc Buiinc$ and
<br />PmfcsionsCodc)orrh{ltor3h.ircrcnrplthcrcfromaJdlh.bnsisforthcullcs.ncxc'nprion.Anyvi.lNlionofScclionT0ll5by$y
<br />aprlic,nr i{, !l.mir.ubjdtstn. appli.anl loacililpcnalryofnor mrclhrn livc hundrcd dolles ($500).
<br />-1,
<br />N nwncr ofrhc lroFdy, or my cmplo)ccs *ilh wa8cs as thcir sle conrcnuion. will do dE *ork xl rrE slnElK is nor
<br />i . rd orofrcrcd for s0lc(Sa 7044- Busines and Pmfc$ions Codc. Thc Conr,.rols Liccnt L2q &Es norlptlylo Mo*mrnf
<br />rhc tmtEny who huilds or in{owi rhodro,,.d who dds ru.h w( hnnsclior hcNllor lhrough hh or hd o*n.mployccs,
<br />providcd rhtrr su.h iqmkftnh m nor inrc .n o, offcEld for sh. Il h.wcrcr. llE building or nrFetmd h $td anhin om Ft
<br />ofc!trpkrion- rhc Owncr Bri*Lr will hdr rh. hdftrcn ot povnE ihd h. or \hc dd nor buill o. inDmvc 6c rnpsiy tor rh. flrlEs oa
<br />-l.,r.smrorih-
<br />nrorcny. trm crclusirclyconlraclins wiln liccnscd..dr&bN b.otr{trucr lh. prcJccl (Sec.7044. Busim$
<br />tr.d Bof$shn Codc lhcConrmcxtrsLiccnseLawdocsnorapplyb0nownnofp('p.nywhobuildsorinprovcsrhcrcor
<br />,nd wh. .ontricB rdr such pojNlr wilh a Cotrlmto(, liensed nurslanr lo rhc C.n'ra.tr\ Lkcnr tj*)
<br />I nn.xctrr,, urdcr Scdion-, B &PC turrhsrc.sotr.
<br />uaa6[&1lo&llENldraN
<br />DECLAAAIII'N
<br />I hcrcby riitm utrdcr p.nllry of Frjury otu ol rh. followin8 d.cLftri,rns
<br />I hivc .nd ull mrn ain ! CcniiEtrr. of Con*nr ro sdlf-In\urc fd kxkcs comltcr$l tr as polid.d nn by Sccrion l7(D oI rlE
<br />tihor (1xlc. l'o hc pslonMrcc oI rh. *ork fir *h ich rhc p.mir i\ i\socd
<br />-l hrr andsillnrinrrin woikcn compcnsurbn insurincc. us rcquircd hysc.rn)n lrmof rhe tjbor Codc. fot rhc Prrormkc of
<br />rh. w.!k r(, whi.h rhis ptinir is Gset. MyBorlcn'coDrl.n\arion inslrane crdu 8rld Flicy nu'nb.r c]
<br />-l
<br />ccnilrrhar inrhct.rrorm.kcofthc wort lbr *hi.hlhis pcirni( is hsucd.l sh,ll..t cnrtloy ony I'c6on inanrnMmi
<br />so 0s ro irNnE suh].d b thc wolkcr' .smp.n\dn,i hw\ .r Caliromia. {nd {8rcc thrr if I stoull bcmm subjt{r ro lhc
<br />workcs comtcnsarnrn F,vi\i.ns of Sccrion lTtX) of rhc bhrr Codc. l shall. fonhwnh comply wnh !ho{ pornions .
<br />WARNIN(; Fiilurc h $.urc s.*cr comlEnsrir covc(gc is urlJ{lul. aid drllnrh )cr b.niti'rl Nmlri\.nd
<br />,tr'r r' .LIr',,' lLrlnrrlj.L. rl,ltl.. 1l'*j.'ri''ion. damscs rs ln'vidcd ln lhc
<br />I hcr.by rflnm undf ,$rlry .f ltryry
<br />ol rhc B!\i.c)rnd Pmrcssio sCodc
<br />DECIAEATI!)N
<br />rhd Iam lion€d undc, Fntn'on' chJnE c ,.nmmmq $ trh serln 7000, ol D'vtrnn .1
<br />andny,Ectrrn ntu,rn,c,x, "^, q r, Z t{O {'4Wr*lWCq'er-Zmn
<br />CONS'f RT-IC]'IoN LFNDIN(i A(:ENCI
<br />Ih.toby,fllrnundd,cMltyolp.rjuryrharrhcrei\rcu.{d.rio Lnding!8cncyforrherftntun..olrhcsorklorwhichrhi\Fflnirit
<br />6',ndcls NanE
<br />AISUIANLDECI.AIAU!.}N
<br />I lmby nlfim undcr Fn.hy of pc.jury on. of rh. rolb*in8 dcc,mr ions:
<br />D.mhion PcrnilsAshcslos Noliarcarion Fcderal Rcgxlarion! (Thlc.1O. Pan6)
<br />-Rcquircd
<br />L.rrcr ot Notiff,ari.n
<br />I.. iryrh{ rhcfcdcrulrcsulariotr\ rcsrdins a\hdosrcnxnal rc trorrmli.$lclo lhn fl,)jt.r
<br />I ccnilirhlr lllNc rc.d rl,isrrpl iuri,u Md {rr.rhri rhc ilt^c rnnnnrri,I i\corNr I rsft r,.rmply*ith all Cnyand Coonrt
<br />iv.s ofrhir Cnyand Counl, lo cnhr dlnn rh.ordinliEcrand Srorc lj*s rclrinB kr bu oi{fl.rirnr. x l hcrchyitr
<br />rbvc nE.lioncd l)nrNny ti, in\pccl
<br />Applicanl or ,\qcnl sistutu
<br />e"^n* n ^",eano, fu2 84L4 fu-:^Qt/r*
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release A
<br />1-t?4y y-p(1{))
<br />Service Meter
<br />FINAL 1lzoltg -A''iD I+.r).*(lutl l-, |'u{rf h"t ?
<br />otes marks, Etc
<br />G
<br />0
<br />-7lza /-e-c,tul.tk-4 oL bak..
<br />L/\)
<br />APPROVALS DATE
<br />Communications Cable
<br />Rouqh e/)
<br />r( rl)
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