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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNI'X BUIt,DER DEI-C RATION
<br />I ha.by arrn undd pdah! of pdjury rhal I an exchfl from rh. Conrraclo6 Lic.hs. In* aor rhe followins r@,4 (sd 70ll I s
<br />BusinN d Protsioo Codc): Any Cit, or cou.ty $hich r.qut6 a Fnn ro coNrtuct. ah6. nnprov., dcmlish or r.?at &v
<br />slru.luc. prio, ro ils i.str6c., slso Eq!i6 lhc applicar fo, such ,cmi ro 6lc s sign.d slal@l lhal h. or sh. b licd.d l)N.lit
<br />to lhc lrovisioN ofrh. Conr,ctorr Lian$n Liw (CnapG 9. Commflcins *nh Sdrion ?000 olOivision I .t the Busins aad
<br />PrcfNionsCodc)orrharh.orsheir.ronptih6.aromedlficbastaorrh.dll.B.dcxmplion.AnyriolalionotsclionT0llSbvsn,
<br />applica for a p6ftn subjdb lhc opplicanltoacivilpcoalryoaf,olmo,eihmfivchundrcddoll6($500)
<br />L s ownq ol rhc rroFny, or ml dnployG with was6 6 lhet $1. comp€nsalion, vill do rh. *or! Md rh. stnd& is nol
<br />inrorlil or ord.d for sl. 156.7044. Busindr dd PofB,oG codq l]le Cohtadois Lic.m. l-av do6 oor a!pl, ro m oNnd of
<br />rh. porqly who buildt or impr.!6 rhqon. &d sto do6 s.h N!* him$lf or huelr or rhroqh his or hs ost .hplorc.
<br />provid.d lh.t so(t noproveMls @ nol into .i or ofis.d for elc I t ho*45. rh. hildins or imprordal ie sld \vithin on. )@
<br />ofempleriJn. rh. o\mr a{i}l6 vill have lh. budo oirovnE rha h. or sne did not triH or ilnprc!. fic pmpslv for lhc plrpos. oa
<br />l. so"nd.frh.prop.ny. r.Klus,rcly contacrins $nh licdstd conrado* ro .onsld.t lhe Itroj<1 (s( 7014. BGin6
<br />and Pmfdion Cod.: Th. Conlrsclois Licmsc La* do6 nd arplr ro eownd ol propcny sho blilds or impror6 rhdon,
<br />dd who.ontdsforsuchpoj<GwnhaGntra.to(nlic.trs.dpu6@lroOc(onrEcloisl-icmsl$r).
<br />-l
<br />d ex.mfl u.dd selio
<br />WORKf, RS' CON'PENSATION
<br />llEcla8alll)!
<br />I haeby amm undd poanyofpsjuryonc oflhc follo*ins ddldarions.
<br />I ha!. ud vill minlain a C.nilicalc oacolN4r lo S.lf-ldur. lor $ork6s conrpcnsrion, s p@vid.d for bv Selion 1700 o f lh.
<br />bbor Cod., fo! lhc psfor]w.c of lh. wort for {hich $€ ponn it issu.d.
<br />( havc and -iU oaiotai. wo,k€d comp.Galion iNL@cc. s r.qun d by Sslion llTOO of th. kbor codc. lor lhc pqfommc. of
<br />rh. so,k lor rvh(h rhis pnnn is iscd. My workdt codpqsalion iBu@cc coris ed loli.t numb6 dc
<br />{ate
<br />zy6 . //_//_2oE
<br />I cdify lfiar in rhcr'6foman eofIhcwolk for whichlhis psnir is issucd,I shall not onploy6nrPfton inonvmu.d
<br />e 6b hdo,n subi(r rolh.$ork6 omrssnion lNs ofcalifomia. md ase rh ii! should bcomc subjd orhe
<br />$olk6 .omFMlion provisioN olsctioo ITO(] of th. tlbor code I shall. fonhNirh comply s irh lhos provisiom
<br />WAININGT Failurc lo s(c *ortm' compmrion covsasc is unla*ful. dd shall subj6l d @plo)tr lo oiminal ,oahi6 ed
<br />cilil ,in6 up lo orc luodr.d rhoMd doll6 (S|OO.C{O). in addilion ro rh. cosl ol.omD.tualion, dan gcs 6 provid.d for lhc
<br />Sdrion rU ,6 or rhe tibor Co'lc. mr6.i dd onomey'! le /L-y'/l---_ t- 20t5 Appltanr: ,<
<br />tr(l;ts_utL(l)t(lla(.lo.BDLgi!&lI&N
<br />I hftby afllro undd poDlry o t prjury rhal I an licds.d und( lrolilion of Chapld 9 (conmdcints wilh Sstion ?000) 'r Division 1
<br />of fi. ausias ud PDlsioN Cod., fd my lic.N is in full forc a.d elIsl
<br />L.q Z'77 72s7
<br />"*",114:2!// ,*'^o*,t
<br />co!$alclloN.L[NplNcacllcl
<br />I hGby aJrfln md6 Fnahy o I ldjury 0Bl lho. i! . codtu lion tndins !ed., lor th. FaonMce otlh. work aor trnich thE Fni ;
<br />issu€d tsd.1097, civ. c ).
<br />ATEIICANI.IICI,AsAIIO!
<br />I hod, arm undd p.f,alty of Fjury on. ol lhc follovioS deldalions:
<br />Dcdohion P6nir! arbdos Nolification F.d6.l R.eul.rio.s ( l ill. 40. Psl6)
<br />-Rcqu@d
<br />ldtdoanoitcalion
<br />I cdi0 in ln€ Lnaol rqlulalroB Esedins sb6tos rdnolal &. nol applicable lo this pRlet.
<br />lll cd't rhd I havc @J lhis appl(alion od sllrc rhd 'h. abov. infomalion Ls cor..l. I asr* to omplv wnh all Ci{v and Counlv
<br />odinanc6 ed srft bws rclalins lo blildirs cosrru.liotr dd h6.by ou$on,r repr6allativB of this Cnv dd Coutrlv to alq upon the
<br />"^,"
<br />' //- l- zo,7
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)Gtt6ZA-tK)-,/
<br />Walls (Rouqh)fAnrr*ln ,/
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh) J t).e*{o -qr)
<br />I\4eter Release
<br />I
<br />Rough rtll /ttr A\niltq '[d-,
<br />Service Meter
<br />FINAL 2 J)zt>J{O
<br />Notes, Remarks, Etc.
<br />It
<br />lt
<br />tl- )
<br />tft
<br />'-t9
<br />I md..! Add6
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<br />ahovc mmhon.J ptupdry lo! insp<.lion purErs- nJ- 2--
<br />Applicinr or Aq6r sirnrrure 7\ ,/ L?- -
<br />Permi,mnrmerpn r )< Aar' 1<ckt^
<br />fT
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