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ELECTBICAL.INSPECTOR RECOFD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BIIILDER DELCARATION
<br />I hcrcby alfifln u rr pcnalry of lcrjury fid I amcxcm t'ron the C.nr!.hn Li.cnsc Low lor thr following rcusn (S(.1r:11.5
<br />Busin.ss and Profcsion Cdc): A.y Cny or Counr, which rcqltes ! pcmn r. .onstud. .11tr, improlc &mlish or rcplt lny
<br />stu.rtrrc, Jrior ro irs issxrncc, d{o r.quircs lhc lp/i.Mr rorsuch l*rnln b filca siSncd inrcmcnl thrr lEor shc n lienscd luBuunr
<br />ro rhc povirio.s oa rhc C.nrEcrofs Lac.n*d hw (Chlprd 9. Conm.Ning wirh scc'ion 7000 ol Division I ofrhc Businc$ and
<br />Pmlcsions codc)or rhal hc or shc is excm lncRfrom aftl rhc &st for r hc .llqcd cxcnprion. Any violari.i of SNrb. 701I 5 by ,ny
<br />applicanr f{, a l].mir suhjccrs rh. {nnli.r b acivilpcnalryofnor m* rhdn fivc hundrcd dinles ($5iJ0)
<br />;p$' .**, r ,h. p-1"ny. or m) c,nf roirc\ I h wJF.\,s rhcr src m,n[lclvrnn. $,.. d. rk *nrr M rhc vo m h nitr
<br />',;rcno"a - nnt,"a r* -t ri<.7r,44- 8;sircs ond Pnlasmns code: Ttu c;.teld\ Licne tis dm3 n r .rply ro 0n owrc' .r
<br />llE pn)pcdy wb blilds d i;{mrcs rhcBnr. Md who d$s such m himsclior h-isctror ihmlgh hh or h.r own.mpbyrc\.
<br />,bvidcd rhd ruch inpmkftnk m mr inrcfrldl d ofi.rcd for slc ll ho*rw. lh. hoildin8 or iq,mrcmnl is sld virhin om )@
<br />of comptrion. lhc Ourcr Builds will harc rlE hrdcn of lmvitrs lh.1 lE or ste dil mr hoild o, in{ftk nE ImFny ror 0E !,uq$s ofr'
<br />Lasown$.rrhcptundy..ncrclusivclyco.r,dingsirhlicctr*d.onr.ctortoconslrucllhcnojccr(Scc70'.l,Bt\i"r\\
<br />and Pmnasion Codc: Thc Conllrcxtr s Li.ctrsc Ltrw do$ noi nptly lo trtr owncr otpDpcn, who huildr or inDrovcs lhcrcon.
<br />and who mnrd.ts fo! su.n rn+cls with d Contradons) liccn{d purua nrrhcConkr.tnst
<br />-l
<br />ucxcnrpt un,lcr S(l I./')o",", .Slzl t"l u-*., )(Y L-cffi.
<br />TOBf,!f,ILI;OMPJISAIION
<br />DEI;IAXa.IIIIN
<br />I hcrcby ofinmunds pcMlty oi psJlry onc ofrhc followinB d(lomrions:
<br />-l
<br />hrvc will nEinrain ! Ccnmcorc of Con*nr to Sclllnsurc for *olkcrs .omocnsur ioo. rs pruvidcdforhysccrion37mof r
<br />liht Cod., lor $. pdL,mR€ ol rhc w.rt td ehkh rh. Frnn is issucd.
<br />-l
<br />nurc and will mainhin *orkcc compcnsario. insurance, $ rcquiod by s(rion l70o ol rhc ljbor Codc, for lhc p.rii,rmnce of
<br />rhc work {m *hi:h r his }crmir is n$.d. My wo si ompensrion insurec .,rM ,rn p. cy 6unb.r m:
<br />/t5.cnily lhri if rhc |xrronMkc oflhcwork hr which lhn 0crmir n i\ucd.l sholltrol cnrpby rny pc^on inany umr
<br />$ !s'o bccom suhicr to rhc sorkcn compcn\lrion ln*s olCalirbmia, and lsft rh,r irl :buld tt.nft shitr to lhc
<br />\$rkc.onlpcnsrtn,ntmvhio.solSccrtrnlTmotrncljtnrCodc.l\hrll.r(,nh*irh.onPlyBirhrho$ri.visions
<br />\lARNINC: ljallurc lo scurc *orlc6 .1Dp.n\rrnnr coE
<br />civil lnNs np ro onc hunJrcl rho!$nd Jolhn lSlll).(xxr)
<br />S.cri,)n 1076olrhc lrh,('{x1., inrcrcd rJ anonrJ_ s frs
<br />*", 'slzl tt n,,,u".,F
<br />IIECI,AIAII!]N
<br />I hc6hy dmrn mdo p.mlry ot p.rjury lhar Lm lia.$d undr FDvision of Chofls 9 (@nmrcins sirh S.{rbo 7()o0} of oivision l
<br />of rhc Busituss and Pm{csrionq Cod.. u.d oy li.eo\e is i. lull for.c !d cffNr.
<br />Li..ns NuntErl
<br />caNsralsrcNu ulcncEN(r
<br />I hcEht alrtm undc. rEmlry oi pc,jury rhxl rhcrc t ! consltoction lcndins r8cn.y rtn rh. p.rroffuct or lh. work lor *hich lhn pcflril i
<br />issucd (s(. .1097. civ. c.)
<br />-l
<br />cenir lhol lhc f€nctll rcsulalio.s rcsldi.s lstxsto\ rcnhlllarc .or rrpltabL
<br />'o
<br />rhis,,mitr.
<br />A'rln iry rh.l I h,vc rcad this amli.arhtr and sllrc rhar Ih. !bo$ inform0ri.,t s comcr I lgr to c6mpl, wtrh .ll ciry snd counly
<br />.nlinrn.cs md Slarc tjws Ehlin8 lo builditrs consrrucrion, ard h.rcb) ourlFrA rcI'(scnrsr rvcr frhkC ,and Coun'ylocnl6uronlh.rh c ftFrnncd nml,.ny hr rlsD.d'on Durn s:-, . Iffil:#;1"'i' " -Wd,tu4oo-i4 *,. - sfi/ r s
<br />,"*u*,,.",,n,,, X/€€l-tsEo;l S a r,c j erS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding i UFER
<br />Translormers
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)rl
<br />lr/eter Release 5 r1 t6 J&Ju3Y
<br />Rough S il|llif.tl*-Ir-
<br />FINAL (t.. f/31-
<br />Notes, Remarks, Etc I
<br />to o t r
<br />4 I L I
<br />--t
<br />Communications Cable
<br />Sub-Panels
<br />Service Meter
<br />\ID
<br />{Lf,ndq'r Addrcs:
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<br />A.[[IJCANL!ECLI[6.II!]
<br />I tlrbydimnund.r Fn.lr, ofp.rjury o.c otthc iollowin8 dcclrr ions
<br />D.d,liri Pdnirs Asbcd.r Norificmion Ftdcril Rcguhrions (Tnb40. P3f,6)
<br />_RquiN lrrrcrof Mril-@ri0n
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