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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUIt,DER DELCARATIoN
<br />I hcrcby ofirm undcr ,t..lry oi lcrjury rhor I 6n cxcnu fmrn rhc Contrc'o6 l-tcnsc L.r lor lhc followin3 rcaen ( S( ?0l l 5
<br />Bu\i.css uil Prolcssion Code): Any Ci!, or Counly whi.h E{utcs a rErmil ro c.nnrud. rhcr. imp.orc. dcmlth or mnrt Eny
<br />(tudurc, Jri, ro n! is\un c, also rqnies rhc oppliclnr lor slch Fmir ro firc tr lilnsi {ar.mir rhsr lE o, sh. i li..n{d pu6u,n!
<br />ro thc prcvhiotrs olllf, Contra.lors Liccna'd t w (Orprcr 9. C.mmrcing wirh Scctnnr 7(m oI Division 3 ofthc BusnEs lnd
<br />Pmrcsn,n\Codc)orthalltorxhc iscrcmpt lhcrcnonrand ihe hasis forthcnllcscd eicnDrion. Anyvn,brionofStrionT0.rl S hy any
<br />iptli.anr for a pcnnil subjc.hrhc applicxnr ro rcivilpctulryoliornn,rrh! firr hx.drcd d.llaB ($50O)
<br />Y!}AtrEBS:I;OMTENIAIION
<br />DtsCTINAIIAN
<br />I hcrcby rfilrnr undcr p. tr.lty of pcqury oft ot rhc fdbwing dc.lnr.rnnNl
<br />-ltaveandwillnEinrain!CcnificareotCone
<br />r r. Sclll$urc lor woriss conEnsarioo. us nmlidcd,or by Setb. l?(x) of rhc
<br />L.bor Cod.. rbr lhc Idlorrune of lne mrk for *hth lnc Fmit is issucd.
<br />A4 1.\.r1
<br />I ccnifyrh$ in Oc F.tormncc of rhc work forshich rhn pcflnir is isued.l shtrllio' enrloyriypcno. inanymMncr
<br />so .sro bcconE subl.cr ro rh. workcr omp.trsdbn la*\ oaCalif.rnia. and agm thar itl ihoukl tEconE subrcr to lhc
<br />f,orkcs comFcnslrion lmvhions ofScrio. r7fi)olrhc tjhor Codc.I shal]. tunhwilh cnnlly *irh lhorc !rcvisions
<br />WARNINC r{irurc io sm wolkctr conqrnsariotr mw.ag. is unbwtul. ,nd sholl s'bicl an cq)lorer to siminal lrmlrics and
<br />civil fincs ur ro oft hxndmd lhousnd dollrtr (SloO.{Xl)). i6 addirion (o rhc cos ofcoryf,nsolion. d!ro8cs rs prorilcd for lh€
<br />Sccti.n 1076 oa rhc lirr Codc. intcresr dld anomt\ f.c\
<br />'itAY t7 2018
<br />I hercby lirm undcr pcn0lryofncruly that I am liatred undcr DmvGion otChaprq 9 (conrftrcins wirh Sccrioi 7ffD) orDivhi,n.l
<br />of
<br />'hc
<br />Busincsand PoLssions Codc. and ryliclnsc i3 in rull for.. aril cfidt.
<br />I oo9?gq-
<br />ilAffiT . ConIro.lo.:
<br />tolsrBllcuoa.LliNuNe-ac[Ntr
<br />I hcEby,fl,nnuMcr lEnrhy of p.rjnry lhal rhcrc k, con{ru.rion hndinS 0gctry for rhc pcrloirnncc ofthc wort lor which rhh rcrnrir h
<br />hsucn (Scc :l(}o7-Civ. C )
<br />Lmdcas Nam:-
<br />aftl.llaNl.lEclllnluo!
<br />I Lrby dtinn u id.r Fnrlrt orr.rjury onc otrh. fdluuing dccl[artun\.
<br />I).nynirn,n P.nnit\ Asbc{o\Norificrri.n Fcdcral Re8nhlion\ ('l'illc.tl). Pda,
<br />Itc!uR,l lrncrol Norili. rnnr
<br />-lccnifyrhor
<br />rhc fcdcBl rcBul3rions rc8ldirs lshc{os rcnNv0l0rc mr umlicrhlc nr rhi\ !n+cr
<br />,t4rrniry rhr I ruk rc l rrxs rprli.ari{nr
<br />'xl
<br />dric rhlr rhc rh'rc i',nniurim i\ .orc.r I !r c. k, .otrrtry wirh all ciry {nl Cotr ry
<br />onlinrn..\ ntrtlSrrr.lN\ruhriry b buil,liig ..n\rrucri,n,. )nJ h.r.6v ivo\ olrhi\(ittrnd Cotr ryn,.drcl ul!i rhr
<br />abo\c rf,rri,lrd Dml[rry tur ifsrrcrnnr Durlx)\c\
<br />Ap!liMnr or [rnl Sirnnlum:1
<br />A-'"o'
<br />ftflaY r r
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleler Release
<br />Rough {/t t//z >,tt 11|'tzt td(
<br />Service lvleter
<br />FINAL 't/o-/rt 5N63
<br />Notes, Remarks, Etc.
<br />COMMENTS
<br />Pole Bases
<br />Under SIab / Floor
<br />Air Condilioners
<br />l. N os'Er orrhc pmpcny. or nycmplo$cs wnh *l8cs ns lhct \olc comr,.n\urion- *illdo lhc,ork and rh. nndm is n.r
<br />irlcklcd oroft rcd tur s.l. (5(.?041. Busincs Md t'rota\\n,n\ Cdlc Thc Coita.r.r's Li.ctrsc Lrw d..s not apdy ro oNtrcr ol
<br />rhcpmpcny slx) huilds or inlprovcs rhcrmn. snd who dEs {ch wolt hinFclfor hcr{lfor rhmrah hil or hcr o*n.nitnrFcs.
<br />proridcd rhd such inlnovcmnrs ec mr ir cndcd .r ofical tu eL. ll howcvc. th: truildmg or impnrcnrnr is sU *irhin on. )w
<br />olcomplcriur rh. Owmr BuiUcr will hrv. rh. hurdcn of pn,ving tb, hc or sh. did frn bxiu or nn dr rhc aroF{y fo. rtr purr$e oa
<br />LNrwnrrofrhcftupd!.,mcx.lurivcly.ont ing wirh liccnr.d.ontackB b.onifl.r rh. pi,lc.i lSN.7(}14. ausirE$
<br />snl fir,ti\siDCodc:IncContra.rofsLicnscLowdocsnor0tplrroanouncrofprcr.ny$h,)hlildsorin,prcv.\rhcrcon.
<br />and who.onk{.klar$uchtmjecrswirhsGnhdo(nlicctr{JlurlmrhrhcG)nra.kr'sLi..ns.Ldw)
<br />I rflcrcnlpI undd Sccrion , B. & P.C. for rhis rca\)n
<br />Dil.
<br />_l havcrnd will maifllaitr *ortc6 conEnsolion insumk-^c. trs rcquircd 6y SG..liotr 37(xJ ollhc btror Code. for lhc perlotrEnc o{
<br />rhc sork ror whicnltisFrnil is tsu.n Mywolkqr c.mpensolt,n inluancc .aricr ana Fl ic, nrnber m:
<br />trnd.r'r Addrcs
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