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ELECTRICAL-INSPECTOR RECORD
<br />OWNER BUILDDN DELCARATION
<br />I h.rcby atrtrm ufl].r pcnally r)f Frju.y rhlr I u cxcmpr frcn rhc Conrecror' l-i.cn( rjw ror rh. following rcrsi (S(.?Olr.i
<br />ausinc$ aM Profc$io. Code): Any City o! Co! y which rcqltcl , pcrmir ro .onddcl. ahn. imptovc. dcmolhh or rcn: ir 8ny
<br />(rucrurc. prin ro irs hsume. !lw, rcq&cs rhc 4plts.' f(r .trch Frmil b filc tr siSn d ,l3tcm th.t hc or she i\ liM*d Puru r
<br />tu rh. [o]nio.s or dE Conlmctols Liccnsd L{w (Chaplcr 9. Conhencins qirh S€.rion 7O0o ol Divhion 3 oflh. Businc$ ond
<br />PmfcssionrCodc) orrhar hc o! sne is cr.6pr rhercfrodand rhc hosi r.r (hc rlkgcd.xc flion Any violathn of Sdbo 701I t by {ny
<br />appli.lnr tor a rcrdn .!bjcci! rhc rppli.anr ro acirilpc.anyoi.ol rmrc th0n fivc hunddd dolh* ($50o).
<br />l..sowncrolth.pmlcny.orm,cnuhrlcswilh*agcrusrhct<,Lconpcn.alion,willdothcwortandlhe(ftrhn,
<br />inrcdc{ or onircd ao! elc (Sft Ix4, auircss und P$f.sions Cod.: Th. Co"tEcrois Liccnsc l,s does .or atply ro an o*n$ of
<br />rhc pmr.ny who builds or iqnows rlEmn- ud wbo drEs slch hrL hi6*lf or hcMlr oi thmuSh hG or hcr own cmplorccs.
<br />!)hvdcd lhar ru.h inpmvcmnts ft mt imciddl or.fi.rd for eh It lnNcEr. rnc tuilding or inq,oktrnt k sold wirhin .n. ,cr
<br />or.od!,lcrirn, rh. Owfti auiu.r will h.rc ttr budcn of pmvirS lhlr trc or shc did mt bild or nnln,k lrt rmp.ny ror rhc lD4r* or
<br />l..sDwtrcr I rhc nmpcny. am crclusivcly conrGrirs wirh liccnrd contucrod t, co.(ru.r rtr r(ic.r (ss 7tl]4- Busrc$
<br />aftl Pnicssbn Codc: Thc Coni.acl{tr s Liccis. l-a* docs nor lpply k, M .wncr .l Frpcrl y $ho t uildi or imrDrcs rh.r.o .
<br />ind who .odach r.r such ttujccls rith 0 conracktrG) liccnsd pursEnl lorhc
<br />_l anerenfl @d6 SNI
<br />I hrr.hy rfind undcr rcnrlryolFrln
<br />-l
<br />h!v. tud wiu ruinrrin a C.diicarc orcdnscnr ro S.lr.lNuic lo. qorkcn' coflrlrcnsd bn, ds Inlidtd lnr hy Smr io. llo0 oi rhc
<br />L.bor Codc. lor rhc n rlomEna ot rhc so,k for shich rhc pcrnir i\ il cd.
<br />_l havc ari *iU nuinrain *orkc* conFnsarnri iNuran.., .s rnun d by S.rrion 3'7(xr of lhc tilxn G c. ror rhc !.rformrcc of
<br />rhc sorl fdwhi.hrlis prrnrir ir issed. Myworkctr comJrcnsarion iNun.cc clrier und F,lt, trumbo r.
<br />Pol'c, Nunbcr
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<br />F\pn
<br />-l
<br />ccnili lhll in lhc,Err'oulncc ol rhc un* tlr *hich rhis p.i,nir is isuL{, I sholl nol cnPloy aor,rrsoi ii My mlnnct
<br />e, asr. h..rnr subr.rr ro rh. workcs con|]cn$ri.n loBs of Califo,nia, atrd Jsrce rhtrl itl rhould bc..m subjccl to rhc
<br />workdr .onD.is,rio. pmvnions ol Sccl i.n 3?00 oI lhc bbo, Codc- I \hrll, tonhsirh R qry wnh th{ nmvisions..
<br />\vlRNlNc l'ailurc 1,, {.wc !or[. ..n]Ftr\r.otr.o\c !cnull(ll.suhrccr 0n cnDlortr h aifrinrl rnNhi$.n{
<br />civil tu$ u0lo onc hudrcd lhouund do ii.omrcn\arion. darosc\ as r,o!id.d rn rh.
<br />Scd ion 1076 .l rh. Lit!tr Codc
<br />I lrdhy rfllrnr undrr pcnulryot lcrjury th.t I a nrcvNion olchrprcr 9lco ntuD.iD8 trir h s..rid, 7(xr,) of l)ivisn :l
<br />oi thc BusirEs and Prol$\n,n\ Cod.. d hy li.n\c is in lirll rora ,i clltcr
<br />l-iccn\ccLs: l,iccf\c Nutr$cr:
<br />l)rrc ( onlrh.to.
<br />CQNSIXI]SUONIINDId$AGENCT
<br />I hcrcbt aitnn undn ltnaltyollE ju.ylhll rhcrc n a con(rucrion bnding agcn.y ro. rh. Frformncc oflhc worl lor whhh rhis lEmir is
<br />nsuedlSm :1097. Civ. C.).
<br />Lcndci{ Ad.lEs:
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<br />AfILITANTDLCI,ISAITTN
<br />I hnl,t llilmr under !.nalry o, pcrju.y ot ofrhc rolI.slng dNllr0lions:
<br />D.,mhion P.nnnsAsbc(os Nolificllion FL{crll Rcsllarn,ns (Tirlc (). Pan6)
<br />R(!r'tr,1 l.ii.rof Ndr i.ii,n
<br />rsh.nosrc r.vrldi! ror rfpliqhl. n) rhnImJc.r
<br />n i\ c.tr cr ,x8rerocomnrywirhallCiirudCounr,
<br />h,rnc rcprcscnr ivcs ofrhis
<br />1-
<br />DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />FINAL U1//6r ffia n{ai/
<br />Notes, Remarks, Etc.\--^J
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<br />:4il ?
<br />APPROVALS
<br />Sub-Panels
<br />Service lvleter
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