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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNER BUILDER DELCARATION
<br />I herby nmrm und.r p.Mlty (,f pcriury rhar I d. cxcopr iiom rh. G,nrdm Li..nsc Lrw f.r rhc follosine tur,. (sec.703l 5
<br />ausiness ad Profc$io, Codc): an, chy ot Counry Phi.h rcquncs a ,sn ro condocr. dlrer. inprcvc. dcnrli\h or Ersn any
<br />dtucrurc, Iri, r. irs issu,^_c. ,l$ rcquncr thc apdiclnl for luch p.mi ro nk i sigftd srllcnE lhat h. or she ii li.cn*d Nrua
<br />ro lhc fmvisi.ns oi rhc C.nrddd s Li.cnsd trw {Chaprn 9. CommcncirB sirh sc.rion 7fix) of Divhion I oa rhc Blsinc* rnd
<br />Piorersionr cI r)orrhor h.trshc G cxcmpl thcrcirunand lhc tEsh nn rh.allcs.dcxcrDplinn. Anyviolario.ofsc.rionT0ll.5bya.y
<br />npplic.nrfor.pcrmirsubjcchrhc,lplican[oacivilpcnalrror.otmrclhanlivehudcddolhrs($500].
<br />-1.
<br />a\ owEr dlrh. tft,|rny. or m, cq)loles wilh No8es as rhcn wh ronDctrsdn r. qilldo th. *mk lnd dc {mlx^ ( ml
<br />inrc .d or olTcrcd lor slc (S(.?Or4. Blsi.sas lnd ttofcsionr Cndcr Thc Coffa.kr\ Lietrs L,w do.s nor rplly h M owncr oi
<br />rhc pmpeny vho b itCs or impmv.s rh.mn. uxl stb dos iKh s* hinsclf or htr*lf or rhnr8h his or hcr o*n en{'lorcc\,
<br />Iruvidcd thor sEi inDowmnhmnn inr.ndcd.rollrcd fnreL.lt howcvc. rlE hildine or nipdtft.r i! $U *irhinom Fr
<br />or con{,hriotr. thc Owmr BuiB.r will lBk rlE Ltrdm of F,vins ihd h. or she dil ml h{ikl or iq,rnlc rhc pmFdy fo! rnc !uq-c ot
<br />1..(owncrollhcpmpcny. n.r.losiv.lyroitrcrins sirh li.cnscd.onttucx'n b c.n\ln'ci rlr Pmr.r {Scc.701'4. Blnncs
<br />! Pnl$sion Codc: Thc Conrn kn s L iccnsc Lr* docs nor ,pply lo un o*n$ or l,n,lr ywho hnildso, inrPn,k. rhd.otr.
<br />rnd who .onlr{.k tur such pmjcd\wirhr Co rs.h(sr!iccnsc rursutrtr orlrc (inrrr!.roir l.iccnsc Lrw)
<br />I rnrc\.orJr rrl0 s..liL
<br />}}llxf,IiBtil}}rt[xs rat
<br />DIiCLASAIIAN
<br />I h.(by amrm undcr Fn.hyotFrj!ry6n.ollhc lolLsing dnlmiioa:
<br />-lhavcand'illminrainaCcnificstcorco.sc
<br />b S.lr lnsuE for wortss onpctrsarn,n. a\ ,rcvided for by Sal i.. l7(x) or rhc
<br />tibor Codc, td thc llcrformncc oflhc w6.l f., {hich rhc pdnil is ksucd.
<br />-ri horc snd * ill munrar " nrkc^ cnmF.nsahon rnsur0mc. rs rcquircd by S<l ion l70o or thc tjbor Codc. for lhc pdlo.mn.c of
<br />thc sork for $hich rhis pefrir is hiu.d. My worksl ompensolion ia$.mcc .!nie. 3!d Plicy numbcr m:
<br />c,.r.,, trtLtt \-u.r.<.l
<br />gzrr3,58t Crll / lfi
<br />,ccniftrhar inrlBl.rlo n!rccolrhcwork for which rhn pcrmir is i\ucd.I \hdlltrol ctrDloylnyn(rwn, itrynrtrner
<br />so aslo t cnnE suhicr ro rhc wo,ken .onFns,rion hws ofcrlirornia. and 03e rirl ir I should lE.om uh]ccr to rhc
<br />wo*nJ .ompcns ion tmvhions oIsecrion:l7morrhc titxtr codc.I shtrll.,onhwilI Luply *irh rho{ [ovnions
<br />WARNIN(; Failr( k, \c.urc sorkcm .nnDutr\rri,nr colcra8c i\ unlasinl rkl $ill srhjccr rrr cmPb:_r' t, (iminrltf,nL'lrics rnd
<br />.ivil 6nc\ up ti.nc hrndrcd thousrnd do1l6 (Sllx).o(xD. in:dlin ro rhc.o{ ol coDncnsarion. 'lnnug.s rs Drovnl.d hrthc
<br />Sdrion 10 76 or lhe trbor Codc. inlerc( and anotuy s f.cs
<br />o",", 5ll0 /1b rrrri-",4
<br />IIIII.ASAIION
<br />, hcnhy amrn und.r !.nshy ol lcriury rhlr I am lianed lndcr prnvision orch.ptr 9(.omrmncina wnh sm'ion rfix)) oIDivi\ion:l
<br />of rhe Busimssnnd Porcssions code. ud,ny liccns is ir lull lirre aJkl cflacr
<br />)o Ifr?
<br />5/lp /tb
<br />CONS'TRI]CTIIIN I FNDIN(i AGFIICV
<br />I hcmby amir! undcr ncnllry of p€[n.y thar rhd. is d connru.lbn lcdins 4cnct fitr rh. l.rhJaMncc.flhc *ork flr whah this Frnrn 6
<br />nslcd (Sc. lo9?, Civ. C.).
<br />L.nJcr. Atl,Ic*
<br />APPI I(:ANT NrCI ARATI(IN
<br />I h.,tl,,drir rund.i,.nulty of pcrjury orc rfth. folbsnrs dcchrarionl:
<br />Dcrmlition Pc.rnh Arhcdo\ Norific,ion Fcdcnl Rc3llal,ons (Iitlc/{), Pd6)
<br />_Rcquncd lrrcr oi N,nifi carion
<br />I .cnily rhd rh. fedclil rcsllarion! Eg,rdin8 rcb.fos rclB,val ae nor lpplicable lo rhis Pml.cl
<br />'?,9 ccnrly lhd I ha( rc,,irhi. rmlElnn md $dk rhd lhc atrvc i.fomari.n is corNr.l a8rc roconply wirh sll Cnvand colnl,
<br />ard'nonccr and Strtc L$\ rchrne rn burklrn8 cotr{rd'on.6rd hcrcbyaulh,i& reE.*nrolivcs ofthis Cilyaod Counlyro cnt.r upon tlE
<br />$ovc ffntioncd ,mpcny aor instrdio. puit-sr
<br />ippli$nl or lEenl SiamluE *, 5/lo I lb
<br />Pemir..rn. (Drin0: 7r //l
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Vollaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduil)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilinos (T-Bar Rouqh)
<br />lvleter Release
<br />Rouqh 5/l',"th 4-\rn ).#h d4
<br />Service lvleter
<br />5/sFINAL ins t 7frfu-;r-)l+*
<br />Notes, Remarks, Etc.
<br />Communications Cable
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