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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNEN BUTLDIIR DELCARATI()N
<br />I h.rchy affiiin undcr pcndly oi pcrjnry lhar I on cxcmpl fmm lhc Conrrlckns l-iene bw ror rhc rollovi.S rc0bn (3cc.7oll 5
<br />Busincss lnd Prcttssion Code) Any City or Counly which rcquncs u Frnir i(, co.<ru.1. allcr. in{novc. &mlish nr rcl)lt lny
<br />srrucrurc, r,ior k, irs issuancc. aln, rcqutcs rhe applkanr lor such pcrmi ro filc ! sigdcd satmnt lh tEorstc k li.cnscd plrslanl
<br />ro rhc l,rcvhions orrrE contm.loas Lian$d tjw (Cha,ncr 9. Conftncins wilh Ssrt,n ?mO or Divhio.I of rhc Busitrc$ lnd
<br />Prclcssions Codc) or lhol tE or shc I crctrll,r rhlEfromand rh€to\is ror rh.alkBcd.xcnprion. Any violorionotScclionT0.ll5 byany
<br />appli.rmrorapcmnsobjdtsrhc,mli.antlorcivilrcnahyornolnnncrhanrilchlndrcddollss($50n).
<br />l. us own roillN nr)Deny. or nry cnrrloles silh wascs rs rhci, v,k.o,rfrnsDrir'n. willdo ltr work md rhc nndurc iIrr
<br />irrcldcd o.o(c!.d tor sle (S.r 7(113. Brsincsrnn.l PRrf.*i(,.\ C,rlc IhcCoMmkn s Liccns Iiwd.cs tror lpplyt'anowncrof
<br />rhc fi)rEdy vho horlds.r inFmvcs rh.Bnr nd who d,rs strch $lt i,inNclfor hcr{lfor rhrooEh hn or h$o*tr c.{'h'y.c{.
<br />pft,vidcd rhrr srch nl]Irovcmnh nr. frn Lictrdcd ur ofltdl fDi { c. lt h.$crc( rlt hilding or i']rpRxrntnr t $U wkhii . 'nc ]cJr
<br />ol'cotrD[rion- rhc()$rcr Bnil cr $ill hrvc rh. bunlcn olpR,ving rhnr hc o, shc did tror htriklor inpmrc rhc,]mIoly turh. PurtiNc of
<br />I. 0sowrc!ofrhc [o!cny, amcxclusivclycont .rios *irh liccncd conkacror ro L-.nntud rht pn,rei (se.7044. Bu(im$
<br />asl lltrrssion C.dc thcConta.k s Li.cn\c Lawdoc\ nor .rtlt n) ,n osns of[o,'.nywho huild\o' inDr.vc\ rhcr.on.
<br />rtrd who contn'.t rar su.h pNjcclswilho ConrnEkn(s) licctrsd puNuanllorhcCo"rra.ktr s t,i..nscLrw)
<br />I drdx.frrr und.r Sc.rio. ,8.&P.C.nrrhlsrc.son
<br />Drlr: Orn€r
<br />IIOAtr.E<AUIDNSAIIA!
<br />DITCI.ABAIIIJN
<br />I hcr.by rffi.,n undcr J).nrlryof,.rluryonc ofth. Lli)wiDg dc.l.rnrbns
<br />-ln!!candwillroinrrinaCeniak.r.ofConsnrhS.lflnsurcfr.pork.rc'comr.nslion.asEovidcdlorbyS(rnr.17{D.lrh.t k, Codc. lor rhc DcrforroEe oi rhc *orl ror which rhc pcmil ir i\sucd.
<br />_l havc nnd will duantuin workds connemalion insurancc, as rcquncd by Scclion l?00 ol rhc Llhot C.dc, ror lhc lrcrfollrrGc of
<br />rl-c w.' k lo \hk h rhF n r nr '\ Fsucd. M, workc^ comJEnsa! on itr\u!.ncc cMicruId FlEy nd mh.r m
<br />cmr, /\,(lrl r,,C! [r.w rrtl .
<br />I \YL
<br />-l
<br />ccnily rhlt in lhc Nrformancc ofrhc work ror ehich rhh pcnnn is ksucd. I shrllnot cnrl,loy ony lcnon in 8ny ntann.r
<br />$ ai r) tE&m \rhj.d ro lhc wolksc conrrcnsatiotr li*s of California. and asrc lhlr ir I should ttom subj.tt lo llE
<br />workcis conD.nsdi,n lmvisiotrs ofScdi.n 3?00 ol lh€ trl,or Codc- I shlll, lontsirh $mply wirh rho{ povnbns..
<br />cilil lin.\ up ro om huidrdd rh.usmd dolltrs ($100,000)
<br />Secri.n 1076ofrhc ljhur Cod.. inrcrc( ind olmy s Lcs.
<br />U-1-t O0 appti^r.
<br />I ncrcby afrtrm ufticr pcnaltyolperju.y rhar I am lienql lndcr pmenionofChnprd 9(.onmrcitr8 silfi Sslhn ?fiio) orDivisi.n l
<br />.l rhc Busin.lr 0nd Pmfc$io.s codc. dt ny liccnsc ir in tull lora n .ffNr
<br />€,lo11Pml
<br />rl.)!$f,ucllaN.LlNDlNs-acDNct
<br />I hcEhy lilrm undcr FnllryofFrju.y rhdr rhdd is d.on{ddiod Lndire oBc.cy lbr lfic lcrfortuncc ofrhc wor* ftx whi.h lhis F nit Ls
<br />nsu.d (S( 109?. Civ C.).
<br />tu,.dcrr rc8tr]lri,nx .grni',!,ah(o\ rcDnNx n'c tur rflltilnc h rhh !r.j.cr
<br />iry rhdr I hnvc rcld
<br />'his.prlic0lion
<br />Md sut dr I 1816 r..onrrly wirh all Cirrond Connry
<br />lirrtrccs trDd sratc t wsrc,irinRro huildins i\rs ofliis Cilynnd Co!nly ro corcr uIx,n rlt
<br />ntxfu nrnti,,n.d pn,pcd, r(r insN.ri(rr
<br />ADIIi(,nl {r A30! Sixnnluft:
<br />ilR nome(priol)r
<br />-
<br />{.ra4.
<br />C..t.)'Q.
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soflit Bouoh
<br />Ceilings (T-Bar Rouoh)
<br />lVeter Release
<br />Rouqh 474 (tc
<br />Service Meter
<br />FINAL '1/t(ls >bffi
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Translormers
<br />I b 4
<br />tlndci( Addn$
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<br />AIELICANLI}ECIABAIION
<br />I hdt6y atim undcr pcn.lt, ot pcrjlry onc or rhe rollowine d..l@rions:
<br />Dcmli{ion PcrnnlsAsbcslos NolifEalion !€dc6l RcBuhlions (-rnle 40. Pan6)
<br />_R.quircd trtl.r of Nolit.alion
<br />I
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