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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O\{NER BUN-DER DELCARATION
<br />I hcrcty alfirm unds Fnahy ot !€dury lhol I r cxcnpt fmnr rhc Contnclon l-tcnrc ljv lor lhc follo*ins mn,n (S*.?o:ll 5
<br />Busin.ss alxl Prorc*ion C.dc): Any Ciry or Counry whth rcqotdi s Fnn ro onirud. axcr, imF..vc, dcnn'lth .r rcpln sny
<br />(ruc1!rc. ! orto ils issuarcc. al$ rcquircs rhcappli.ant lor suchFrmit io filcssisncn n emnl rh hcor shc is lienscd I,unuanr'
<br />lo rhi pmvisions ortr Conhcror's Li..ns.d Ins (Chafl.r 9. Cdmftfting wirh S.clion ?cu) ol Divtion I oflhc Ausincrs and
<br />PmtesionsCodc)orth.llEorshcncremptlhcrctomrnd$cblshnxlhcalkgedcrcmption.Anyviolarionofs(li.oT0.ll5bylry
<br />q'plicant tbr a pcmil subjels lhc applic.rnl to 0 civil l).nllly of nol 'mrc than filr hlndrcd dollars ($5U))
<br />-1.
<br />,s o*Br ol rh. pmFny. or my cmploros pnh wtrgcs as rhct nrc .onrlcnsll ion, will do lhc r! ood lhc srBrurc is nol
<br />inlcnlcd or oticrcd lhr ule (Scc ?044. Businc$ Md Pmfe$ions Code The Conrrrcloi\ Liccn{ tiw d@i Nr r{'/y b m.wtur or
<br />rh. pn,f ry who btrilds or inpdvcs rh.E,n. md w'x, dds ruch w6* hins.li or hftslf o. rhmugi htr or hc. ostr cmploycel
<br />prolidcd rhat such inDoEmnh dE not inrcndcn oroftcrd for sL.ll tx)scv$, rtE huiui.F or nrq,mm.nl ir sld wilhin om )16
<br />oI on{,hlhn. tlE Owmr Builr.r vill hjrc rh. bodon of fmvi.g thn hc or sh. dii mr buikl or inproK Ihc ,$ttry fo }r pur,[s of
<br />-!.
<br />rsowtrcrolthclopcny. rnrcxclusivclyco racrin! wrh li.cnscd coftrdom ro .onnrucl lh. nrclccl (Scc.7()'tl. Bo\incss
<br />a'rl lbfcsin Co,lc Thc Conrmckn s t-icensc l -a' d.c\ nor alrply ro r owncr of pi(,Frry *no h ild\ or impn,v.\ Ihcrc.n.
<br />and Eho .unr ts f.r su.h lmj.rls wirh d cln ncbd\) lt.nsrd pursu r ro rhc cbnrlcroi \ Liccr€ ti*)
<br />lr'ncxcmtrundcr Sccliotr .B &PC i rhNrcNrr
<br />}TOEfi]&T:IAUITNSAIIANlu(L nIIll)N
<br />I h.rcbtrlTn utrdrr p.uhyorp.rjor!onc ofrh lnllosing d..irrrtions
<br />lhrvctud will rimainaCcdificarcofC.nscnrbSelfln\urct(r$orkrf.oniFn\rrnnr.rs Jro\idcd Lr bySc(rion:17(rOoIlhc
<br />lihor Gdc. for rhc perLnuncc oirh. qo* tu nhi.h thc pcnnir n n\ucd
<br />I hrlc rnii trill nrn rin *orklN .on1Fisrri,,n inntuncc. rs rclrncd ht Sc.r i(n l7m or rh. trhd Ci)dc. lir lhc Nrlinn Ec ol
<br />rl'c qo'k turshich rhis p.rmir i\ i\nnl My worltcrs m.T.ns: i{)n i'Nrrn.c crdi.r rd tx)lict nun$cr c
<br />i[[.,D,.^xl Ca.i'l^ f$\ K
<br />l \ .\"r
<br />I .cniiy th.l in lhc pcrfofluncc oftlE work tor qhich
<br />'his
<br />p.flnir is i$ucd- I shall nol cnDloy any pcnon i', Dny nrntur
<br />v' a k, tf,@nE sul,jd n' lhc rorkcs com!.nidt,n hws olCalifffnil atrd asN rhd irI \honld h..om sutjNt
<br />'o
<br />rhc
<br />w.rkc^ conrpcnun,n pmlixt, s of Ssrion l7tu.t rhc l ntxtr C,xL. l \hall, fr)dhwirh onlplt wirh thoe nmvnio"\ .
<br />WARNINC: Failurc ro scurc wortc^ comp.nsllio. ovcr,Bc is u.laetul. and shrll subicl m cmploycr ro cihin{l lrfllrkx tnd
<br />civiT 6n.s up lo on. hun&cd lhou$nd dollan (Sloo,mo), in oddnion to lhc cosr oicomFnetion. danuB.\ ds tDvidcd rar rhcil:L5j& TX:;:d#:
<br />I hccb, alfirmundcr pcMlly of pcrjury lhd I um licenrt ufl'lcr riDvhion ofChspro 9(c.'tumn.in! silh scrhn ?000) ol Divhion l
<br />of thc Busirc$ and Pmacsions Codc. ond my ltcnE is in tull torcc and clfrl.
<br />a Ft.t.f'Y-"
<br />IOd9IBUqIION.LEIjDITICENII
<br />I hcahy nfftrm undcr J[idryorpctury rhar rhcrc i\ i mnnocri,i h.dine agctrcy lor rhc pcrforru.c otthc work r'or whi.h rhn pcnni is
<br />hsucd lss 109?. Ci! C )
<br />attllcarfDEcl,AS{Ilr!
<br />I h.1rt, afrimr undcr licnslty ol n€rjur, om oflhc lolkrwins d€l08lionr
<br />DcnDliiion Pclnits-Ashc(os Nolificrliotr FcdcEl RcSulolhtrs (Tnb 40. Pan6)
<br />-Rcquircd
<br />Lclls of NorifEalion
<br />-l.cnil'_vthal
<br />lhc icdcrnl rcsuhrion\ rc8dnins arE(slos rcnmvil arc n.r rpplicrhlc k, rhil pmJc.r
<br />It6,u,t,, t t,'.,.,a,ti.,nnt.,ri('nl\coftc.r. l,gmh.o'nprywirnallCilyrndCounry
<br />o'di"anc$ rtrd Srxrc l:'s\ mh!iry i) huiiln,g oirhis city.nd Coutrry to cnrcr u{$n Ihc
<br />ubovc nrnri,nctl popcny lor iI
<br />Appllcs orAsetrlShnniuE:
<br />Ac
<br />Lnto"
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouoh 6h /tk ,l' 41''
<br />Service l\ileter
<br />FINAL 7/6/ E SA*$
<br />Notes, Remarks , Etc.
<br />L.ndcis AddE$.
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<br />Site-Work
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