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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION
<br />I hcrcby 0fltm undcr pcnalry ol lerjlry lhar I dn dcnfl forn rhc Conla.k,n Liccn* L!{ f{, rhc rouoring rcrsn (Str.70.11 5
<br />Businc$ ond Pmfc$ion Codc): Any City or Counry *hkh r.quncs 0 Fnnil ro clnnoct. ,lr.r, nnProrc, d.mlth or rcPlt lnv
<br />srrucru,c- p.i., ro ir isslaftc. nlso rcquircs rtf, 0ppli.ad for snch IEmn lo fiL r risnn! rur.mnr lhtrt lrc o. shc t lia!.cd nu. anr
<br />to thc pnrvisiotrs of lhc Conlracxr's l,i.cn{i ku (Chaprcr 9. Comnrn.inS silh Scclion 7m0 oa Dililion I ofrhc Busi.css und
<br />Prcfc$ions Codc) or rhar h.orshc i{crcmpl rh.rcromand rhchrsn for lhc rllesedercnflnrn Any viohttuof SctbnT0:ll5 h, {ny
<br />,rplictr r lo p.mir suhjcri lh. oplliconl to a civil ,:cnilty of ml mr. rho fivc lrundr.d dollrs {$5Oo)
<br />-l-
<br />ar o$ncr ot rhc pnrcfly. or m, .mtlot(s wnh waecr * rhctr elc c.mpcnerii,n. will do rh. wo* 0d rtr (FI|uru n mr
<br />inrcndcd or oicrcd rd qL (s(.7(}14. Busircss 0trd Profcssions Codc: ]]lc O,nr,cl.fs l-i.cnsc ti* dm\ nol amly ro dn ownn or
<br />thc rmlEny who taild\., inrpr.ki rhcdn.,nd wh. dfts suh *s* himscllor hctslaor rhruoeh his or h.r oln cmpktyccs.
<br />pn,vidcd rhdr .uch i,npmBnnls !rc mr inlc!r(& n offcEn lor elc lt hr$tlu. rhc boiuin3 or inrPmstmnr i\ eB sirhin nm ,car
<br />ofcoq,trhn. rhc O*ncr BuiLid, *ill hnv. Or htric.olpovinS rhd hcor stc dii n hoiu or nqmw lhc Pmlsly ,or rhc PlrFrc or
<br />l, rsowncroflhc prcFny,3nrcrclu\ilciyco.rra.ri'rg wirh liccned coftrdoF ro connrucr rhe P'(,jd (Se 704'1.lru\ircs
<br />rnd Pn'ls\in Codc: 'rh. Coniircny\ Liccnsc Lawdoc! nol inrlyro ano*ncr ufntufr ywho huilds.r imtrov$ rhctcon
<br />,id wh. .onracF ior such rmlccr s wirh ! Conrrucbn s) liccn*d porsu r t, rhc CoDlrr(l{,t l-iccNc ltr*).
<br />I xqrcr. rpr und$sc.rn,n . A & F.C. turrhi\ rcr\,i
<br />1rcBK!&T.clIlIfjNIAfION
<br />OEIIAAAII()N
<br />Ihcrehrrltumu d l.'rxy or lcrlury om of rhc nnh*ill3 d$lur n,0s
<br />-l
<br />hlvc oid willnuinr.in a C.nirr.rc ofcon$ to Sclf-Insurc tu workcr' con FnernJn. $ ptuvidcd for by Ssrion .Um.t rh.
<br />tibor Codc, lor lnc ,sforromc ol rhc sork tor which rhc t.mir h issucn
<br />-l hrvc and will'nainrsin work.N comp.nsation insurancc. ns requircd h, sccr io. 1700 or rlr Llbor ftdr- for rh. ncrtunuNc of
<br />lne wo.k ftn which rhn p.mir is i\su.d My *ortc^ co qEnqrior insrrJkc..ricr ind lFlkt nunh.r dcAi4otn4oIt tt
<br />-l
<br />ccnilyrhlr nrlhcr,.rlormaneofrhc sorl f.r shichrhh Ptirni k hsucd.l shallnor cnllhyanrlc^on in ony nrMmr
<br />$ \ t, tEcotu \uhlccrr,lhc uorkcr' smDetrsaliotr lrus oiClliftndir. md i!rc htr iiI nFunl bccqnc \tbrLd brhc
<br />eo e^.onlll.nsrrn,rphltionsolScclionl?00olrhcL,brAxh,Ishtril,r.'nhuithcomflysilhrh,{prcri{nnrs
<br />IVARNING hilurc lo $tr'c work.^ .onllcn\diotr covcfusc is unlosiul. ind \hdl \uhF.r lrr cnlloyct k' crinlin,] J.i,hics rnd
<br />civil l],rc\ up lo o.c hu rcd rhoo\rtrd dolla'r ($1m.0(D), in,kldlrion h rhc coi ot.o f.trsdri,'n. d{m&8cs !s r'ovidcd fd rhc
<br />LffiliIruiti
<br />I hcEh, lmrd u.dd pcMltyofpcrjuylhar I !m lien$d under lrclhion or chlprc. 9 (omflrmins *nh Sdkrh 7uD) ofDivhion 3
<br />ol rhc Busirc$and Pret€sn,nr Codc,,nd my lkcns n nr fulllotcc ood crisr
<br />-Anro ,.,,.^,"*",.,,*, 6 194I9L
<br />ItAY LT h-'eid
<br />CONIIAIJI:IIQNIENDINIi.AIiDNT.I
<br />Ihcr.byrfln u trFnnhyolrErjryrharrhcr.isacondtucri{,nLndin8r8.fl.ylorlhcpslirrunccofrlfworktirqhichrhhrcilniri\
<br />i\sucdrs.r :1097. Civ. C )
<br />AITIICAXTI]I(;I.AEAIION
<br />l h.ni6y rrlm xnd.r pcn lly ol !.rjuryoncollhclbll{iwin8 dcchruln,n\.
<br />Dcmliri,,n lrcrmih A\hc{os Norifici(io. f{dc$l Rcgulnlions llirle,1O- Prn6)
<br />-Rcquncd
<br />L.lrcr of Norifi .arin
<br />-l
<br />cdiryrhd r hc Ld.ral rcgul.l io ns resrdins asbcsros removll dc Mr arPlicable to $is proirr
<br />Z#rlnn , ** **rnis afirlk,rion ald sr . rh'r rhc aiDv€ inromri.n is.oMt. L8re ro.ondy, h 'tlc ,.nd (huntv
<br />ordin.nccs rnd Slarr ljvs rclrring h buiklin8 .on$rucrn,, uld hcrcb N 'v.\ urthtr( v an'l cuuntr t, cnrcr u
<br />'nthc
<br />HAV 117 ?','"$.vc nrtrlioncd rrcplrly l'or inspcdnnr
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq i UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />It/eler Release
<br />Rouqh 5/n zh 9'E Llr,-?-lfl<
<br />Service Meter
<br />FINAL I ,-fi-/s ,./)e{*,"(rr)Notes, Remarks, Etc.
<br />Air Conditioners
<br />brdci. Ad.[.s
<br />Appliclnt o. Ae.nt SittMluF
<br />t€miteDnr(lnd):
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<br />tt
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