|
ELECTRICAL-INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Solf it Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough T'to/b 4z 1-i>fi)L*:7W1
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc.
<br />OWNER BUILT}ER DEI,CARATION
<br />I hcrchy rmrm utotcr Fnrky of Frrury rhar I m.x.mfl li1,o rhr c(nnrrtu' Li..n$ tiw f.r rh. followinS rcNon (Sc. ?0.11 5
<br />Busincs and Pmfe$ion Codci Any Ciry or Coun'y whi.h rcqutcs a Fnnn to con{Dcl. nll6. imnrolc. dcmlhh nr EIrn rny
<br />ctu(, tri.rti irs is\uan.c. trl\. rquncs rhe ap icrnr f{tr such rEnni ro filea sirncd {arcftnr rh,r lE.r sh. is ltonql puisurnt
<br />ro lhe lnvhions oa th. Cotrlrlcror's Liccn*d Lnw (Cnaplcr L Conmrn.in8 wilh Scclion ?ur) ol Divhion :l olrhc Busin.$ and
<br />toorcs\nnN Codc)orrhlt ltor shc hcichpr rhcrcfroni lnd rh.hlsh fo, rhcrllc8qlcrcnurn,n. An, v{lf,rion .f Sdi Fn 70:l I J by.ny
<br />opplrrir fom Fmrir \ubicr\ rh aptlica h a cilil pcnrhr of nor mE rha! filc hundrcd doll!6 {$5Oo).
<br />-1.
<br />as oqncr ol rh. lmtrny. o, ry cmployccs w h w.e.s a( rhcn $b .omlcns.rir{. will do lhc $!rk and ltr (nrlurc n mr
<br />inretrhd or ofiscd fo. slc (Sa 7044- Ausirc$ and Pr.ac$iotrs aodc: Thc Conrraclols ,-tens l.i* dcs nor arpl, b ,n uwncr or
<br />lh. D$Fjdy wk) builds or inryoEs OEErn. Md *h. d*s skh knl hims.ltor hcsclror rhmu8h hh or h.r of,ncmployccs.
<br />ln)vidL\l rh3r \rch iDprolc'Enh dc nor lnrcndcd or ofi.rcJ r'or slc ll hrwcvc,, rtr hxilttrg or iq,rownrnr ir $ll w hin oN ]cd.f.oq'tri.n. ltE Ouncr Buikc. *ill lErc rhc h{rden of prcli.g lhd lE or .hc dil mr build or impmrc lhc Impsly lor rhc rlrFr ot
<br />L a\o*ncrofihc prol}cnt, d)cxch\ircltconlrncrin8 wirh li..nsed conirmror\ ro cotr{tuc! rhc pn,l..r (SL\. 7(!l4. Buucs
<br />rM h.l$sin Codc: Thc clnkidols Liccns. Lrs d.cs.ur upply h.n owmr olpro|xdy !h. builds or nnnrncs rhcrcon.
<br />rnd who conrr0cr\ ior such rn Fts wir h ! Cotrlnrdo( s) lncrNcd Nr{uinr ro rhc On rucroi s l.iccns. tjs )
<br />I a .xcmPr unncr Sccli(nr-. B. & t'C thrthi\.ca{'n
<br />}rcBKD&I3;AIISENTAIIQN
<br />DIICLdIAUAN
<br />I hcaby rfft rndcr Fnrlry oflf,rluryonc ofrhc r(rlowing dc.lnrdion\
<br />-l
<br />hrvc nd rillNinrain a Cenincorc oiCons k,Sclf-lnsurclo!workqrco,nF{suri,n.usprovid.dnrbyscctn'ni7{Dolrhc
<br />tibor Oodc. lbr thc ,.rformrEc of lhc qork for phi.h rhc lEnni is hsucd
<br />lhrrc r rl willminrrin workcrs conrp.n\dnnr in\lrnncc. as 'qonrJ h!Sc.ii,rr 17(X,.frhc l;rh.r Cidc. io rh. pdlhrnMrccol
<br />rhc woik turwhi.hrhis p.rfrir is ilsxci My work.( .unl).nsrr i,n, i'rsuhn.c.nri$a Flicy trutr$cr rc
<br />-l
<br />ccdily thd ln rnc tErloirrrmc olrh. wolk for {hi.h rhis ncnnir is nsled. I rhill not cmploy ony pcron in any ornmr
<br />n Nloncqrmc $'l,jcd ro lhc rorken' co n{c nsal io n hs\ofCalil'ornia- rnd x8rce rhrlir I dblld hcoft {hj.d ro rhc
<br />$orkcn compcnsilion pmvnion\ ofScction 3700olrhc L.tDr Cdc.I sh.ll.lonhLvirh mnnly Nirh rho{ pmvnion\
<br />civil fitrcs u0 tu onc hundrcd lhousnd dollan ($).()(lo), in diidr ro rhc c.{ (n .omp.nsrrion- dan$E.\ as pdvidcd for rh.
<br />s..ri, 3lr76 olrhc I rhr(in[. i'ncr.n
<br />I h.icht {lfinn un c, l.n,ht .r r.rjury rlu l ,b lienwl u i( t (,vi\bn or Ch,J'rc. 9 (GnnnE..nr8 wilh Serion ?dI)) ol Divhion .l
<br />or ihc Businesnnd PnfcssionsCodc. and nryliccNc n in fulllnrcc ad cfiirl
<br />66s t4e
<br />ft
<br />I hcahy nltunru cr F-.nrlryol lcrturyrhd I is u.nnslruction lcndin8 rrcncy aor rh. pcraornEnN olrhc work lbr whi.h rhh Frn n
<br />issucd (S.r :ltD7. Civ. C.)
<br />A.TIUCAXI,DECIAf,AIION
<br />I h.nt y arm unde, r.nal y of pcrjury oe of rlE rollowins &{le!l ionsl
<br />Ocmliriotr PcnDjts.Ashesros Norilicrrion Fcdcr.! RcBullrions (Tirlc40, PIn6)
<br />-RequiEd
<br />Lcllcrof Notincarion
<br />*,"'fi'j:',.,1},:l
<br />aguhrn,n\ rcEnding aslcstos rcmovd lrc nol umlic,hlc x, rhir pR,j.tr
<br />k 0rpllcdionrrldnalcrhur rh. alr,v. inftrturbn is.onccr L&re Io conply wirh rll Ciry ond Counry
<br />ring ro buildinS .ondrud ion. arld h.rchyrurhorir rcprcs lovclofrhisCiryoodCounryrocnrslrontlE
<br />^pplic!nl
<br />or Asdr sisn!lury
<br />Pemi'Nmne,pri;LJ4
<br />-f!,yAlw
<br />L.dci" Addrc*:
<br />-
|