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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE COMMENTS OWNER BUILDDR DELCAf,\T!ON
<br />I hclcby lllirnr undcr pcnlhy.t pcrjurt rhai l .n cxcnlpr ironr lhc Conlncior' t-iccn\c bw for rhc iolk,eina rc!$.1scc7j.ll 5
<br />Busn$s trnl Pr.fcsson (ttc): Any Ciry or Cou.ry *hich requiE\ , Fnnn b con{rucl. ollcr. i porc- dc Fhsh or rc|ui my
<br />srruclurc,,'.t! ro irs is\u!mc. ako rqxift\ rhL lppli.nr r.r suchErnit lo filca skacd natntnr rhar hcorrh. is liccn\ed I)Uilulnr
<br />t, rhc pmvi(ions oflhc Conlr.crois Liccnsc.l La* (Chaptc,9- ComntNinS wirh Scction 7000 ot Divnion .l olthc Busincs\ (nd
<br />Pmfcslio.sc:odc) orlhol h.orstc hcicnrpr rhcrcfroraid rfic hd\i\ r(trrhc allc8cd excmlrion. AnyviolurionorscrimT0ll 5hyrn!
<br />rlpli.a lnrntcnnil subjals lhc lprli.rnr to,civilFn,llyorn.r nbrc thnn fivc hundrcd dolld\ ($500)
<br />l- as o*icr of rhc pml.ny, or my cnrloyces *irh suscs rs r hen $L d,tuI)cn\arii,., will do rhc s'od orl ltf, d rm $ nor
<br />inrcndcd or ollcrcd for slc (Scc 7{}44. Burincs and Profc$n,ns Codc:'I}c Co.rtocr(tr s l-t.nsc liv dcs nor alrly lo anoNner of
<br />rh.lmp.ny qho builds or iqr()vcs rhccrn. u whodm\sochwnlhi'nrcllorhcisclforrhoulhhi\orh.roencnrl,)yccs,
<br />pn,vidcd rMr slch i,npmvcnE$ m nor idcndcd or oflircd tor slc ll noNchr, rh. huildinS or inPmvcnEnl is \old wirhin o c ,ttrr
<br />dr.onplcriotr. rh owncr Buikc! willhlE rhc bnrdeo of pmvi',s rh,r l'. ot shc dil ret buitlor in{rclc rh. pmPcny f.r thc PutnB ol
<br />D.le O*n.r
<br />WORKTRS'COMP."NSATION
<br />DECI.AEAUAN
<br />I ncreb, !firm und.r Fnshy ot pdjury onc ofthc followiry dcchrdions:
<br />-lhovcu
<br />*iUnuinuindC.rlifi.drcolcotrsnrrosclf.lrsurcfo.wo,ken conpcn\lrn,n, N B)vidcdlorh,Se.rion.lT(x).rrhc
<br />tjhor Codc. lor rhc rcrformmc ofrhc *ork for shich rh. p$mn n hsucd
<br />ll halc aid w ill nrainrsin u.rkcn comFnslion inslrancc. !s rcquirql hy sccrion l?m or rhc tihor Codc- aor th. p.rromRc of
<br />rhc wo lor whi.h rhi( p.mit is isskd Myworkcrs &arpcnsrrion iNUraNccntrtr kl t'oli., Nmtlrsc:
<br />/V^-ll o,; .r. t I lo"!.,,1it, * ?ii(lns .
<br />Y9 w c9 7tl Oo ol
<br />I ccniiithnr in lhc pc ornmnccolrhc work ror which rhis p.rmir ir isnrcd.l shollnoi cnrdorany Ns.n inany anncr
<br />$ s h hTflE hicd k, rht w.rkcr onpctrr.tiotr hws ot Crlifornin. lnd 4rcc rhd ir l should h€onE suhJc.r tr rhj
<br />rukcr'snnr(n\nrn,nlrRrisionsoiS.crionlT0Ooflh.rjlnrCodc.l\hrll-fonhsirh.onrtlyNirhrhnEpravirions
<br />WARNING I'rilurc lo $curc s.rkcn coi!f, ern covctrgc is nfl sinl. and shall suhic.r r,r olr.ycr to ri'niMl P.nrhics md
<br />.ivil linc\ up kr om hundr.d rhouend dolla6 ($100.fiX)), in.ddnnn ro ric co otconP.nsri.i. dlnra8cs r\ rn,vidcd fttr rhc
<br />Sccr ion 1076 oI r hc lihn Grlc. inrcrc$ ,nd arlormy\ ltc
<br />5 4
<br />DECLANAIIAN
<br />I h.nhy.l6.n undcr |.Mllyoip€riry rhar Ln lidnsd und& ptuvilion ofChapler 9 (co'nmftin8 with Sdion ?000) olDilkion l
<br />or rhc Bu\irE$ .nd Polcssions Codc. dn my lncnsc is ir iull tu( a t .der
<br />l- z-r>6o82-to
<br />'.,", 5f 2=lrt -.".,-",-,DA-&/'to. J.:J-- AG>-
<br />COXIIBUqIIANIEND,IIA.&GENIjI
<br />I hcrcby 0flnm undcr p€n.lry of D€rjnry rhs hdc Ls , .onerudion Lndins ascrcy lor rhc rdromtrtrc of lh. Fort fo, shi.h rhiudnnl h
<br />nsucd (Scc .1097. Civ C.)
<br />A.IIUIAII.D&SJNAII'N
<br />I My ainm ufto pcn0lry of Frjury o't of rh. rolk,wnrg dclaolions
<br />DcrmlirnJn PcirnireAshcslos Norificarioi Fcdcrai Resullrions (Th|.40. Pnrt6)
<br />Rcquncd kllcr of llorifi caion
<br />lccniryth[ rhclcdcrulrcsulalions rcA{ding a\tic\rn\ rn$v lrrc orrP|rlicftlc k' lhisl]tr,Fr
<br />I ccniryrhd I havc rcadrhis apDlkrrnn, drd nrrc rhdrthc.bvc inrin uri,,n n.nrucr lrg1Nrocotrllllr]ilhrllCirtrndCounry
<br />onlnakrs ind Sralc Li*s rclaling ro l ildinscoi{o.rnrn, hci.b}ltrlhori7crcprcscnrrrilcrofrhtCiryondCou.lyk,cnr.rdFBrlf,
<br />rh,vc rnrtnrcd nmDcny lnr in\
<br />,\DDlir l nr ,\,t01 Sitnrluro s .L?-lt/
<br />e .)'\,'.
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouoh
<br />Service [t/eter
<br />FINAL T//6,/,v s\<x
<br />Notes, Remarks, Etc.
<br />tD/stG.
<br />-t.
<br />oso*tur otrhe porEnr,,frcx.lusivcly.onrra.rirg will lic.nrd coDlr!.loFlo.on{ncr rh. fmjct (Scc.1}l4, Busine*
<br />dnd Elrssb. Codc: Thc Contr0crols Liccnse Lau does nor !ppl, tr,n.wn.r ollrop.nywho buildr or impov.s lhcreon,
<br />ond who mnlEcrs for su.h lmi{k with 0 ConrBdo(9lk ned Fursunr lo rh€ Coduscrors Li..nsc tiw).
<br />-l
<br />m cx.mpl undcr Scdio.-. B. & P.C. for thn Eason
<br />L.n.tcr'r a.ldre$
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<br />Site-Work
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