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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$v lrrc orrP|rlicftlc k' lhisl]tr,Fr <br />I ccniryrhd I havc rcadrhis apDlkrrnn, drd nrrc rhdrthc.bvc inrin uri,,n n.nrucr lrg1Nrocotrllllr]ilhrllCirtrndCounry <br />onlnakrs ind Sralc Li*s rclaling ro l ildinscoi{o.rnrn, hci.b}ltrlhori7crcprcscnrrrilcrofrhtCiryondCou.lyk,cnr.rdFBrlf, <br />rh,vc rnrtnrcd nmDcny lnr in\ <br />,\DDlir l nr ,\,t01 Sitnrluro s .L?-lt/ <br />e .)'\,'. <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soflit Rouoh <br />Ceilinqs (T-Bar Rouoh) <br />Ivleter Release <br />Rouoh <br />Service [t/eter <br />FINAL T//6,/,v s\<x <br />Notes, Remarks, Etc. <br />tD/stG. <br />-t. <br />oso*tur otrhe porEnr,,frcx.lusivcly.onrra.rirg will lic.nrd coDlr!.loFlo.on{ncr rh. fmjct (Scc.1}l4, Busine* <br />dnd Elrssb. Codc: Thc Contr0crols Liccnse Lau does nor !ppl, tr,n.wn.r ollrop.nywho buildr or impov.s lhcreon, <br />ond who mnlEcrs for su.h lmi{k with 0 ConrBdo(9lk ned Fursunr lo rh€ Coduscrors Li..nsc tiw). <br />-l <br />m cx.mpl undcr Scdio.-. B. & P.C. for thn Eason <br />L.n.tcr'r a.ldre$ <br />- <br />Site-Work