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ELECTRICAL.INSPECTOR RECOHD
<br />APPROVALS DATE ID/SIG.COMMENTS OWN6R BUILDER DELCAiATION
<br />I h.rchy alfir$ undcr lc.olly ol Frjury lhol I an cxcmrr fmnr rhc Conrreror' l,ien$ lje lor rhc ai,Uo*ins icasr 1s...70.r1 5
<br />Bu\in.s\ and Profcssioi Codc): ny Cnt .r Coxnr, whi.h rcqutcs s Fnnir k, .on{ .r. alrcr. inttuvc, dcn,lhh or rcrut any
<br />srudurc.,,.d kJ ns isuaR., aho rquircs rhc appli.d ro, \u.hFmir b 6lc, ri8n.d NarcnEnr lhdlror\nctlicco\cd puNanr
<br />ro rh. pmvist,ns ofrhe Conrrscrois Liccnsed t w (Chaplcr 9. Commcrcins sirh Sc.rion 7000 ofDivision.l.l rh. Businc* and
<br />&olcsn,nsCodclorrhalhcorsnc cicnpr rhcrcl'ro andrhchnshli,rrhcllhrcdcicmflnn An!,!n rri{,nolscclionTl)ll.5byany 1
<br />ryfli..nrf.ra|f,hnnsubjekrhc.nlli.rtrrtoacivilp.Mhyofnot $rcrhm nv. hundrcd dolli( ($500).
<br />I.i\o*nqofihcpr.pcnr.ormycnlpkiy.rlwirhwrscsasrhcnvrl..o.rl.nsa!id].$illdorh.workdMlhcsfrlurc not
<br />icdet oroftc.cd for srlo (Se 704,1. Busilrc$ md Piofc*iotu C.d.r Th.C.ftn.rols Liccnsc Law docs trol0mly lo! oencr.f
<br />rhc !!,|xny *ho huilds or in n,E\ rtrron. snd wtx, d@r sch wr.t hims.ll or hc .lf or rh('trgh his or hcr own cnyl.yccs.
<br />nrolidcd rh such imnmtlmnrs nc mr intcMcd or oltar}d hr {h. lt hoscvcr- rhr hoikling .r i.npmEmnr h $H *irhin onc F{
<br />ofc.'r{hrion. ilr O*n.r AuiBo aillhaw rh. bod.n ofpmviq rhri h. or sh. did tr.r buikl or irrprovc thc tn,Fny tu rhc puryne ol
<br />-1.
<br />r\ o*rcr of th. !repcny. 0n cxclusivcly cotrt.criry with li.cn*d .onhc1.s t' .-onslrucr rhc pmF._r ( Scc 7O,l4. au\incs
<br />i 1 ft.tc$hn C{xlc Thc Contactn s Liccn{c l -aw d..\ nor rpnly h m o$if of pmrcrly who huilds or inrpovcs rhcrcon.
<br />rM qho .onhcn lor such pmjltts wi'h a Co rrcto(s)ltcnscd ru ur ro rhc Conrradois Licclsc li$)
<br />I rrrcxcnrtr utrdcr Scclio
<br />q -6 -/{
<br />I hcrchyllfirmundcrn nallyof p.riuryoNoflhcfollowi.gdcclerlions:
<br />I htrvc.rrl erllnuinrai.0 Ccniicarc ofConscnrr. sclf.Insurc fo, *orkctr' conll,cnslrion. a! nroridcd lirr by s(ri{,n .1700 of rhc
<br />L,txtr Grl., f.r rh€ rcrform..c ofthc wolk tor whi.h rhc pcnnir k is\r.d.
<br />I halc rnd uillm.inhin workcrl comDcnsllirn insuntrcc, as rL'quncd hyScdionl?Ol)ofrhc t,horCodc, r{trihc |xrronmn.c or
<br />lhc wolk tur qhichtht pc,nir is hsucd Myworkcn conpcns0rion insurln.cc, crrntlB,licy nun'hd rc
<br />PolicyNumhcr:-
<br />I.cdify rhd in thc p$fornuna olrh. qork r.r whrh ihn Il' mir h is(ucd. I sh0ll nor emlloy rny rr.rmtr in an, nknftr
<br />s $ l', tcom slbxrl ro lhc wortcc curpcnsllioa law! ol Californi!. rRI lrcc rhrr if I sh,uld h( r \ubj.cr hltE
<br />wo,kcn'cotrrpctrsorionpovnionsofSeclionS?OOoflhcLatsrCodc.lnulllonhsirhdnnplv$irhrtb$proli\ions..
<br />WA(NINC: |3ilurc rn Ecurc workcli.on,!.ns ion urvcmgc is utrhwlnl rnd shrll \ubrlrr rn cnrtlorrr h (rnnnrlFnihics a
<br />.ivil firos trn k, on. htrn,lreJ rh.u\nnd dolhn i$llxl-otxlr. i', rdlir mn, dr.qcs rs pnr! cd l'or rhc
<br />S(ri{nr ll)76olihc l-ahtrCodc. i'rcrcn rdd a orRy \ li.r
<br />*,., ?-6 -/8
<br />Ihcrctry.{fir undcr pcnalrynlp.rjury rhsr I am licenEd uder pmvGion orChl,lrcr 9(commcn.inB qnh sfttnn lfix)) olDirision l
<br />of lhc Arsinc$ ind Profc$ions Codc- and myliccnE is in tull lhre o,xi cllccl
<br />II)ISIBIJCIION.LINIIINIi.ACDM:I
<br />I hcruhy rffirn xnd.r Fnalry ol pcrjur! rhd rherc is 0 onslrucrion LMin8 ag$cy lor rhc polotruEc oI lhc worl ihr whi.h rhis !&mi( G
<br />i\r&d (Scc .lO9?, Civ C )
<br />AITLI1;ANI.D!:IIABATII)N
<br />Ihctr$ydfin undcr pdtralry.fltrrury.ic ol rhc lollowin! dd.lrturiois:
<br />I)cmolirn'n I,cmirs Ashcsros Noriticlrion rcdcfl,lRcsularie$ (litlc t0.llrn6r
<br />R.qun.(l I c!rcr.a Norillcrr on
<br />I cc'r'l,rrl'rr rh f(dcml rc!tr1.1i()tr\ r(sJkltr! tr\hL{o\rci(rrlrrc !ritdi.trbI i' rh]\ fnil..t
<br />.r(1iM,,c.\ rni Sixrd l-rss rclxrirE t, huinli',9 .otr{n'.ri,)n. a,rl iurkxiTc rcj'c{nrariv.s orrhis Ciry rnd Counrr lo cnrq u[n.rhc
<br />otnrc nEr'iomd roncnylo! iNnccl
<br />Appli.snrorAAcnr siAmr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />I\Ieter Release
<br />Rough
<br />^FINAL
<br />Notes, Remarks, Etc tT \
<br />6",u1",
<br />7-G /7
<br />Sub-Panels
<br />Service lVleter
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