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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIT-DER DELCAII TTON
<br />I hcrchy aafirm rnd( pnrhy 0r p.rlury rh.t I dn cxcnrlr irom thc C.nrreron l-i.cnsc tie,orrhc rollosinS rca$n (S.c70.115
<br />Busincsc and Prorc$ion Codc) Any Ciry or Counly *hich rcqlics ! Fmir to co.nflcr, ulls. imrrolc, dcBrkh nr rc.6n ony
<br />sruclurc. Eior lo ns nsulne, il$ Equncslhe al)plicdl lor such [f,,nir t,lik r sigmd slstcmnt lhal Lor rhc ( li.cn*d Purua
<br />ro rhe [olirions .f rhd Conrrroas LiNns.d taw (Ctirrcr 9, ComnEncins wnh ft.lio. 7000 or oitision ] ot lhc Bt\inc$ ahd
<br />PofcsionrCode)orrh.llEo.shctr.rcnl,rtherclronMdthehnsislorrhcrlhs.d.rcmprion.AnyviolalionolSedionT0ll5byDny
<br />applic,nr ior a pcflnn subj$ts lhe arrnlicarr b !.ivilpcnahyolnor o,odrhan 6!. hundtcd dollar (5500)
<br />L as owEr or rhc pmlEny, or my cnrployas wilh wascs as thcn st cont'€isarnnr. will do rh. work dd lhc nMr@ is n
<br />inL.dcd tr o0crcd for el. (56 7044- Blsincs ud PDtcssion\ CDdc Th. conrrrois Li.ens Law docs nor {paly lo rn owncr oi
<br />rhe pmFny vho builds or inpows rllrcn..d wt$ ds such wlk hinsclfor hcr{lfor rhr.xgh his or hcr own cml'loyces-
<br />p.ovidcd that such irnnnrwmols m nor inrcndcd n' oltu n, skt ll ho*ckr tlE buildill8 o, impmitmnl is sll *irhin onc ,tr
<br />of.onnhrbn, ttt Owner Buillcr vill h.w rnc hrdcn of pmving rhar hc or sh. did nor buikl ot inuorc rhc Impoly fot llx pulx,{ oa
<br />_l. rr o$rcr of rhc l,oIcny. rm erclu\iv.ly c.nrKtinB sirh licc scd .otrirr.lors lo .onn rud rh. pn,F.r (SN. 7()1]l, Bunnc\r
<br />r l li)fLs\inr Codc ThcCon(m.rois l-iccnsc Lawdocs nor apply n) rn.sncr of p()l*dy who buildsot in{,tnv.s rhcrcon.
<br />an{l wh. conrrucrx lbr such tm]c.h wilhdCoftdclo(s) licc sL{ numurnr ro rhc Contncrois l-ic..\. Lnw)
<br />I lrcxcn,tr u dcr Sc(ri,ri .1, &IC lirrhtr.rvn,
<br />Dnle - Osner:
<br />woRxrRs{t)MPEr\tsaTloN
<br />DBIAAAIION
<br />I hcrchy amrmunds pendlryotp..juryorc ollh. r.Uow ! dclmalnnr
<br />-l
<br />hnvc,xlwill ndnrlin !CenificolcofCon*nr to Selr lnstrrc r(tr *ork.d .onPcnsor ion. ns lmviled fo, brSdn,n lT0Oofrlr
<br />titbr cod.. ror$c l.rlomrna oflhc wort for wtich Ihc D.rn hnsucd
<br />-l
<br />h.vc n.d will nxrinhin rorltcfi comr.tr$rion in$hi... r\ r.quncdbySccrion:l7lx)ofrhebtx,codc,rurrhclctlornunccol
<br />rhc 'ork lor*hich rhisFrmir isisrudl My workc(.oml.nsdtun iNuroncc caricr ai Fric, numb.r trc:
<br />l.cnilyrhrr inrhc pcrtunmkc Dfuhc aork lbr Nnirh this lc.nil is issucd.I \lull mr .mpby rtry trr$n ir ntry ,rii.r
<br />v, s ro bcconr subFi ro lhc $orkc*' conp.n\arnD hw\ of Califontir dnd a8ftr I hir il'I sh,rkl hccom {hier ro rh.
<br />trorkcn.o'npcnsari.npn,lirn,NofSNn.tr3700oflhcL$orCod..lsiall.fnrhsirh.oilpltwirhrhosclrovisio.s.
<br />WARNING Fsilurc lo *rurc workcc' comlcDsurion colmsc is unliwhrl. lnd sholl subiccl an cmpbrer ro dimnul pcMlrics otrd
<br />civil fincs up ro orc hu.drcd lhousand {tollF (5l0o,o(ro). in lddirion to dc .o{ oa comPc.etion- dum$r ds Eovidcd for lhc
<br />SNti.n 10'76 olthc L0bor aodc. inrcrcn and atr.,rcy s fss
<br />Applien(:
<br />LTCASEI.CQNNAqIqB
<br />DECI.ABATqN
<br />I hcrehy lttmundcr peulr, of Frjury rhar ! an liNns.ri und$ pmvhion ofCt.prer 9tonuEfting sirh s.cli,tr 7filo) olDirtion l
<br />or rhc Busircs.nd Profcsions Gdq and my liccnsc is inflU ro(c dnd c,Icct.
<br />CONEIETiCII}NIIINDINCAGIX!I
<br />I hcrchy llirn undcr Fnrlrrorpcrjury rhar rhco is d con{dcriotr lcndina ascnc, r{r rh. tdlnrmancc ofrh. \ork fff shich rhi\ Frmir i\
<br />issucd (Sa. 3097. Civ. C ).trndca*Naim:-
<br /> PPI ICANT DECLAI(ATION
<br />I H,y atlim ods pcnalryofD.rjuryon. olrhc louowine dccldarions:
<br />D.molirion Pcrmns.Astesros Norificarion Fcdcral R.Buhrn,ns (Tirl. 40. P,n6)
<br />Rcquncd brlcr oi Nolifr!fion
<br />_l ccrrifyrhd rhc lidcrnl r.suhlbns rcgrnlin8.sbc{o\ rctrk)ulflc norrppli.lblc n, rhis F)jccr
<br />lccnilyrldll[vercsdrihal'plicrrionard{arcrharrhcrhiMinLnnaii k comcr l!grc!roconflywirhrllCiryondCounty
<br />oditu.ccsdtrdsrorcljwsrclori!3rohuiuingcotr(.ri,[arxlhcrhyauth.riz.rcJ)rcr.rlli'!5otrhi\CirylndCoumyrocnrsuPonllr
<br />ah,vc nrmidrd F)p.fly lor in spccl io. nuryo\cs.
<br />ADDlienl o.l\gtnl Sixn{lum
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light 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 />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equrpment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />Irileter Release
<br />Rouqh '*{zlvt
<br />Service Meter
<br />e.\ilfi
<br />Notes, Remarks, Elc.I I I \-z
<br />T7r-v4)
<br />FINAL 1rc->e)
<br />l,iccn\c Cla\\:-Li.cnsc Nunb.r:
<br />-
<br />l),le Corlm.rorl
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