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ELECTRICAL-INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards )
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)I
<br />Ivleter Release /,/zt,/,zq /".1K)-i.t////
<br />Rough t/
<br />Service lvleler
<br />FINAL /://2//a )
<br />Notes, Remarks, Etc.tl /,/ H/"
<br />OWNER BUII,DET DELCAI',{TION
<br />I hcrcby amd under pcnrlry of Frjury lhar I dn cx.mpr Itum lhc Conlrlcnd Lncnsc L.w ntr lnc nrbwing @e,n (s& 70.11.5
<br />Ansinc$ and P..fcsion Codc): An, Ciry or Counry which rcqutcs { IErn ro .ondrud, ahd, impti,w, d.'mhh or rcp8n any
<br />\hcrurc, prior lo ns nsud.c. al\o rcqutG rhc a,,plicrir ror such f,dn ro nh r si8n.d slll.mtrl th0l h. or shc is lianscd p!^uM,
<br />!o rhc provisions ot rhc Conrrcctolr Liccnred tjw (Chaprcr 9- Con'ncmio! *irh scction ?0o0 or Division 3 oflh€ Busineri and
<br />Pn,ic*ioosCodc).rrhllheor\h.hcx.rrprrh.rcitudlndrh.tu\iqrorficollcScdcxcn{,tn'n.AnyviolarionolS6rionT0ll5hydny
<br />applicrnrroraFrmirsubiccrsrhc.pplicanrioacirilp.nalryornormrcth,nfivchundEldolllnlS5lD)
<br />6l-1, N osnr or rhc F,rrny, .r my dntldr.cs wn h wrs.r ,\ rhcn {rc omp.trqriotr. will do llE Bort and fic nBlE n mr
<br />inlcndcd or oflaEd r.r slc (S(.7o44, Busi.cas und ftotsnff Codc: lhe C.nrrerois Licensc Llw docs nor trlply lo,tr own*or
<br />rhc pNp€ny who hui8\ or iqrows rhe@n- and *h. d@s such rod. him{lf.r h.*.lt.r (h$u8h his ot hcr owncmployc€r.
<br />pmvidcd rhrl su.h i'np$rcmn* orc mt imcndcd o. oltarcd fd srL ll howcw. lhc tdikling or i.q'mv€rNnl h $ld {irhin onc }rr
<br />of.o.{,Lrir. rlr O*ftr Aui[cr will h.w rhc budcn ofFovin8 rhd h. or shc di].in hild or irymrc rhe pop€n] lor tlt I[{ne of
<br />I. as.wtrn ol rh. pft,p.nt,,ncxclusivclycontrdinS wnh licctr*d conr..lo6lo connnd rhc rrcjer iScc.7044, Bunm$
<br />,d Pmfssion C.dcr Thc Conr,acror s Liccnsc Llw docs n l ll]nlr ro an o*ncr or tn,p.n y *ho huilds or imp vcs rhctco.,
<br />rnd *ho .onta.h r.i su.h t.ojccb wnh o co.rtu ro(9liccnsdpmur ro rhc Conrodors Li.cnE lj4
<br />l:mr\rnnr unrr
<br />/*"t lv,It
<br />Sc.ri{)n . .B &PC lnrrhi
<br />'/ e etlz2-
<br />I hcrchy ifiirn utrdcr trDnllyolNrjuyotrc ol rhc IolknvirE dc.l.rari.ns
<br />-lhlveudpillnnrinroinaCcniaEarcoiConsnrroSclflnsu.cforworicFcompcnsdrtun.,rpmvidcdrorbySalion3T0ooflhct2hr Codc. fo. lh. p.rlormnc. of rhc work for whth rh. pcnn is nsued.
<br />-l
<br />hrvc und willnuinruin sorkeN.o,nFn\ali,)n iNur$ce- as rcquircd bt sccrnnr]?m.l rhc blror C dc.lor lhc pctionDN.ol
<br />rhc sor( l'orwhich lhnFln,il is i\$<l M,+orlrn conrcnsarior inntrrmc crtricr plict nxnrh.r nc:
<br />/r,(L l.cniry,har
<br />'n
<br />rhc [!€rrommc ulrh. tr.rk ror sh'.h thh r.nnir h issucd.Ishallnol cmrloy rtry per$n in dy nrnn.r
<br />s tr\ ro iccom \ubjd ro rhc worlcF' ."n'n€n\a! ion laws ol Californh- ,nd lse rhar il I shoxld h..om subjd to lhc
<br />sortcrs ompcnsln'n tnvi\iors ol Sarion l7(ro ot rh. Latxtr Co!e. l shlll- fonh{irh .oq)ry wirh rhos ,novkions
<br />WARNIN(;: Friltrre t' scur sorkc^'.o'np.trs ri.n rorrrrle i\ unlr$ful. rtrd \hdll subl..r arr cnrpkilc t,' {in,inxlp.mhii r
<br />civil iinrs up ti otrc hundrcd rhor\rnd olh^ (SI0O.(XX)). ir rd{lili(m k,hc.f\ ol.r rtrns ri({ rlxtrr!.\ x\ t,()v (t.(l tu' rl'd
<br />Srrn'n 1076 ofrhc llhorCutc- inrcrc( rnd rrkrmr'\ tuc\
<br />t+arl+)/c e
<br />I hcrchynmrm utrdcr Fo.llyofpcrjury lh l am liftnxn undcr Fi)vhion ol Chaprcr 9 (d,(ftn.i.! *irh sdion ?{xx)) .f Oivisior 3
<br />or !h. Busi.css and Pmfcssions Codc. {t 'nyli.ctrs h in tulliorcc endcflar
<br />Lcndcls AddEss:
<br />-
<br />AITLICANI.DEI;IINAUO!
<br />I lrt$y atrm undcr penrlry of p.{!ry 6 c drth. rolk,wing dc.luurt,ns
<br />lxnmlirion PcrmirsAsh.sros Norificorion rc'icml RcBularhns (Tirlc4. P r6)
<br />-Requncd
<br />tlrrcr or NoilEorion
<br />I (cdifyrhlr(hcfudctulrcgulrrii,N rgrtrdi ! r\If,!o\rr r,qlrrtf,InfDli(.hkn)rhi\fri!.I
<br />,61..iirr 1 l ld,c rrld rhF rttnl'r '.tr kl {.rc
<br />, rLlir,, (1.,'n,l s'rrc Lru\ (Lrii! r. hdilJi'rt !.trnru
<br />rh)vu tr,ctrrn'ncd l]n,pcny i,tr i,,\p!.ri.n prrIn,{\
<br />lhd rhc ihnc inlnflNrion i\corccr I iarehcoDplywirhrllcntrnd c.umy
<br />dd h$cbyaur,ntrnc rcprescnlalivcs olr
<br />n,Orr"r^o, n ont"rf tr* {fO t4 D
<br />t"*tr." ""* tp;,,rt, /1ry'r-l
<br />fih Cit, lrd Cornryro...o W.nrL
<br />*,"*fztlrq -
<br />Sub-Panels
<br />:o-,lfr
<br />Policy Numb.r-ErpiEs:
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<br />Licc nsc C hss:-Lic.nrc Nuf,b.r:
<br />-
<br />Drl.:- Conlmclor
<br />-
<br />qTNiIIIUGIIONIENIINIi3GEIII
<br />I hcEby dlfm und.r Fnahy oa p.iury lh[l rhm is . oiirudi,tr kndins lscEy {or lhc pcrtorlr@c oi rhc work ror whi.h Ihh lrmir ii
<br />hslcd (Scc. 3097, Civ C )
<br />If,Mcr s N.m:
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