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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS 1)!tNt,:t DULDIR DId,CAlt,\',lI( rN
<br />I h.(by amrnr und(,cnalry of pcrjury rh[r I mcrcmrr rmrn lhc Conrrach Liene l,w for rh.lollowitrs rclsn ls"7oll5
<br />Busincss aod Pr.ac*ion Codc)r Any Ciry .r Coutly whicfi rcquiE! a FYn l lo ot{ru.r. rlrcr. inrrmvc. d.frnish .r tltoir anv
<br />srtucrlr.. tdor ro ns irsulncc. dlso rcqu ircs I he anPlicanr tor su.hFnnilto filc0 sisncd stntcmnl lhar heorshc L\ liccnscd llrodnr
<br />ro th. roYisions of lhc Conk0dors Licen*d Llw lchapr.r 9, ConrNrcins wirh Sccrion 7(xI) or Diviriotr I 'r rh? Btrsin's rnd
<br />horc$bis C.dcl or lh hcor shc hcxctlpt rhcrclmm.nd I hc hasis ror rhc {llcScd cicnPrbn. Anvriohtionofs.dion70lll.5b,an,
<br />oppli.rnl ror, rcnnil suhjcch rh. {Plicanl lo 0civilpcnaltrof..r mrclhrn five hundr.'d dolh6 ($500)
<br />-1.
<br />as owncr or rh€ propny. or my emll.rt s wirh waScs cs rhcn $b d\nptnssti{'n. *ill d. rh. sort and ll* srclm h n''
<br />inrendcd oroffcrcd for slc (5(.7044. Busincs ond Prcfcsion\ C.dcr Thc ConlEcttr r Liccn* kw docs nor applv to an o*ierof
<br />rh.lolfny wln' hritLs ot imtmws ltENn. orn *ho d@* rkh mlt nn$clf.r hcrcllorltmuEh hn orhfown cmtlovcd.
<br />proridcd rhnt such inprcEm s d tut inrcnd.d d ofrctn for slc It k,w.6. Ih. tuildinA or inlmEmnr t $H si(hin ofl its
<br />;fcoq,lcrion. rlEo{ncr Buiklcr willhlw rlPhu,thnolpmri.s rh h. oi she did nor ttrild or nryn*e lhc,nFnv ror rhd purposof
<br />-1.
<br />!s owftr ol $c pmpcny, a crclusivcly conrmcrins snh li&nscd contmcroF r. snslruct tlE Irojccr (Se. 7044. Busi"t(
<br />nnd PDf$sion Codc: Th. Controcrols Lic.nsc l-aw doN nol.FIly to d o$ncr of,nopctv wh. builds or improvcr rh$con'
<br />and wh. co mcrs lor such p.jc.ts wilh s ConlEclods) liccn{d pDNanl lo Ihe Coor$dols Licensc tjw)
<br />-l
<br />ar crcq)r uMcr Scdion-. B. & P C rd rhis rcason
<br />D5l€: , O*n.r:
<br />W()IKERS (lirMPFNSlafi)N
<br />D&CLAAAIPd
<br />I h€rt y !,fim undcr penalryofpcrjxry onc olrhc lollosins de.ldarn,nr:
<br />-l
<br />hrvcrxnlsillrMn rirrCcniicoreofContcrloScll_lnsurclnrso dI.onrrcnsario.,\ fllvtrtcl iu hvsNn'tr l7(x)'trhc
<br />tjh). Ciie. ior lhc pcitni,Dtrcc ofrhc qo,I n)r whi.h rh. Fnni n nsdcd
<br />Ih.vcrl]dwillnrlinrlinwo*.rs.oiD.tr{lionnNtrftnc.,rsrcquircdhyS.cri(:1?00olrhcIrh.r(inlc.lorlhcpcriornn"'l
<br />h rhn n!fl ir'ilisled I{ywor[
<br />LA-
<br />L.
<br />-l
<br />ccnify rhar in lhc pcrformakc otlh. work for e[ih rhh pcrmir is isucd. I \hrll nol cnDlov 8nv PcNon in.nv monNr
<br />r, as to h.om subj.rl k, rh. Mtk s'con!.nsarion hw. ofcalirorni!. md lsm rhd ill should h..o,m br.€lrolhc
<br />wddctr ornltnslion pmvtiohs ofS.rlion ]TOOotrhc l2bo. codc.I shatl. rodhwnh onulv wilh rlbc,mvisions
<br />wARNINGT rnilurc ro ilff sorkcc' s,m''c.qrion svcmEc is unlaqful. nnd sh.ll subi.r r. cnplortr lo sininal FMhas atrd
<br />.ivil fi.cs ut lo onc hnndt d thousand dollar ($l{$.mo). in oddilion lo rh. ost of comJrnsltion. danug€i as lFvni'r ror rhcI"riryiq""""lJ:w- t rcENSFn comRAc,Ton
<br />TFCLARAIIoN
<br />I hcEby arm und.r p.nrlry of perjlry rhar I tm lian*n undcr Provtion of Chaplg 9 (.{mmminS wirh S<rbd ftx)o) or Divhion l
<br />of lhc Businc*dnd PolcssionsCode. ard nyliccn$ is in tul!lorce,ndcficl
<br />-\c-2.r-\
<br />qONIIBU!:IIONTDIDDC-AAENCI
<br />I herchy ar0rfl uniLr lr.aliyotptrlry rhar rh.tc h a onsldcrinr kndin8 r8emy f.r rh. pclforromc otrhc *ork tu shich rhi\ trrmit is
<br />isucd (Sec l(r97, Civ. C.)
<br />APPt ICANT N[(I dNATI0N
<br />I trd,y tr0im undcr lcmxy of,,crjur, onc.frhc rolk'*nr8 dc.l[elt nll
<br />Dcnk irio. Pcrmilr Ashc .s Norifi.{ion FcdcralRcrulnli.r\ ('lirlc40. Pd6)
<br />Rcquircd I drer of Norifi c.rion
<br />-l
<br />ccnify rhrr rh. r.dchlrcSuhlions tlddinS.sb.slos rcn,vrl m nor {'tlic.hlc t, rhn rn'1..t
<br />-l..nifyrhdr
<br />Ihtrvcrcadlhhaprlic.rionnndsrrlcrlul rhcalr,vc irlonnrl i{,nis.or..r IrsrcchconrPlrwrhullCnrr.dcoxnry
<br />onlin ncrs rnd Sr c ljs\rhringk, huildir8 irc tutrcrcrl.livcs ollhh Cny trnd
<br />mvc rf,nrutrd tol,cn) lor
<br />:D
<br />ryiK.
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Itrleter Release
<br />Rouqh <J-r.-rl "t8.r I ''4{?2,
<br />Service lvleter t7,tB,rB z ?c 6,,a'
<br />). r*,tg z b;;^;;;e7/
<br />Notes, Remarks, Etc
<br />APPROVALS
<br />FINAL
<br />tf,n.lcis Addrcs
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<br />1
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