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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O'IVNT]R BUILlIER DELCARAIION
<br />I hcrchy ltlnm undcr Nnalry al lrcrjuy llrl I d cxcnur froD rhc C.nts.rorr t-i.dns ttra for rhc hllowin8 ,.a$n (S...70:rl 5
<br />stsincss and Pdt$ion Codc): Any Ciry o, Cou.ly which r.'tuircs o rslnir lo consrrucl. alrcr, impn,vc. dcnn,lish .r NtE r r,
<br />{flcrurc. prirro irs is.xrtuc. ako rcqxncsrhc atdicnnr fd such pcmn ro filcr sigtud srarcmnr rh.r h..r rhc is liccnrd pu6u.nr
<br />ro rh. ptrrlhions of rfu Grnrr{rois I-icciscd L{r lchrptcr 9. Connrc.ciog Nirh S.crion 70( of Divi\b. I ofrh. Brsin.ss and
<br />PnricsiotrsCodc) orthd h.orshc iscrcmrl lh.r.from and rhr h*h lor lh. rllc8cdcrcmfrion Aryvhl ionolSccri{,n70115hylny
<br />amlicanr for !lcrmil suhjalslhe atpli.ant lo acivilpcnahyofnol nmrclhan tilc hhdrcd dollur (5500).
<br />-1.
<br />as owncr of rhc p$pcny, or my cntloyes wnh wngc\ A rhcii nnc coml'ensrion. will do lhc qork dtl th. strrlE i mn
<br />itrrc cn .rohtrcd ior uh (Se ?044. Businc$ and Prclt$ions Codc Th. conrek s Li.cnsc Law docs oor drply ro o o[mr oI
<br />rhc pml.dy who h{ildroi inlrmhs rh.mn, dnd who des ssh qo* himsclfor hcMlf.rrhFu8h h( or hcr oancmploycs.
<br />lrovided rhar such nnpmrmnh arc mr inrentn orolIcrcd tor elc. tl. homvcr, tlE buiuins o! n{,tuvcm h $ld wilhin onc )tr
<br />or.onpLrirn, lhc O*nc. Bliklc. sill hivc rhc hil.n or F)vin! rhd tr or shc did nor buiH n. i.pnrrc thc ,'mlEly f.. rl! purlbs oI
<br />-1,
<br />!soBncr oirhc pmr.ny. r,ncx.hsivcly conrracrins $irh liccn{d c.ntn toF ro consrrucr rlE !$jccl (S( 7014. Bn(in.(
<br />dlld hnissinCod.:'l h. Conk*nn s Liccnk bw docs ror r,,Ily ro an oqncr olproP.ay who build\ or nnpmvcs lhcrcon.
<br />and uho conrEcrs tor sucn I,n)Fk virh o C.nrmdo( s) liccnsd purdxnr tu rh. Co r.cktr s Liccn* I2s)
<br />llOaKE&r:grMSENliAllAN
<br />IIDI;'dSTIION
<br />I hocbt rflnr undd Fn,lryoftsjuryorc orlhc iollosir8 dc.lararion\:
<br />-I
<br />h,vc i,xl will rtuinrain u Ccaificlrc of Conscnr ro Scla l.slrc for workds ompcnqri.r as rovid.d ror b! Sdion ]700 o, rhc
<br />tlbd Cdlc, a{, rlr r.rronMmc ol$c work for which lhc trmi n &kd
<br />-l
<br />havc (nil sillmrintoin $. c^ comFns,ion insunn.c. t{ rcqui..d by S(r ion .l7l)O or rhc tjbo. Codc. ior lht prrronM^_c or
<br />rhc *ork lorwhichrhn p€rni is t\!.i. My workn( .onr.ns,lion in$rrcc otricr ei lnicy numbct uc:
<br />Y/l(r
<br />XP,,(
<br />oS-ronc t ( c*t . ^,^4L4(-qt?us \-ro-,dtl
<br />-lceniiyrhulinlhctcrtordhnc.olrhcworkf(rwlricnrhN!.nnir
<br />is nucd.l shall nor cmPloya.y Pcrson inlny nldnNl
<br />so i! b h...nrc suhF.r ro I hc workcs' .o macnsal ion laBsolcalifornir- and nBE rhd ill should t cotr{ srhr.d ro rh.
<br />wo*cn' coqrtrs.r ion nmvnions ol Sccrion :17fi) ol I he titr'r c.d.. I \hrll. fonh*ilh conlPry wirh ih.* provisions
<br />WARNINC: Faiuc n, *uc workcN compcnsilion covcrs8c is unl.wfll- lnd shrll subjd an cnlPloys lo oninil FrkEs (nd
<br />civil fincs !p ro orc hudr.d rhous,nd dolh6 (Slln.uD), ifl ddniotr ro rhc cor or..ntEnrrrion. &nE8es 3s lrovidcd aor rh.
<br />S(rr,r lon, ol rhr ljrnr CoJ.. 'n'.m{dnd droflrcy s Lc\
<br />>'"'"1-t*t9- tg Xppt""'t w /L,@'
<br />Ul.[LUiD{9NInrlrI()llD!(Ir\tsilll!)l
<br />I hcrctry aflnD undcr penalryofFjuryrh l !n lien{n undcr ttuvision olChrprcr 9 (coDnrcncins wilh Sftrion 7000) ofDivnion 3
<br />.f rh. ansincs rnd Profcssions Codc. and nryliccnse h in lull for.c and cffc.r.
<br />D(*-"""",519 ) s->
<br />>,,"lrJ>,-tq-ts 7az- -/pi^-s- /:r..A 'z
<br />l.cniltrhd l hc lcdc.,r I rc8ul ionsFguiiDB ish.nos rcmorxl lre nor rptli.nhL ro rhis fotccr
<br />I rnilyrhnrI hrvc rclld ihn ryplicdri{,n rkl {ar. rhd rhcxh,vc inln i$ ir .orccl. l .3ra lo conrply $irh rll ciry a d coutrry
<br />ordinrnccsondSrdclnwrrclarinsiohuildingcnndtucrn)n. dhcrehylurtutrizcrcrc{nr.rivcsolrhisCiryan Counrr ro cnrn trPor rh
<br />L Jb.vr rnrtuNd nbrcny for insFctiotr nurF{s
<br />for,,.-, - n*-,.n-.*'{'4 ji1?
<br />f,".-,**..,0n.,, R- st< I t t3-+./o,.eg.,n.,-z
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding i Groundinq / UFER to14lt9 ,{/aq7 )
<br />Torqueino
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release tolllty..{,t4f(/1-
<br />Rouqh /o/qlt9 ..<144(i)
<br />Service I\/leter
<br />FINAL rch ltq /.uLq f4)
<br />Notes, Remarks, Etc t,
<br />(
<br />Translormers
<br />Air Conditioners
<br />-lrncxcnrDl
<br />undcrSedion-. B & PC fu rht rcinn'.
<br />D!lP, OPm.
<br />a1
<br />CANiTBII(:IIAN.LENDINIjICENSI
<br />I hcrh, amirn undcr Fnrlryotpcijuryrhd rttc il a @n{ cridnknding.Ecncylorlhcptaln,rurccofrhcsorklorwhichrhispcrmin
<br />n\u.dlSr.. 1097.Civ. C ).
<br />Irl'n.,'. A'lJ'c{
<br />-
<br />AITUSANLIIEII.AAAION
<br />I lrr.b,,mmxndci Fnolly ofFrjury orc ollhc fouoring d(lamtions:
<br />Dcmlin,n Pcrmih Asb.sros Norilicrrion Fcdcr.l R.gularions (Tillc 40. hn6)
<br />-Rcq!ircd
<br />brr.r or fiorir'cartu.
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