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ELECTRICAL.INSPECTOB RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNEX BUILDER DELCARATION
<br />I h.rcby afarn u.dcr lEn0ht of pcdury lhot I .m cxcq)l lmm lnc Conlnctor' Lius lj$ ao. rh. aollo*inc ra$n {s.c.70-11.5
<br />Busine$ and Proacsion Codc) Any Cn, nr Colnry lhkh rcqutc\ ! rMlr b ondtud. alrci inpbvr, &nrlish or Etat rny
<br />(rucr@. Fi6r b ns irsudm.. ,l- rcquiEs rh. anpli.dnr for su.h rmir r t,lc a siSmd st.lcmnt lhal hc or stc is licensd nlNant
<br />to thc provisions ofrtr Conrrlcror's Licenscd Las (Chaflcr 9. ComnEnci,s ui(h Sccrion 7fiJ0 or Division I ol llE Busincs {nd
<br />Pbfc*n,ns Codc) or rhrr h.o. sh. k cftrrr therefr.m rnd rh. htrsis f.rrh.alk8cdcxcnDrion Anyviolorio.oaScdionT0:ll5hyaoy
<br />ll,Ilic0nt lor a pcmil subjeck lhc aDplicanl to rcivilFnahyofnol mrclnrn fir! hood.€d dollds (i500).
<br />_1. 6 owner .l rhc pnrpcdr. rtr ny.f,f,brt4 *irh wrlcs n\ rhcir n,l. ..nDctrs[tun. will do rlE qork td thc $nEt!rc is n'r
<br />inrc*ld oroft.r.dr(nsrlc(S.{.704rl.Busircsd.dt'iDfcsltrNCodcTh.Cotrfucror'sLiccnscl,iwdocsnorq,nlyn,snowturof
<br />lhcpmpcny Bno hlild\ or nnp('vcs Ih.Nn. lnl who d{Es {c[ work hnn\cllorn.r*ll or rhnrueh hi{ or hd owncnlnloyccs.
<br />ptulidcd rhnr su.h inlmwnf,nh aN not ir ctrdcd or otllrcrl for kL. ll, hrsc$r Ih! ttrrtiry or iq)rawnrnr is $ld wirhin om )rr
<br />of.ontkrion. dr O*n.r Buiud willhnvc rh. hordcn ofprovirB rhd hc d shc did tr.r build or inll)mE Ihc 0n{rny lor rh. puqne ot
<br />-1.
<br />0s owrcr ol thc ropcny. om cxcluiivcly contacr ins snh li.cnsd conr,lcror\ ro @nsrdcr ilE porrrr (Scc ?u:r. 3usifts
<br />mJ t\trli*sbn Codc Thc Contd.r.l s Lic.ns tiw do.s nor ,m!t b an owncr of proFny who hu il& o. inryoEr rhcrsn.
<br />and *ho contmds for such lrrojcts wirh a G'nrEcto(t lkcnsd lunuanr ro rie ConrEroir Li...sc Li*).
<br />llaBK[BlroMtENSA]IOn
<br />DICLAMIION
<br />I h-rcby nilnnr undcr rrcnalr, ntllcrj!ry onc olrhc lnlbwins dcchrrrion\:
<br />-lh.vc4r'dwillNinriinaCcnificarcofConsenrloSclflnslrc{oruo*cGonpcn{ri6n.arti.vid.drorbrscclionlTfi)orrh.tjbor Crodc. ror th. Flfonmmc ofth. qork for which rhc pcrnln n kslcd
<br />I h.!c and willmlinl.in workcN compcns ion insurarcc. as rcquircn hy Secrion 1700ofrh. tibd codc. ror lhc rcrfot,Mrcc of
<br />vortcG conll,cnslrion insuruncc clFicQnd rr,licy nuilh.r e.
<br />\€7730 7-t'\q,.
<br />_l.enilyrhrr inrhc p.rlurtun..olrhc s.rk fur qbi.bthis pcnnir is i\sucd,I shrll not cn{byonylcBon ir lnynEtrn .
<br />H, Ntob.com subi.l ro lhcqo crsconrEnsnlionlawsofcalirorni0.rtrd0srcclhdirl\hDrldbccomsuhjc.rtrrh.
<br />*ukcrs, c.mp.nsrrion prcvnions of Scd ion 3?fi) of ihc L$or Codc, I \hrll. liflhsirh comply wirh rtx,{ pn,visn s..
<br />WAnNIN(i Fliiulc t, Krrc $lrkcri.ompco\dn,r.ovc.Jgr i\ otrhstul. md {h ll subj.rr flr cn{'[)ycr tu crimi',xl pcft,lris rn
<br />.ivil finc\ ut b om hundrcd rhousand dolla^ (Slfi),(xt)r. i', rdil n,i b rhc.o{ ol.onr.trsri r. dlnugcc !s poliJcd lq rhc
<br />Secrion .10T6 oithc lf,titr Codc. inrr.i rnd orft! s fLT\*"''7:b:fr
<br />I hcmby nrifln und$ pcMlryorrcrjury lh,t I am liccn*d u*ln povkion ofChapter 9 (curmming wirh s.crior 7000) ofDirkion:l
<br />ot rhc Businc$ lnd hofc$ioos Codc. dnd
<br />'ny
<br />licdnsd is i'r fulllor.cdndDn.r.
<br />B I 7'L
<br />7-rLa-2-a7<
<br />CANSIf,I,T:uI]NIINIIIGIGENCI
<br />I heaby a,Irm u.d( ,,culiy or nc.jury thd rh.m ir a coNddk . LndnrS 68.fty for rhc pcn(JlmNc of lhc erl f.r whkh rhis Fmt G
<br />issucn (Ss.3097. Ci! C.).
<br />ATILIIAIIJ]ICIIIBAIIIIN
<br />I hodry dmm undd l.nalry or tcrjury om or rhc roll.wing dc.hroi ionsl
<br />DcnDlitiotr Pcrmits-AstEsros Noliliqlion Federal Resllllio"s (TnL 40. Pd6)
<br />R€qlied Lclcr ol Norifiorbn
<br />lccnitr_ 1tur rhc i.dcrrl r.!uhrnins rc8rding rsh.no\ rrnnnrlrrc orrnfl(nhlckrrhi\t'i()f.r
<br />I ccrrilyrhll I hdvc rc rhhaprlic0rionandn crhlrrhcobvcitrionuiioni\corccr I aF$ h .omtly wirh dll Ciry !.rl (nutrry
<br />orJinrnas atrd Shlc Lrwsrcl itrsro buildins consh,crn,n. uxl hcrchyrurho'izc r.pr.sc rrivcs DrrlrisCiryMdCountyrocntcruponrhc
<br />rk'rc nf,trlotrcd pm,[dy lijr
<br />ADllic..t or 1{$l Sirnnh'm ?:?:tl>
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Condrtioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilinos (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL 7t%tK t"(/QQt
<br />Notes, Remarks, Etc
<br />-l
<br />amcrcmlt undcr Scclion-. B. & P.C. lor rhn rcason.
<br />D!(.: OMe.:
<br />n
<br />Le cl. Addrc$'-
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