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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNDR BUII,DER DEI-CARATION
<br />I hcrch, rlilrm und.r p.Mlry of rcrjury r har I dn crcmpi r6'n rh. Conrncro6 t-iccns bw ld rhc lollowin8 rcisn (Ss.?0] 1 .5
<br />Bu\incss Md Proltssion Codc): Any Ciry or Counry shi.h rcqunc\ tr ltrirnt to cotr(rud. alrc!. nnpr.vc. dcmolnh or rqun Jny
<br />{tucrurc. Fiorro irs hsuucc. Bho rcqunes rhc lprliclnr lor such p.rmir h m.! sisnci itrttunr rhrr hc or shc is licc.sed Nf.Mr
<br />t, rhc pri!tion\ ol rhc Conrracrois l.iccn{d l,aw ((hrprcr 9- Connncncing wirh Sccrn,n ?(XI) of Divisn,n :l of rh. Busincs and
<br />P$fcrsio"s Codc) or rhsr tEoishc iscx.mpt rhcr.li.n d rhc brci\ hrrhc rllcg.d cxcm.)rio. AnyviolationolscdionT0.ll5br!.,
<br />rlpli.aolforrpcrnlsuhjerrlhcappliconrt{,!civiltcn.hyofn.rnyrclh fivc hundrcd dolhs ( 3500)
<br />l. a! oNkr of rte popcn y. or my.mpk,)rcs sirh wiEcs as rncir $lc con,!.n\ation. will do th. w(,lt nl tlt nf, uEh fr,1
<br />imorLd or ofcicd tG qlc ( SN.7044. Busincs ond Prolcssbns Cdlc Thr Co.k.cror's Li.ctr\c Llu dcs trol ot'/y r) an o\'.cr ol
<br />ihcF)pcny *ho $uilds or irlroE rhcfrn f,nd Nno d{rs nrh wort hiNsclior hcr{lfor rhmulh his or hcr .wr .mDloyccs.
<br />n.ovidcd rhar such inlxrvcnrtrts rrc Dor ir cM.{ or olTcR'd hr $L. ll ln)wcrcr. rh. huilliry or i,nrucrcnr is mld wirhin onc )tltr
<br />ofc\ rrlcrKr, thc Osnf Buikld qill harc lh. burd.i of piuving rh,r h. or \h. did nor build or impn*r inc lop.ny lor lh. ,'urr.r ot
<br />l. a\ o*ncrorrhc pn,!.ny. xndclusivclycoftrcrinE sirh ll.cn\cd.ontrcrns h con{rucr rhc Ihi.Jccr lSc.. 7(U'1. Btr\irru{
<br />{xilh)fs\btrCodclhcConknrofsLi.cnscl-trrdocsnurrff,lyk,.ownc.olpr't^-ny*hotruild\orimpr,ksrhcrc.i.
<br />3id sho .ontd\ tursu.htmr.h sirh aCotrrnrk4s) li.cn\cd purn,n blhcQ ra.rn s Liccn{ L1w)
<br />I rmcrrn+ t dcr sc.ri,n, . B & t'.C l,n rhn '.r{n'
<br />O*,$
<br />IIOBTDBS:TQIIIENSAIIAN
<br />DECLAB{IDN
<br />I h.r.by affhi undcr l)cnllryofFrjrryoic ofrhc n,lk,*ing dcchflrion\
<br />Gxlc,lor thc lcnhnMmc oaih. work ri,r which rh. pcnnil i\ isucn
<br />rid sill rnnrnr solkcr'.o tf,n{rotr ii\urxtr.c, r\ ruqrncd hySc.rmD l7(X)olrhc lrhor atdc. l'o. rhc t^-.nnou'ncc oI
<br />.$ml.osarion insurdmc micr u Flicy numbcr N:
<br />c-^-v\
<br />rl)CD R A DI ADIV
<br />-l
<br />cenity lhal in lhc 0.rri,irnincc otth. work ior whth thh l).i!trir h nsucn. I shrll nor cnDloy any peN,n in nny tunn r
<br />m 6 ro bccom sutj.sl lo lic *o*e6 comricnvlion la*! ofcaliforni(. lnd asE rhar irI sk,nld }*.on* ruhj(r o rrf,
<br />Nor*cn' co'q,cnsil ion provnionr of Sarion :]?(xr ot rhc lih.! Codc, I shlll nrdNirh conplt wirh rlby F)vhn,.s .
<br />IVARNlNC: l.ilurc r() sccurc qorlcn .onr,'crsrririn (.vcrrsc i\ unhwtul. nnd $rll \ul+cr Ir cnrploycr t, si'ni'irl n mhics Md
<br />civil firs up lo.tc [tnd,cd lhousrDd dolln^ (SllxJ.(x)O). ir nJniiiur to lnc con olconrpcn\ilion- drtr8cs d\ F,vidcd ror rh.
<br />::':siffi[{''*."1
<br />utitt\tlrtIt.rit
<br />I hcob!rffi nund.rIxn.lrlotrcrxryrhd Itrh liL{trrd utrd.rpruvni( .fChitr$9(.omtrErf,in8wirhSccrio.T(xX})oaDiltion:l
<br />ot ihc Bu\i.e\sand Pmfc\rnn,sCodc. drd ry liccn{ is i. fullfitrcc uid.lTer
<br />8)-\
<br />(
<br />t5 (
<br />I.;OIEIf,I]CUAN.LENIINGAGENCI
<br />I hcrcby lmrnuid.r rEnahr.aFrjury rhd rhcE is. con{d.rirn lcndine ae.ncy aor lh. lcrformncc ofrhc work for whi.h rhn tEmn n
<br />isslcd (S( 3097. Civ. C.)
<br />A.EIIICANIDECIAEAIION
<br />I tmtry ofim uid€r pcnllry of rE jury o.e of rhc follo*ins ddh.ar ionrl
<br />Dcmhion P.rmits.Asl,c(os Norificalhn FcdcEl Rc8uloliofls (Tnt 40, Pul6)
<br />-Rcaoircd
<br />Lclcrof flotiarclrirn
<br />h8&ding ash.sos Enrvrl r. .or ll)plicablc lo $k lrojat.
<br />n ad stdc rhar thc abovc inforrori.n is coE6r. I uElN ro Loq,ly wnh ull Cny and Coutrly
<br />0ulhoriTe rcprcscnrarivc\ olrhn Ciry ud Coumyt, or.. ulr,n rhc
<br />-,"Sitlltv
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si gns (monument)
<br />'Lile Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilings (T-Bar Bouoh)
<br />Meter Release
<br />Rouoh
<br />Service l\/leter
<br />FINAL vl101t9 /<,u6(,x)
<br />Notes, Remarks, Etc.
<br />u
<br />Pole Bases
<br />Lcndcis Addrc$:
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