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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.OWNER BUII-DER DALCAN,{TION
<br />I hcrcby lffirm undcr p.mlly of perjury lhll I un cxcmll fmm lh. Contracros Licensc ti* tor lhc f(rlowi.8 E $n (se ?0r I 5
<br />Busincs rtu Pmfcsion Cdc)r Any Ciry o, Counly whkh r.quiEs a riamir ro .oi\rrucr, alrcr, inpruw. d.nrlnh or rcptn .ny
<br />rltu.rue. prtub ars issubn.c. sl$ nrtuire rhc,rdi.,nr r.r su.h p.nnir ro iilc a signcd edcnrnl lh0t h.or shc h liccnscd l,usuonl
<br />ro rhc rmlhions of rh. Conhcrois Liccncd Lrw (Chaprer 9, Comnrcncins $irh Secrion ?mo of Dilhion I of$c 8u{nc!s ond
<br />Pmtessions Code) or rhar h€ or shc is er.mfl rhcrcamn and rh.l,&sis tor rhc alLscd.r.n/i.n Any vi.hrion of Se.-lin ?01I t by lny
<br />{pli.0nr td r pcrmir \ubjc.rs 'h. ,ppli.anr ro a.ivil p.mlry.r oor mrc 'h fivc hundrcd dollus (3500).
<br />-1.
<br />as owncr ol thc ImFny. or ary cnplole\ wilh q'aacs !s rhcir v,lc compcn{li,n. *ill Jo rhr *.r* ,ild rlr $ 1urc is mr
<br />i,ncnd.d or oncrcd nrr slc (Sr.. 70.14, Bu{itu\r aid Pn,rcsion\ Grd.: Thc Contu.tn's Lkcn$ Ilw docs ml omly ro an owner of
<br />lhc pmrcny who huilds tr im[ovcs tltr@tr. aDd qlD d@s such mlk hinNclfor hcrcltor rh,oush hh or hcr own dnploy.cc.
<br />prolidcd rhDr su.i impmrtntmn inrcndcd orolTmd lo. elc ll h.trclcr. rhc ltuildins or impnrtmnr is eltl *ilhin nE J(.tr
<br />ofonDlcrion. thc Osrcr Buiuq sillhrk rhc hxdcn ofprcvirs lhlt hcor sh. did n ttild or i,r{r,rt rh. pn,Fiy nn rhc purFs of
<br />-1.
<br />$ owm, ol I hc pmpcnr. am eiclusitel, conrrrcrins *irh liccn*d conkacb^ r. $.qru.r rh. poi\r (Sc. 7044. 8u!rcs
<br />,M P$fs\htr Cod.: 'rhc Contr.roas Li..trsc Llw des nor trpIly ro 0tr ow.cr oltropcrlyNho builds or impmrcs rhcrcon.
<br />"nd who conllacts lor su.n pDjecrswirhaConrrscr.(s) liccn{d plrdlor rorhccont,cti\ Licctrsu hw).
<br />-l
<br />m excmpl !.d6 s*io.-, B. & P.c. for rhis ,en
<br />Dil.: Ow...
<br />lull8x!&L:c0Mf[NraraN
<br />DECI.AXA]IA!
<br />I hdrby ulltD undcr Dcnalry of Frlury onc ufll[ foll.wing do.l
<br />'ariotrs
<br />I hrvc anJrill luinrain I Ccn ificarc oa c()n*nr b Scltln\urc for aorkcra .omp.n\d n4 .s proridcd l byScclionl?(x)ofrh!
<br />Itrhn Codc. for lhc pslolmncc olrhc work fff shich rhc !.rnrir h isucd
<br />- \hrr. rd",ll,r d *.rlc^ -o '|rn.srnn NuBftc, J\ rcqumJ hy
<br />rhc,*ork lor uh*h rhF pcrmir i\ n\ucd. M) r nr\ch' mmtlrnsor nn In,ua(c
<br />1700 ofthe hl'l)r Gldc, ror rhc rcrfonMm. or
<br />€vn| >V.lC-. <4{o
<br />oTee P
<br />$lRNlNC Frilurc ro sc.urc *.rk.n conlPctr\rtio, cov.nt!. ls unh{tu|. dtrrl \hrll sul)].rr dr cnr oycr t, lririNl Fmhi.\ md
<br />. \i' r1.. Lt'.,.,Thu'.'.."1,1 ir.,.'.ltl,ltr r(l'!'rx,i
<br />srcrirnr 1076orrh.l rhtrC{ o. i, crci rnrlrrrtrtrcy \ ric\
<br />,{ orcn trtr\didr. nnnx.\ a! prcrnlLd ftr r[c
<br />?41loL orr,,*r, X
<br />u(]NstiurcNMltl]l3
<br />DECIAf,AII!]N
<br />I h.rb, !fii.n undcr lcn.lly of pcriury lhrl I m liensn undcr pmvhionolChsprer 9 (m6ftmi.e wnh Sdk. Turo) otDivnion l
<br />of rhc Busiftss and Pofcsshns Cod.. 0nd my li.cnsc is in tull forc. Md cflel
<br />L3a TtrD()5
<br />b tqrG,
<br />gJN A!{:UONIEADINGICIIII
<br />I hcEht affirn und.r Fnrlry ol pdjury I hal thcrc h a conslflcthn lcodins 0gcncy nn lhe p.rfonmncc orrh. work lhr whi.h this lfflnn n
<br />i$ucd (S( 3097. Civ C)
<br />Lcndeis No'rc:
<br />AITIIIANTDE!;LAAAUON
<br />I lf,ftttaflin,u rr pcmh, ofp.rjury onc ofrhc fol[,tring dc.laDrions
<br />Dcmlirion Pcrmih A$$tos Norificart'n Fcdehl Rcsuhrn,n\ flirle40. PM6)
<br />-Rcquircd
<br />lxllcr of Noriln_arion
<br />I cdrilythd rh. rcdcfll r8uldrio.s eB&dir8 $hrsos rcnhvrltrc or rtlli.$lc k, l hi\ |fl jccl
<br />-l
<br />cenilyrhat I hlvc rcadlhis appli.arion d(alclhlrrhc nvc informarioi i\ corc.r I dsl( r. &nlnly wirh all Cily rnd Counly
<br />o.dinancc\ rtrd slat. L.es rchlin8 lo buildirB consrrudn,r, anl hc.cby aurhtri^ reprc\enrarilF olrhi\ Cir, dd Counry'ocorcr up.n
<br />'hcrhor. nnrirnRJ nn,lxiy ntr irtccl(
<br />A0pli.!nl or Ap€nt SiEnalure
<br />r'"*i,* r,." rr.irl, ( 3414 l/L;
<br />Alr
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />as, Pool, Fountains
<br />Siqns (monument)
<br />Lite Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />FINAL 4K4e,J.*tYz {-tr)
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Sub-Panels
<br />Service I\/eter
<br />l.cnifyfiir in thc pcrlonMncc oirhc uork for Bhth thn !c nil n i$ucd.I shallnol cnfk'y]iyprrwrn in rn! matrncr
<br />e a\rohc$m subjd Iolhc workcd' .o n{rnsar ioo laws ol Colilomi'L snd asdrhar irl sbuld tronB suh].cr to rhc
<br />Norke6 conrpcnsrn,n Dmrisions orsmiion lT(x)of rhc ljhtr Cod.,l shall, ronhwirh.ompry wirh lho* lmvhions
<br />I
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