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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION
<br />I hctoby rr6rm undci p.mlty or pcrjury rh.r I un crcrp! rtun rhe co.tnckn- t-tcnsc Law lot lhc tullowin3 rcr$n (sN ?0]l 5
<br />Busincss {nd Pdt$ion Conc): ADy Cily o! Coutrly which re{lutcs ! Flnril ro coindd, nlrcr. in'l0vc, d.mlhh or Eprn rtry
<br />sd.rrrd, t inb ih isxanc.. aho r.qun s rhc Dtr i.unr r{r \urh pdnrir r. filcr siBncd {arcnrnr lh.t h.or shc n liccnscd pursanl
<br />xr thc novtions ot lhc C.nlrocrols Licen*d L, (Chlpler 9. Co,uEncins *irh sccrnrn ?mO or Dilision :l ofric Busincss lnd
<br />Profcsrion\ Codr) or rhlr hcorsh. texcdpt rh(ctonrund rlrcbosis lq rh. ,llcgcd cxcnllotr Anyvn,l.rionofSc.lirn?0lltbyany
<br />ippli..nr r(x ! p.mn subF.a th. .trplicrnr h a .ivil Nn,lry or nbr 'fltrc Ihatr nvc hu Mn'd dollas ($500).
<br />_l.a\osmrorrh.pDlcny,ornrrcn,plorc.\wirh*!scsasrhcny'h.odf.\,rn.wllldorh.worldtrhcsmlurcnn.r
<br />'m.Mdl or orctud ttr eh lS( 7044, Busift\s aM Pr'fcsi.ns Codc: Thc Conracrois Liccnsc Lrs docs norapplr ro ai owr.ror
<br />rhc pm0.ny who luilds or inl0rolcs rhcNn. and $ho des such "o* hinrsclf.r hcrcltor rhoush his or h.r own .mployccs.
<br />piovidcd rhrr \uch i'.novcru m fr, inrendcd or oilcrcd for {ok. lt ho$cv.r. rhc t{ilding or impmvcmd is v'ld wirhii otrc is
<br />otcotrDlerion.rhcO$ncrBuildcrwillhnrcrtEhu cnolpoving rnd lEor\he did mr 6oikt or i'q,,,rc df, pmpcn! a,n rlt purF,{of
<br />-l.
<br />r\owncroflhc proll.ny. lnrctclusirclyconrraclins Nirh liccn{d c.nkrhd t, .onsfl.r rlr a,ojccr iscc 7u,u. Bu\irc\\
<br />0M Brli\sbi Cod.: Thc C.niiNkr'\ Li.ctrsc L.*d.$ not aprlyro rnosncr ol propcrl!*ho build\ nr iNprorcs rhcrdon.
<br />and who c.nl6cl5 ior \uch rrord\ *i'h r Conr r(t licctrrJ puruxnrro Ihc Coitrci{r\ Liccnsc tjwr
<br />Fo e
<br />1 !^ c.
<br />ulrttl!{lt{D
<br />I lr'.hr.lln ru J.rnctrrlryolt)crjuryorr.lrh.frlk'wi'rg(lc.lnfunotrs
<br />-l
<br />hrv! Md will nBirah d Crd ilicdc of Consd ro Sclf.lnsurc ior workcF .omFnsar iotr- r\ Folid.al ror by scclion l?00 of rhc
<br />l-ahtr Cod.. ior rhc p.rf.i@N. rt rh. woik lor whkh rh. pcmir is issucd
<br />I hxv.itrd willnrinhin *orkoa.onrn nqri()n inrurancc, ar rcquircdhySccli,,n:17(X)ol'lhcl-lhorCodc.lorrh.lcrronnan.cot
<br />rhc trork ror ehkh rhi\p..nrir isissucd. Myworkc* .onf.nsarn,n nBumm..rricr!trd Flicy Nnrhcr !rc:
<br />l.cnilydrarinrhcpdrformrrccolllrRorklor*hi.hrhislcn r is tslcd. I shrll n.l employ ant IrcNn ii rny nt i.t
<br />s .s b bcc.N subjsl io lhe rorkc6' compcnn ion hws of Calilomiu. and lgE rhor ir l sbrld brtom suhi.d Io lla
<br />sorkers compcnsrlion pmvtionsotSecrion 1700afrhc llbor Code.I shrll. fidh*irh co tply *irh rho$ pNvisiors..
<br />$ARNIN(; I:riltrrc n) {curc *orkcr\ .o rtr srri,)tr rr ralc n unlxutul. md shrll suhlccl .n cmplolcr ro qiniial rMlric\ an
<br />, I kldfiotr to rhc .on ol cotrrp.ns]rion. da.ng.s rs tioridcd ror $ccivil fitrrs trp h otrc hundrcd rhous0nd dollr6 (
<br />sc.noi l(JT6olrhc tih.r C'odc. inlcrc{ md rk
<br />"",",9./47 // * ^,,,,[rltrL -c,&J=-s
<br />I heEh, trffirm under F.nalry.r p.rjury rhd I an lisnkd und.r pmviion ofChlpld 9{commtrcin8 wilh Scclion 7000) orDivhn,n:l
<br />of rhc Busin.s dnd Pofcsiors Codc. md ny liccnE h in tull lhc ad .tlccr
<br />Lic€nscCIo$:-
<br />Conlrodor:
<br />IOXEIBIJgIIONIEIDIIGJIGDN(I
<br />IhcrcnyMirmundcr pcMlly o{ Frjdr, rrDi rh.rc hr cordrudbn hndnrs ag.n., for rhc !c om.nccoflnc wort [i, + hich rhis Frn,ir i\
<br />i\strcd (s( lur7. civ c.)
<br />_l ccnilrrhlr rhc rad.rxlrcErhrn,nsngddirsasb.{o\rd rvdl d ior ,|llicrhlc ro lhn nrcrrr
<br />lcdrifyrhd l hr\t rcrd rhi\rtpli.dionflrdnaic rhnrrhcih,rc itrlorufli(r n.omcr l rE.c k)con,drsirhrllCnyindcourry
<br />ordinai..s dtrd Star. bws rcldinC ro lldltr!.onnndrr. ntrd hcrchrrxrltrtri/c rcpr.\ctrr{n?\ olrhnCirymd Cou rybcnrculIr
<br />atxk nrnri,,ncd pnrpcnr lar in
<br />\,( c/,{ppllcad or aqlSignal
<br />P.mlrN nrmc (rrino:
<br />Q<-/cs**
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / 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 Rouqh)
<br />Meter Release
<br />Rouqh
<br />Service l\/eter \
<br />dltd\\{ ,-'aaaK qT\
<br />Notes, Remarks, etC lTT 7 -v
<br />AIP]EAILDECI,ABS.IPN
<br />I lrr$y uflim undcr penolry of perrlry one ofrhc followin8 d(larurioo\:
<br />Dcm.liliotr Pc nnlAstrsos Notificarion Ldcral Rcsularions frnlc,r0- Pan6)
<br />-Rcquircd
<br />Lcttcr ol Nolilntion
<br />Pole Bases
<br />FINAL
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