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ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS OWNDR BUILDER DEI,CARATION
<br />I hcrchy aafirm lnder pen,lry or pcrjury rhar I m.r.mpr r6n rhc Contr.clos Liccns LoB for thc foln,wing rcd$n (sc..7(I]1.5
<br />Busincs ,nd Profcssion Codc) Any Cily or County whi.h rcquircs ( pcrmil r. coniru.r. ehci impor., dcmlisn or Epan 8nl
<br />srru.rurc. pri ro its nsuoncc- oh. rcquncs rh. uprlicanr In such pcdii ro fihd siSncd otmnt rh hcor shc h lic€nscd rfl!.r
<br />n, rh. l,n,vtioN orrrE conlraclor'r Liccnrcd Llw (Chaphr 9. ConmcminE wilh Sccrion 7m0 oa Divirion I ofthc Busincs lnd
<br />Pmt$n,trs Codc) or rhsl hcorsh. ncicmpr rhcrctomann rhchaln fo, rnc allcscd .xcnflion. AnyviolalionofSdionT0ll t by any
<br />aprlicairtor r Dc,mir subjeck rhe 4tlicanr r. a.ivil Fn"lry ot nor nft rhu fivc hundrcd dolla6 ($500)
<br />l.dsowncroflhcno[lcnr.ornrrcnDloyaswirh*ascsuslhcirvrc.rnDcn{trnnr,willdolh,*ortundlhc(Blurcisnor
<br />i' cndnl or ollcrcd for elc (S\-'.7044. Busikss and Pflrfc$i,)n\ Codc: TM Contncloir Ltccnsc L{w d'cs F ,r/y t, rn owrcr of
<br />rhc fmn ny whn burlds or in{mrcs rhcNn. ard who d€s such u) himscllorhcnelforihtouAhhisorh.rawncDpbyccs.
<br />prclidcd rhrr such imjrmrmms m tidflL{ or ofimd f(r $lc ll hflwclci rhc boiklir3 or inlIrrnrnr h v,ki *irhin .N Jrr
<br />ol$nr'lciion. tlE owncr Buitlcr $illUvc rlf htrd.n ol pmvins rhd hc or shc dil tu{ ho,ld or irrorc lhc PmFny lbr rhc l {nrot
<br />l.0sowncrorrlrcropcny. lnrcxclusilcly.ontrodins sirh licctr*d conr,kt,F &, .ohsdcr rhc pojcd (Scc 7o+r. Bunncs
<br />md h,f6{bn Coddr Thc Contac(or's Liccnsc ljw des nor nrtly to !n owncr olpropcnyvh. builds or improv$ rhcrcon.
<br />and *ho conrrach l'or slch pn,jc* wnh
<br />" Co.trc{onr) liccn*d pursu.r b rh. conticrois Lians t!w).
<br />-l
<br />amcrcnfl lnds Sc.ri
<br />D.rE:- oM.r
<br />---wonx riiiolrprrrilrroF
<br />DEcld.Bllllotr
<br />I hcr€by rfrrn undcr Dcnaly of pcrjury oft of rhc followins delahrionsl
<br />-l
<br />nav. ard will roinhin ! CcnifEarc of Con*nr lo Self-lnsu€ tor *orkds .omF.srion. s povidcd for by Scclion 1700 ofrh.
<br />I$or C.d., for Ih. Frlormnc. of th. ao* for whth lhc p6nil is issucd.
<br />-lhawandwillmai
<br />oitr wortcR conFnsarion ins!6ftr, e\ r.{uircd by S.Elion l?00of $. kborCodc. for rlE Frrorum of
<br />yworkcn con,Fn\rri{,n i',\u'r'r(c.! rr nl }rlcy trunrhcr alc
<br />-lcenifyrtlliorhcpcrfornutucofrh.*.rkf.iwhichrhi\
<br />jm i\ n\u.d,I $all not cnDhyeny pc6oo inanytu.Nr
<br />$ ds t, h..om suhj.rt to lhc wo ss omDcnsatiotr hrs oi Caliaomia. lni !sE. rhd ir l sh.uh t$onE subi!' lo ttr
<br />v.rkss .omp.n$tiotr frovisbns ot Scclbn ]TOO ol thc L,t{r Gic. I {h!ll. ronhwirh conDly *ilh lhot Pnvnions..
<br />WARNTNC: Filur. rJ {curc Mrkss cotrrEn\{tion cotctusc ir unlo*rul. and \hall \uhl.rr M cmlh)q tu lrnninul ri(nalns rnd
<br />rivil 6n.i up h onc huMrcd rhoustrd dollon (SlO0.UX]). in rddirion lo lhc cod of ron$.\.ttun. d.nu8c\ as Ptovidcd lo! rh.
<br />Sc.rion .1076 ol rh. hhr Codc, inl.rcs .nd dtonry s fcc\
<br />,,'.ttlc 08 2018
<br />I hcrchy aflirm udcr pcn,hy olFrjurylhal I m liccnsd undcr !,mrision ofChapr$ 9 ($mnhRinS wilh Scclion 7mO) or oivisi.n :l
<br />or $. auqincs a.d Porcssions Codc, and ny li.cnsc n i. full fotr and cfl(l
<br />R.,-,.",,..*r",*r, t0'aa sr"-,ifitGa3ig1&.-,*".-f41&n""- -CAIEIB]JqIIAN.IENUIE.{CENCI
<br />I hcmhy nrllrm trnd.r,,.nalryofFrjury lhar lhcre kr comrtuclion bnding Dscrc, r,r rhc Nrlormrcc ollhc wotk for shich rhis Pcrmir t
<br />nskd (Scc :1097, Ci! C ).
<br />AfIUQTNLDECLABAIIQ!
<br />I hcrdry 0fiim undcr p.nalty of n riury onc orrh. f.Uowing dccldarhnsl
<br />o.mlition PcrmirrAsb$ros Nolifi.ation FedcBl Rcsulat ions (Titk .10, Pan6)
<br />-Requircd
<br />t rlcrolNotifislion
<br />I can'l\ tu rhclcdc'zlrsulin,,n.slJil'ne a.h.{.s 'r hr0l 'r mr smlkanc h ths tmJccl
<br />f,]*,,*'".r*,.;r,,",,','";.,;",,.,,,,,",h,vcinr(mu ,.n iscorsr I ",rc ,o conrry {i,h n, c,,y,id coun,y
<br />..dinrnccsond Sllrc Llsxrclarint r. buildinSconiru.tion. axl hcroh,nlivcsofrhnC ydd Co{mr ro. crulbnrh.
<br />itx,v..rtrrioEd I'brcny lbr i,r\pcction ruqnsc\
<br />Applic.nl or A46l SiEndure
<br />g:tu
<br />-9 ."-i t-
<br />,,"'"TllG f0,
<br />6.
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFEFI
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Irileter Release
<br />Rough X/r</t )qt7
<br />Service Meter
<br />FINAL 4/r</rs a\t(
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Pole Bases
<br />t nd.is NrnE
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