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ELECTRICAL.INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNER IIt]ILD!:R DET <br />I hcrchy arfinn urdcr lcnllry (,r Pciury rhar I im crc.lPi r.on rhc C. <br />-CARATION <br />nxadod l k.trc btr f., thc tqilorry M$n rs(.4n1.5 <br />Bxsin.ss atrd Pmfesioi Cdc) Any Cily or C.unty which rcqlircs a Fiinir lo .onnocl nxd. imltovc, demlish or tn3n drv <br />srruclurc, prtu ro nt issuarcc. also rcqunca lh. smliclnl for sucn Frmil lo fik ! iieftd sl cm rha! lf, or shc i! li'cn*d PuNa <br />ro rhc pmvisions ofltrc conk0clols Liccn\cd ti* (ch.Prcr 9. codmrcire with ssrion 7{xx) of Diliiiod ] of rh' B$in'rs Md <br />Prcfcssions Co<te).r lhol tr or stc i\ercn/ rhcrcfrom lnd rhc h,!I ror rhc rllcs.d crcmpri r Anrriol,rionofSecri'n70ll'5hvanv <br />appli.! lor d r.rmil suhiErs rhc {pplic{nl ro scivilpenulryofnol morcrhln riv. hundrcd doll'is ($500). <br />l. us owmr ol rhc l'ol.ny. or my .nDbyes wirh wlBcs 0i rh.n $k .lnDcnqrion will do lhc *orl od rtE stnduc i n'r <br />indnd d otI.Ed fo; s[ rsd ?Or4, Busircss and Prct rsioo\ Codc 'lhc Conrmlol s l,icensc hw docs nol amlv to itr osrcr of <br />rhe p6Fny who builds or i'rrmv6lhmn- ud who dei ruch m hinNlfor hcisclaor rhr.lgh hh or hcr own 'mFlovccs'providcd lhlr such in{,owmnts N mr iorodcd oroficEn 6rsh l[ tu,ucw. thc lDildins or i,pmrcmd n $h ai'hin onc Fd <br />;romlhihn. lh. Ow;r Buikl.r rin havc 6c burdd ot l()ving thd hc or shc dil mr tuild or iqrovc thc lmFnv for rhc l'uqrc of <br />-1. <br />acoe@rordc prcpcnr- an.xclusiwlyconlro.tins wi$ l,.cnscn contkrom to con(tucr rhe p(&cl (Sa. 7t}.4. Blsincs <br />and Pnitsqhn Codc: iia Coitacrols l,ic.fi. Liw doc. nol aDrlv lo tn o*ncr otPmpcnv who build' or imnrcvcs rhc'eon' <br />a.d sho 6nra.rs lor such pojccr3 eilh o Conr8clo(t limn*d Purunt ro rh- cotrklclois Li.cns. tiw) <br />I rDcrcnDr 0idcr scdl.n-- B &r'c ntrlhnrcr<n' <br />l{ortKEfs' (:oMPoNs,rTl(lN <br />DECLA RATI(IN <br />I h.rcby am,ntrndd p.mlly of Fiury om oflhc fouowh8 drldalions: <br />I hore dt wiu @inr.i. a Ccnifrcarc orcon*m ro Self-lnsurc tor mrkcB coryr..dio.. !s pEYidcd for bv Sslion 1700 ofrhe <br />tjh.r Cod.. for lhc pcrformft. ofrhc worl lor *hi.h ih. lcmi n isrocd <br />-l h,ve and *ill mainlain *ork€B c6mp.Dsalion insuraace. !r rcqun.d hvSclio.lToo of llE ljbor C'dc. for rh' Frr.lfrm' or <br />nurion inixr!rcc qtrtr rkl lnlty c€a hENL1 cl <br />-l <br />ccnityrhar in rhcr.rlormarc.orlhc work i(tr whichrhh Pcflnit is issdcd.l sh,ll nor enlll.v0nvlcnon in 'nv'mnmr <br />so rst' tr.o,rc sublccr ro rhc workcr' lannP.nsar n, n hws of(alifomia. an a8rccrh irI rh.uld tEcom \objd hIhc <br />wurkc( comDcnslrion Nrvisn,ns ofscclbn:l?molrhc tit r C.dc lshall.lonhqnh.omtlvwilhlho{prorisions' <br />WARNIN(;: Frihtrc ro sccurc soAcr comPcn\dn,n c.vr tc is lolasrul. rtrd \hrll \uhjccr ,rl cnPlovcr b 'riniml Pcnalit\ md <br />civil fincs t9 to onc hundrcd rhousond <br />Ssrn,n 1076 oilhc tihr Codc. i crcst <br />D,,". . o+- oE- Lg <br />ilp.nrdrnJn. danbs.s rs frovidcd nn rhc <br />l,pli. ,l: )<-2c-4L!- <br />I hcrcb! amrm undcr pcdhrofpcrjury rhnt I m liansi u.dc. rovishn ofChafl.r 9 (omnEeing rith Scclion 7tx)0] 'rDivilion ]l <br />6f lhc Busincss!.d Pdf€.sionsCod€. a.d ry lkcn* h in tullfi,e rln cllal <br />4K2 <br />O:t - 05- t8 cor*o-,!%q*- <br />lhcrcbydiftrmUndcl|*nlllyoIFljUrylhllthscksoijrudhnhndingaScmyforlh.ocrlorueoflheworkforghichlhigtInnitis <br />nsucd (se 1097. civ c.l <br />TELLCAIiLDECLAX{IIA! <br />I llr.hy rflim undcr penllry ot Pcriury orc.frht rollowitrs dcclararions: <br />Demolirion Pcnnir*AstEnos Norircation rrdeol Rcguhn ns (Tirlc 40- PM6) <br />_Roqrt.d I.ncr ol Norilluri(nr <br />-l.rnilyrhrrrhe <br />lc(l.rrlr.3ul nn1rc8:nli'rg r\hc!osrc nirnlxrc no1 |lli.rhlc n'rhi\ lnrE r <br />l.cnil-vrl rlluvcr. lrhirrpDliclrionxdn rc rlr r rhc finc innr ui is.omrr lrgrLtt)'omplywirh rllCir, rnd cou.ly <br />o'ditu cc\ rtrd srrr.l.r{\ r.lrr 3 ro huil{ti'rs rchr.uthoriTc tryrc{ntarivcs olthn Ciyind Counryft, ctrrd <br />rh,vr r^ri,Nd Drc|rcdy kn ntrPc.rk!rtu <br />oa- 09 -tY <br />l,emile aft € (prinl):)('+/ <br />Jc- <br />/c-A) <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Lile Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bondinq / Groundinq / UFER <br />Translormers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinos (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />[/eter Release <br />Rouqh <br />Service ltileler <br />FINAL <br />Notes, Remarks, Etc <br />-> <br />APPROVALS <br />Communrcations Cable <br />Liccnsc Clas:_L--