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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DEX DET,C RATTON
<br />I hcrcby afinrn u.ds lcnsll, of ncrjuly rhir I m cr.'Dpt rmn rhe (t)ntnclos t,iccnsc law ior rhc rdlowing eoFn (Sa7031.5
<br />Bu{iNss ond Pmacssion Code)r Any Ciry or c-ounty *hi.h .cqutcs a lsmir ro con{ru.r, ol'u, i.rrrovc. dcmlish ,tr qan rny
<br />*rucru.c, prid io ir\ issuan c. lho rcauncs thc olplicanl l'or such pcmir b nle s sigftd sralcmnl thll lE or shc i\ li.cnsd Nisumr
<br />ro rhc rrovhions of rtE Conrr!.rofi l-i.cnscd tiw lchrpr.r 9, d)nrmtrcins unh sert 7000 or oivkion I of rhc Blsincs dnd
<br />Pofcsions Cddc) o, rhsrrrs shc is cxcnpl thclciom and thc hash lor rhc arlc8cd .r. nrPI ion. Any viohlion otSfcrirn 70115 by ony
<br />ptli.,dr ror a p.flnit subjek lhc applican o!civilpcn,hr.rnor m.6rhan 6vc hundrcd nolhn 11500)
<br />-1.
<br />is owncr of I hc pmp.ny. or my cnPlors! whh wtgcs as lhcn $b conuo\or ion. will d. rlE wr,ik nlhcstrtuEis ,
<br />inrcodcd or o[.r€d ln sol. (Se.704:r. Busincs md Profcssions Codc] 'fhc ConrrKkti Lic.n* tiw docs not 0prly lo 3n owftr or
<br />rh. tsFny who boildc or iipoKs tlENn. uid who dG tucn M.t hiiscltor hcMllor lhrcu8h his or hcr osn cq)loyc.s-
<br />Drovidcdrhat such imrmvcmnh e mi hrendcd orofictn for {kr. It h,mvd,lF. huildinA or iqrct'tnr il skl wirhin om }cor
<br />or conlihriun, rhc O*ncr Buildcr will t"r rhc h'dcn of Inoying rhd lt or \ht did 'd huild ot irn0mrc rhc InPcny lor rlE InqrM ot
<br />-1.
<br />asowrcr ofrhc Dmpcny.,rlcr.lxsivclycotrtu tnrg wnn licensci conrrado^ l(,.onslru.r rh. Pd,jecl (Scc. 7044. Bx.inc$
<br />,rd PtuftsiJn Codc: Thc Conlimrals Liccnsc Law docs not upnly lo M o*tur orpn,Fny who huilds or nnprolds rhcrcon.
<br />d who co mcts for such PIojccls Nirh a ComEcrodn licc.\cd pu$un ro rhc Conlra.rol\ l-iccn{ tr*).
<br />I .Dc\cor|l undc. scur
<br />()*n.r:
<br />w(rRx8R$ c()NtPENS/\I ION
<br />D}:IIAXAIIIJN
<br />I hcrcbyafln undcrF-nahyofFturyoft orrhcfollowirgdel.rations
<br />I hrvc and will lmirl{nr a Ccnifrare oa Consnr ro Sclf l nrur tu wo.kc^ conD.nsulion. as pn,vidcd rorbyScclion1700olrhc
<br />Utxr Gnc, lor rhc ll.lfonu..c of the work for which lhc !.rmil h issoed
<br />lh.rc and sillmatrril. soricr\ coaltcnsrrioi insornn.c, as rcquircd byScction:17(X)ofrhc Iih.rG)dc. ior rhc Pcrlaruncc of
<br />itsucd My*orkcn.. rtrNarion insumtrc. cnric! @l F,lic, mn$.r dc
<br />t a h -ln>r.\.1+o1?
<br />-l
<br />ccnily rhlr inrhc p{ nur.orrhcworklorshichrhisprrnrilishsucd.tshillnor.nrtlny4.,PcsoninanynrMtrcr
<br />$ a\ t, tf,co'B rubjc.r k, th. wolkcr ompensrion lu*\ otCBlitnnir. d 0grcc thd itl should hc.otu snbj&r ro rlr
<br />workss contFnurnrn ,mvisions ofS.clion 3TOOoIlhc bii.r Codc,I shall. f.nhwithconrlly rilh lhot px,riri.ns
<br />wARNINC: Fiilrr. t, $.ur $orkcN .oDpcfls.rion coicrrsc i\ !nh$ru
<br />.ivil ti'r\ up t,.nc hu'akcd thonsrtrd dollnr ($l{)0, 1r)- in rddirion kr
<br />bj.rcl on cnrploy.r t' ai$innl NmhEs !.n
<br />o rl{Nrrnn,. damrrN 11lnvldcd rhr lhc
<br />jli(i6"u8'?CIlt"'l;:l
<br />DECIIAAIIA!
<br />I hcrcby amm undcr pcnllry of lerjxry rhar I 0m lic.nk\d undcr FovnionofChaprd 9 (omftrcinB wilh S€tirn ?000) orDivision l
<br />.t $c ausin.s rnd Polcsions Codc. a,n 'ny lic.n* ic in tull ror.c .rn cfccl
<br />( oorl S(
<br />ts
<br />COIEISIICUONIENDINC.{EENCI
<br />I hcEby amrm undcr pcnahy or p.ijury rhat lhm is a co.(dclio. lcndins o$ncy ror rhc ,.rfomuncc ol thc Yorl ror whhh rhh Fnnir ir
<br />issucd (Sd. .1097. Civ. C )
<br />Lcxdci. Nam
<br />-
<br />A.EIICANLDII1.II8AII9!
<br />I lrrby lmmuDdcr pcnrlly or pcrjur, onc orrhc r.ll.wing dc.l0r.rions
<br />Dcnnnirn Pcrmns-Ash.sos Norificorion Federal Rc3uhrinns (Tirlc40. P.n6)
<br />-Rcquircd
<br />lxnc.of Noriff, ion
<br />-5-l .diry rhd I hNc. rhnrptlic rri{,n afrlnrrcihri rhc ab.\c i'nn'rmrn I l3le rocon{rly sirhnllanyond Counry
<br />.rdi',rn.c\ trJ Srrrc Lrtr\rchr Ir, hui]nir!.otr{rivc\ olrht Ciry nnJ Counly ro cnlcr uFr llr
<br />nbovc nrtrtioL.d pmpcny lar inir'{rion
<br />',,rt il at -,A pplic.nt or *ol Sitn{lu r 5;L [4^
<br />Site-Work
<br />Underground
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Torqueino
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilinos (T-Bar Rouqh)
<br />[/]eter Release
<br />Rouqh n/t{l't e\\KA
<br />Service lvleter
<br />FINAL 9lr\t6 |Mq,w /ktl^ I li6/n)
<br />INotes, Remarks, Etc.
<br />Pole Bases
<br />Transformers
<br />Air Conditioners
<br />,,",",4 ij
<br />Lcndq'\ Ad,nc$
<br />-
<br />I ccnily thot rhc fcdcral rcsllariom (sardine ,sbcsros dn,valrc nolo,I'lkoblc ro rhis tojccr
<br />tt
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