|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDIIR DELCAR,{TION
<br />I hcrcby trftrm u.dcr lcnllry or Fcrjury rhul I um cxcmlr fmm rhc Cnnrracron Li...s. trr frr rhc followinE lcfl$n tsec?O:11.5
<br />Businc$ and Protcsion Codc): ny Cn, or Coxnrt whkh i.quncs . Frnit lo ooslruct. !llc.. im,,rov.. d.mlirh or mPifuny
<br />(ru.r!rc. priff ro ns isuec, also rcquics rhc applicMr lor such lrnnil to nh 0 \igtud darc.rnr rhal tr or shc k liccn$d puraunlr
<br />ro rhc flovGions olllE Conlr(.t, s l,iLrnscd tf,w (Ch,fl.r 9, Co6trndn8 *ilh Sccrion 7O(I) ol Divnion ] ol rh. Busin.ss a.d
<br />Porc$innr Codc) o, ihar h..rshc i\.rcnrfl thcrcfnnn.nd thc h{sh rorlhcalkScdcicnprioo Ao, violurionoisccrion 7011.5 byony
<br />qrpli.mi for a p.mit subjNls rhc applicanl lo r civil ltcmhy ol nor nmrc ftan f]vc hundrcd dollas (S50o).
<br />l.asoenc,olrhcnropcny.ueichsnrlyonlr!.rinssirhliccn\c{t.otur.r,Nb..nslrucllhcpr+cl(Scc?(DJ.Buincss
<br />and P.ofc\bnCodc: Thc Conts.t \ Li..trsc Lawdoe\ m( !fl,lyr) or.*ncraaprrp.nyeh(, buildsor nnpmvcslicrcon.
<br />rtrd sho cotrrml\ nn \uch lmjccr\ sirh r (inkrcttr(\ ) li(n\cd puNrN n, rhc C:ontu.tol s l-iccn* hw)
<br />-l
<br />ucienrpr undcrSccri{n B & PC turr[is rciv,n.
<br />Dale:- Oenor:
<br />woRxERs' cl)trtPE[sATloli
<br />DECLAMIION
<br />I hcrcby aflnm undcr penalt, ot pdury ot drrhc r.llowing dNlanrt,nsl
<br />-lhave!.dsillnuinrainaCcdilEar.ofCons.nrbsulf-ln\ur.r(r*orkcncon[cnsarion.]spn,lidddftrbysetion]7mofthcLlbor Codc- ao! llE I'c,fo,nurcc oi rhc woik ror whih th. Jf,rhi' i\ i\sucd
<br />_lhrlcrnd*illrEi'nrinworkcs.ornrctrsarioninsunn.c.*rcquirdhySc.rion:lTrnofrhcLri^rrCodc.hrlhcp.alormnccoi
<br />is ksuc{. Myw.rkcri onrNDsrrion irsmncc ca cr rnicy umh.rm
<br />-l
<br />rcniryrhrr inrhc p.rroflMtrcc orth. qork Ibr e[i.hthhrcrni is n\ucd- I ihllltu cmplo, any pcrwn in any mlnncr
<br />$ rs b h...m subj(\i
<br />'o
<br />thc workcri conD.nsll ion hws ol Cal 'ornia. rnd dsoc rhd il I should hccom {b]cd lo rlt
<br />work6.orlxnsdionpovhiotrsolSectn,n3?00ollhcL!ho.Co{c.Isltrll.r.dhwnhsDPIywithrhocPmvibns
<br />WARNIN(; tilurc b {cun rork.^'crnrFi\rri( ..vcrn8c r unhNl'ul. rtrt \hrll suhJ..r xn c lplotcr I' ailnirr t^-Mhi\ a.'l
<br />civil finci nt io .ic hxndrcd rhouslnd doll$s ISI(XJ.(I)O). ir rddilion n, rhc co{ of.on
<br />..:iliiil.dt'"5[T:ffi
<br />I h.Nbynfinnundcr Fnalry ol pcrjuy rhar I am liccna\, !nd.t ofCh+rcr 9(.onnmncitrB wili Sation 7flX)) ofDili\ion l
<br />o-\ oo'14 o-ot
<br />*"AlrG 0 a ?0ll \co flr.
<br />coNllalclr0N.LElolNli-{GElcl
<br />I hcEh, aanrm und.. rEfuhy of perjury fid thcrc n a con(flcrion tcndin8 tr8cncy lbr rhc Ilert mun.c or rI[ sork for which thh ,cmil h
<br />isskd (S(. 1097. Civ. C ).
<br />A.8IIISAIL.P&CLANAI(,N
<br />I tmby anhn undcr pcnlh y 6r D.'jury onc orih.lollowins dc.ldarions
<br />Dcrmlnior Pcirnils.Ashcsros Norificorion Fcdml Res!larions (Tirlc 40, Pr6)
<br />-Requncd
<br />Lxrrcr ot Nolifrrion
<br />I crlifyrhar rhc liilcnr I r.8ula I ions rcB$diirE ash(n.s rc.x)ul rrc orrffli.rhlc h rhis !roiccl
<br />R:r,:ilyrhrl lh!\c rcd rhhrtpLi.rrn)n il {Jrcrhd rlr rh,vr inrornBri, s.orccr I rsrN roconrplt wirh ullCir)_.nd County
<br />t y surh. r izc rcprcsc alivesoflhhCirylndCornrybcnrnutl,nrh.smd Strrc Llws rchring ro 6!ilding consr
<br />.hrvc nf,nri(,rd fl.pcny lor itrspNlion
<br />A ppliunl or AA.nl Slarulrr.
<br />Pentrile n{nr(Drinlr:,o/ 4,o'
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Bonding / Groundino / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rouoh '7fL'?ftl a\7,$
<br />Service l\,4eter
<br />FINAL 1/44/t't aiDc6X
<br />Notes, Remarks, Etc
<br />Site-Work
<br />Under Slab i Floor
<br />-l-
<br />as o*nc, of rne Dmpcny, rr my cmplolc.* sirh w.8.i as rhet q,lc conFns0iion. *ill do lh. uork lxl tlt ir-_tn is ml
<br />imcnd[d or un rd rn slc (Se 7tr44, Busim$ md PDfc$iotrs Codc l hc G) rr.(,\ l-iLrn* tiw d.cs not trplly lo a. owtr ot
<br />rhe rmpcny pho tDilds or imrmwl rh.d4 dd {ho docs skh work hifrscltor hcr$lfor rhmuSh hh or ncr oun.nploy..s,
<br />provid.d rhar snch inlnov.mn* m nor int.M.t o. .trcFd for sh. ll hoBE, llE hoildina or in{,otm.r i sH wnhin .ic }t
<br />ofcory,!:ri.'n, rhc O$ncr Blil&r ,ill haw ihc bxrd.n oa tmving rhdr lt or qhc dil tror huild .r inlpreve lhc I]$rdy ror rh. !)u!-$ or
<br />.f rhcBtrri'r*r Prolisions Codc, ud my liccn$ i\ tu tullhr.rrdrllc.r
<br />I
<br />I
|