|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.O\''NER BT'ILDER DFJI,CARATTON
<br />I hcrcbynfllr x.dcr ,.n0hy or ncrjury rhar I dn .rcmpr rmnr rh. Co rmlo6 Liccns t w for thc lhfi,*iry rclsn tscc 7011.5
<br />Ausnrss lnd Pi('acsion Cdc): Any Cily or County qhich rcquircs d pcnnil to cotr{rud, alr€r. nnpovc, dcn.lhh ar rPair My
<br />(rucrulc. prhr ro irs hsu,ftr- al$ Equirc\ rhc,pplirn.r lor skl Frmn b nbr riSn d arcm.r lhar h.orshc is liccnscd ,)uNrnr
<br />lo rhc pmvisiotrs ofrhc Contmcrois Licc"rcd L.w tchanrcr 9. Co'nmemins wirh Sccri.n ?(] ) of Diei\ion,r orrhc Businus d
<br />Pol'cssions Codc) or rh lEorshc iscxcmpr rhcrcimfland rhcl'osh for rhc albscncictrgrion Anyvn drnrnofsd6.T0.ll.5byant
<br />arpliclnt iorapernrir suhjsIsrfie rtplicad ro rcivilncn0lryofnot mrcrhan fivc hundrsldollrs($500),
<br />I. a\ owig or rlr noltdy. or nry cnrrk,yc.s wirh w.g.* r\ rhcir $lc .otr$ns.rbn, will do lhc wolt ind lhe (trre !\ iol
<br />iNc,rd.d orollcrcd for elc (Ssr(}l4. AusnEss ed Profcssn,ns Codq Thc Ontrrl \L[cnscLlwd(E\ ,8rtlyrosnownfor
<br />rhc tnlEny Nlm buildsor nnpmks rhcBnu l wk) dfts slch *orl himsclf or h-^clf or rhbuBh his or hcr oRtr cmployccs.
<br />pr(,vidcdrhor slch nlll)m\cnrots oE rbr inrcndcd oroffcBl for$k lt h.*ctq. rhc $uilding or iDpmsnrnr hsoldwiihinom Fr
<br />of.un!)br$n. rh. Owncr Bur}ln wrll hN rh. brd.n ol pmvinB rhd hc or shc dil ml h{rld or irlYrer rhc Impcny lbr rhc porll){ of
<br />-1,
<br />as owrt ol rhc piop.ny. am cxclusivcl, contracrir8 wirI licctr*d .onrrdon n, con{rud rl! F,jr.r (sd 7O,u, Burtrc$
<br />and I\r bsi,n Codc Th.cl,nr.cror's Li..nsc l-awdocs nor lllplrh trtrosncr ufpi('Fc ywho huilds or impnlcs rhercon.
<br />ind who contmcrslbrsuchprolcclswirhaConrr!.rn(s)li.cnrcdpuNumrrorhcCon[acttr\Lten\cLro)
<br />-l
<br />aDcxcml undcr Sccriotr-- B & P.C. r'orlhn re!\oi
<br />D,le Orner
<br />WOR(TRS ('I'MPIJNSA;TiO
<br />0Ecld.Salpx
<br />I hcrcby srrfln undcr pcnalryo{p.rj!ryonc oflhc nrk'*in8 dechrrlions:
<br />I hxvr a'xt*il1 ri'nri'r rCcnin.arc.l C.r$trrh Scll l \urc ttrwo,kcN d..D.nsarion. i\ I)'ovidLal for hySccrion.lTU)olrhc
<br />lahrCnlc- fitrrhc p.rromanceol rhc surk turwhichthc p.rn,ir i\ i\sucd
<br />I hDvcrnd will m0iflain worlcrl cornpcnsution insuEncc. as rcluncd bySccrn,n l?00ofrhc tibor Codc. rot rhc FrioinEnN ol
<br />lhc work f1tr shich rhir p.irnil is tsNd My *ortcs conrr.nsali('. insunne curicr and Fricy tu n$.r ml
<br />I ccnifyrhnr inrh. p.rfor@tu{ofrh. wurl rui shi.hrhi\ I'crntn a hsucd,I shlllnor crnfloyrnytE6on inznymnnftr
<br />v, !s lo b.conr subjccl to lhc so.kcr comFas(ion llws oiCrliiornia. cod aErc hI irI \Ix'nu h.o'ft subj.cr ro ttE
<br />*.*ns.onr.n{tionpmvisionsofScclion:lrOOoithcLit{rCqlc.l\hall.r.nhwirhLa,nPlywirhrtbsPmvhions..
<br />WARNING: trailor. n, \c.urc solk.r'.onlrnsari(,r.ovcfusc ( utrhwtul, d shall \uhjd !n cmnlo)rr t,.nninrl Ftulras und
<br />.ivil 6n.s uF t,) ond hundrcd rho!{nd doll0r ($1fi).000). in rddirion to rhc cosr .i compcn\ltion. daroEts ds pbvid.d hr rhc
<br />S..rion 10T6ofrhc trltxtr C'dlc, i crcirtrd ormy\ier
<br />x]nlrv
<br />IIDCI/f,d.rIaN
<br />I h.Nby ltlirm uMs l.nollyoiperjurylhd I m liensrlhdcr obvhiun oiChaprd 9 (.o'mnci.e wilh Scciiotr ?000) ofDivisn,n l
<br />of rh. Busimss dd PofGsions Cod.. orn my licenr G i. full fora u crt'(t
<br />&\(
<br />(ONSIB]J.(.:IION.I.EIDINIi.AGENCT
<br />I hcrchy lafi,nr undcr Fnahy ol Frj!ry rhrr rhcrc i\ tr onnncrirn Lndin8 aecncy lot lhc Fromstra ot lhc work for *hi.h rhh Fnnir i3
<br />issucd (Se 1097. Civ C.).
<br />AEUIANIDICI,Af,AII9I!
<br />I h.r$y,frlnn undcr prnally of perjury onc oithc lolbwu dcchElion\:
<br />Dcfrririon Permih AstEsros Norifi.alion Fcdcral RCBUlarrN (Tnb40. Pan6)
<br />-RcquiEd
<br />trrrcr of Norii@li.n
<br />l.cnifyrhd rh.fcdcrll rcSuhrions rcgmdin8 a$c(os rcnnulrrc nor amliclhlc b rhis F)j.cr
<br />_l.cnilyrharlMvcrcadrhnsppliurn,n:u'dnsrcrh{rfuxh,1dinfonnnrl\..ftccrIrSrNroomplywirhullCiryrndA,u y
<br />ordi'r ccs rnd SrrrcLrws rlrrin! bhuildirg.otr{fl.ri()i. u h.rchyrurlntrrcrcprcsctrlrrivcsolrhhCir,and(i,umyt,c.rcrup.nIlt.
<br />rh,ve 'mnri,ncd Dn,mnvfu insmllion oxrm{\
<br />,rppr.-r*ex*rsic*r,- * rfl t--"'-'
<br />,, ,**-.ron t, /tl"tllt*' VOr'/
<br />&/r/ta
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communicalions Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding I UFER /,4ulr*Mtof*.'lp
<br />LTransformers .t -!
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lVeter Release
<br />Rough
<br />Service [/]eter I l
<br />FINAL I 4wlrt[)cftiDr ry ld-
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Site-Work
<br />=
|