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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DEII DELCARATION
<br />I hcrcbr oflnnr trndcr pcnahy or p.r.,uiy rhd I am.xcnDr liorn rhc G)ntmclo$ Licen\e lj* forrnc lollowing eos r (5(70115
<br />Ilusin.r\ a l Prof.si,)n cdc) try Cily or Coutrt! which rcquncs r Fmrir lo onnod, alrd. inpr.v.. d.mlhh or reFn any
<br />{tu.ruc. rrid ro n\ issnnm.. als rcquncs rhc arpli.o rb! such I'crn l lo lilc a sised {dcmnr !h! tror shc is li.ctrs! pu^uonl
<br />ro thc provkions ofrhc Conrlacrois t-ic.ned Lr* (chaprcr 9, c(,nncmnrS with Scclion 7fiJ0 of Dilhn,n 3.f rhc Bu1,nc$ 0nd
<br />Profcssn).s Co.lc) or rhd hcorshc i\.xumfl lhcrcron ind th.hsis for lhcrllcscdcxcnlprion. Aoy vidarioiofScdionT03l.5 by!try
<br />rppli.anr lnr tr !.mi suhj(rs lhc rDplica.r tor.ivillcMlryolmr morcrhan fiv. hundrcd d.llds (s500).
<br />l. al osncr.frhc pn,Nny. or nrycmploles wirh er8cs nr th.ir arle comnctr\arion. $illdo rht wrk dxl rhc slMlurc k mr
<br />idcndcd or oltcrcd l'or sllc (Sa.7O1-1. Busincs lnd ltofe$ions Cod.: Th. c.ikn.rols Liccnsc tjw {locs nolapplytu rn owNr of
<br />rhc pmpcdy (ho boilds d i'rqros rh.u)n. urt who des sch vo* hnnscllor icrsllor rhn,ugh hi\ or hcr o$n cnlloyccs.
<br />provi.lcd lhirsuch i,npn*cnEnh rc rn inrcndcrl or.ttcnd rbr {lc Il k)tt!.r, rh. huiklin8 or rlmrcmnr h sd*irhi"onc }u
<br />ot.onfLri,i, rhc Owmr Buikhr *ill lllvc rhc hord ot pmvinS lhd hc or sh. did nor bxiu ot it{mrc (hc td'Fny lor rhc purtns of
<br />I. asowncr oilhc pmpcny. om cx.tusncly conlrrr ins ,irh liccn\cd cotrtack"s ro.onsrudl rnc pm]cd (Ss. ?O14. Bu\inc\s
<br />aftl tltrlssh. Codc: Thc Conrracrors l-i.cnsd Ltrw dds nor stply b Mowrcr ol pro,Erty who 6uild\ or tnphvs rhcr.otr.
<br />and who conracr\ ror su.h l)t,Jc.rs silh ! Conltr'ons) liccnscd pusuont ro rhc Conka.tn \ Liftnsc tiR)
<br />Ir rrcnfr Dnd$Sdri(,n .a &PC li)rlhi\rc!{[
<br />D,le Oener
<br />woRxEn-s' c-oMPEI{SATloN
<br />DEClrl&lIO!
<br />I hcrchyuffir und.r Fndkyorpdjuryorc ofrhc tollowirB d(lomlions:
<br />-l
<br />har ud sill minllin a Ccd ificDrc .f cons.nr b sclaln\urc r(, *or*cN .ompcnsal ion. !\ pmviddd ttr by sNr iotr l70o o f ihc
<br />tjhor Cod..l.r th. p.dormme oarhc sork n, $hich thc Frmn is i\\ucd.
<br />Ihdv.dndsill,nrinrrinqolkcrrcorpcnsalioniNuram.-asrcqutcdhySc.rn:l?U)olrhcljboiCodc.forrhcpcrr.rtun...f
<br />rh. work nr whih tht F.rmir is hntrn. My workcN compcn\arn,n iisurrfrc .drifi exi Plicy number uc:
<br />T
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<br />ccniiyrhnr in rhc t rfortui.c ofrhc woik for trhi.hthrs Nrnit h issuci- I\halt i.r cnlloy riy pcmn ir rnym ncr
<br />s, rsroL(n.sublcdk,lhcwo crl (nrp.ns!ri{)n law\ ofcllilni,ri( id rsrcc rhd ll l should hccom \uhjccr rorhr
<br />w.rkcr' .onrFnsarh !tr,vhi.n\ of Sccrion .17(Xr of rhc lihtr ('o1., I shrll. lonhwirh conrply w irh rh)q Pmlnt'n\ .
<br />WARNINC Foi'u'e In s.drc wqk.,i curn .n\arnn.r{mgc r. utrllrrul. d \hull \uhirr sn.nrli'J.r
<br />'n
<br />om,nd FMli.\ dnd
<br />civrl lincr un ro onc hundrcd rhru.rnd Jolla\ riloo,QmNn ,Jd ioo !o rhc c!! or c rnncn.dion, '!nruc.' r( Prord.d lor
<br />'hcScroi.lo76of rhc L€tqcodc nlcN dd drqFv rf.".. \ I n
<br />,,,". ( -G -t( ^,,#,-!v*tr^-lG- .'
<br />LTCENSED CONIRACTOR
<br />DSC!.ABATON
<br />I hcEh, altr unde. pcdlry or pcrjury (hat t an liccns.d lndcr pmvhion oaCh!fls 9 (conmrci.g vnh Scdion ?U[) ofDivkiotr ]
<br />of rhc Busimss and Pnfcssinnr Codc. nnd my li..mc h in tu)l nre ard tu.
<br />""" g<'C- l{.
<br />CONSTRI]CTION I TNDIN(I AGENC1
<br />I h.rcby 0iltm uEd.r lEnohy of ncrjury rhd rhcrc h a onsln(lidn lc.dinB l8.Ry ior lhc l,cnormrcc oa rlE srk ror whkh thk Fnn ii
<br />i\su.d rscc 1097. Civ. C.r
<br />AIPI,II]6NI-IIEII,IIBAIIO!
<br />I hdrby iflim undcr p.nolly olpcriuryonc oflhe foUowins dccluralions:
<br />Demnirion Pcrnn. Ast*nog Norifi.arion F.tcral Rcrulations (Titlc 40. Pan6)
<br />R.qLiBl tdtcr of Norification
<br />-l
<br />ccnify rhlr rhc fcdcral rcslhrk,nr Eganling alrEio! r.mtal m nor epli.rblc lo thh pmjcr
<br />-l ccnily rh l nsve read rhk npplic0lion nn alc rhal thc 0tnvc infomlion is corer I !88 ro corply *ilh all Cily lid Counly
<br />o'(linxN.\ rna Srrrc I r*\ftlnri'rgr nrr xl ltrrchylurh.ri7.r.[c{mnrivcrorrh C:iryitrd CoutrrrlocnlcruF'nlhe
<br />:ltltrc nrtrlnnd poNny lbr
<br />A|lnti.lnr nr A8enl SiX xlsre t\IJ
<br />Site-Work
<br />Underoround
<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 />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />l\4eter Release
<br />Rouqh
<br />Service lvleter tl
<br />FINAL u g tq /U//h (q)
<br />Notes, Remarks, Etc rl L.z
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