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ELECTRICAL-INSPECTOR RECOHD
<br />APPROVALS DATE COMMENTS OWNER BTIILDER DELCAl.ATIoN
<br />I hcrcby rrfinn und.r pcnalry o{ r.rjury rnd t a'n crcnrnr frou rhc Co rtr.hc Liccn{ tiw for rhc l'ollowins rcav'n (Scc7)11.5
<br />Busincs lnd Prolcssion C.dc) Any Cily or Con y whi.h mqun$ r Fnnn t) .otr{rucr, rlrcr, nnn()vc, dcn1olhh .r reNn ,tr!
<br />{d.rxr., pri{, b ir\ is\trNc, also,cqlirc\ rh. rypliclnl lor such rEnnir ro fiLa sisncn slaremnl rhir lEo.shc t li.cnscd pu.sanl
<br />to thc povnions of rfu Conr..brr Li.cns.d b* (Chrpt$ 9. Comtuncins wirh s.crx,n 7o0o of Dirhn,n I ol rh. Businc* ,nd
<br />Pmtc$ ids Codel or thrl h. or sh. cicnu rhcrcfn,mrndrh. bfis f(tr rh. dllcg.d crcnDrion AnyvnndionolSerirn7011.5hyan,
<br />rppliclnl lor r pcrmil suhjsislhc aprlicrnlto 0 civil Nnrlry or mr nDrc rh fivc hundrcd dou!6($5m)
<br />I. $ o*&r or rh. pnrpcny. .r ny .mpk,rrcs sirh wl8cs !s lhct n,k co u.n\at bn. will do rlf sork dn rh. {turxh i\ ft
<br />inrendsl or oflcrcd for sole ( Sa.?Ol4. Businc$ and Prolcssions Cod. Th. Contictois Lisnsc trw drcs nol ,Fply lo 0n owmr of
<br />rhc pniDcdy who buildr or infmrc\ rh.ft.. arn who dms mh solt hin\elfor h.r*Uor rhmogh his or ter o*n entloyccs.
<br />Ptuvnhd rhi such nnprohmnh cnolinrendcioroffcr.'lforsa.llhowcvcrrhcttritli.8orinlrr.vcnrrkhUwirhi'ro'Fyrir
<br />olco,r|]lcri.n. Ih. OwNr auiftr *ill h!rc lh. budcn ol ImvnB ild h. or shc did ml huild or tq,mvc lhc ptrrlfty for lhc puq-e ot
<br />-1.
<br />asowncrolrh. n oFn). omexclusivcly contrucri.S wirh li.cn$d.ontra.rosro.onso. hc ptuFd (Scc. rO{-{. Bun.c\s
<br />and Pn,rcs\bn Codc: ThcConrDckn s l.iccnsc Las docs rol!,rplylo !now.croll]rotEnywho buildsor imfiorc\ rhcrB,n.
<br />and uho .onlra.h f.r su.h pojccrs wirh a conrlck,ns) ltcn\cd rrFdnnr b rhc G)nracrtr r Lic.nsc Law)
<br />litrr.irtrrfrr uMfsccrioi .ll &PC ntrrhnr.r$n
<br />,,," sf ."of 16 "**"x
<br />I hcrchynflirnutrdcrI.tr lryof pcr.Jury.itrof rh.folli)*ingd.clrr irnrl
<br />I l[vc mdsill mainlai'r r Cen ifiQr. of Conrnr ro Scltlnsurc for sortc^ .omrn\!iion. s\ pmvidcd ior hy56--rioi.l7(X)olrhc
<br />trtxr(-l c,lorlhc perrom0nccolthcwork r'or which rhc ncnnil is kslcd.
<br />Ihrvcrtrdwill rinrrirwurkcrJ..nr!.n\rrnDi'rsrrrm..arrcqutudhySednn,:17(X)ofrhcbhnC{ c, for rlr Frror.rd.c of
<br />rhc $ork hr $hichrhistcrnir is issrcd. Myworkcn .. lncneri.n
<br />'nrurntud
<br />.min ,,x] nic, nnnrh.r tuc:
<br />l..nify rhxr in rh. F.rformsnla ofrtu $ork I{r whth lhis tcnnir n i\{'.d. I shxll nor c,nploy lny p(ron in rny n,Mmr
<br />so s t, bcconr suhlcd ro rhc sorkch c. p.trsiton laqs ol Calif{niin. d a8to. rhat if I \hould tr.o r b,cd r. rh
<br />workcrs.on{cnsdhp()vniotrsoisc.ri(flTmofrh.lihrcodc,ldhll.fonhwirh.o'ntlywirhrh.{rrovisr.trs.
<br />.";,.#618 nrr,,-.,,X
<br />I hcrcbyitlirnuMcr pcnrlryof p.!trryrlid I im li.c vJr cr i(,n ofChnprn 9l.o'nnEncing wirh
<br />of rh. Busi,rs rnd PR,rcsn,ns Codc. rnd mylic.n\c i\ ir lullbrcc a cllc.r
<br />qANSIBI,]CTIoXJiUDING.ACINqI
<br />I hcrcby om.inund.r Fnohyorpcrjury rhd rturc is, snsrtuciion hnding.Ecfty for rh. p.rforMc orrh. work lor which rhis lrrmn i\
<br />hru.d ls.c 1097. civ c )
<br />APTLIgANIDECIAXAIION
<br />I h.ftby dli!6 undcr F ihy.lr.rjoryonc olrhc lollo*irsdcclororn,ns
<br />Dennhn,n Pcrnnts-Ashc(os Nolificornr FL{crul Rc[uhrn N (Tirlc40, Pnn6)
<br />Rcqrncd l.nrrol Mnii.ari)r
<br />l.cnililhrl rh. tcdfilicguhii.ns toEnnliig *L$os r.nbvrlrrc ioi 3t,Ili.ahl. ti, rlri\ pnr]ccl
<br />l.c ilirh l hrtc r.dd rhi\ rpflkd nr dd (dcrhrr rhcah'!c infonturi(,n i\.oftcrr l rlrLrk'(,nnlysirhnllCityind Counry
<br />ordi0rk.{n'klSrar.lrwsrul,r'.gr.buiklnrE.on{tucrn,0.!ft1h.r.hyalifiri.(rcnrc\. rri!r{ofrhi\CirtudG,unryt,cnrNutitrtrlr
<br />,)l-
<br />ahovc nFnrioncd propcny ior insp(r
<br />Applir,nl or Aserl Sknr!tre r+
<br />Pemh*nnme rpdnr, { V NICA iI\ztEAI
<br />L6_hBE;-
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Frre Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough A/0//q tf5:l,vx.{q).,
<br />Service l\rleter \_:.../'
<br />FINAL /b/(//B --peh %?./a)7tNotesRemarks, Etc.\:--/
<br />*)
<br />ID/SIG.
<br />Meter Release
<br />WARNINC hilulc lo sur workcr' empcnsltion corcn8c is utrhwtul- ond nEll \ul,r.r an cnDloler to sininll ,lorltts and
<br />cilil ,lncs ur lo orc huftlrcd lhousnd dollar ($lm.00o). in rddiriotr to lh. co( ol comp.trgln'n. damscs as pmridcd fo. rhc
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