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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/srG.COMMENTS OWNER AUII,DT.]R DELCARATioN
<br />I hcrcby rrfinn ufld.r penllty ol nctjuiy lnar I oncrc'nfl ln,m rhc ConlrrdoN Lijcns tiw for thc folb,nE rco$n (Scc?oll5
<br />ArFnrc$ and Prolcsion CRlc): Any Cily or Counry qhich rcllutcs a I'crmit lo conxlrucl- !!tcr. imprct. dcmlirh or rcpan ,ny
<br />{fl.rurc, Firn' irs is!u.c, ulv, rcqun s rh. trprlicanr ntr \!cn rErmir lo lilc s \isncd {rc@n' rh{ hco, sh. h liccn*d pusu0tri
<br />lo lhc nmvisiotrs of lhc Contrctols Liccn*d Lnw (Chryrcr 9, c.m'ncfti.g Nith Sccrion ?O(D of Divnion :l oflhe Dusincs and
<br />Profc$ionsCodclorlhllhcorshc ncxcmpr lhcrcio ondlhc sisrbrlhcallc3cdcicnulion.Anyviolori.notsmrionT0llSbyuy
<br />,mli.di lnr n p.nnir slbjccrs rh. lppli.anr b a civil !.fulry ol nol mnc rhan rilc hxndrdl dolldc (S5m)
<br />-1,
<br />r\ owB or thc poFn), or nry cnrlloy.cs wilh e,8cs as rhcir srlc .ompcnslio.. eill do rtr wok o!.1 th. stB'iuE t nol
<br />inrcr cd ororlcrcd rbr $k ( Ss.7(N.4. 8.sincis and Pmfcsions Code: 'rhe ContHctols Liccn{ Law docs nor a0plyroanosncror
<br />rhc tmltny whob{ildsoripmsth.mn.andwh.d,Bs.hwolkhrnE.lforhcrsclfo.rhmuahhrorh.ro*ncmployecs.
<br />pn,vid.d rhar such imthrmnk m n ic krl or offcbd fDr sL.l( hokw, rh. huikling or in{roumnr is$Uwirhrnonc ,ts
<br />of..'rylc1ion. ih. Owncr Blildcr will hrvc rlt t rdcn ol pn,ring rhdr lE or shc did fin h ld .r impmw dd tmFiy for d. I)nrlbs ol
<br />I. a\own.rol rhcrrr.nt, anr.r.lu\ivcly..nt!crin8 wirh liccf\cd.ontrctr\bcoi{flct Ihc Forccr (S( 7()14, Businc$
<br />! lnnir$i{Codc Ihc Conrrcnr'r l-iccnsc Lrwdocs ior rppryro anosncr o, pro,icny sho huildsor nnprovcs rhcrcon.
<br />rtrd sho.odnchfors&hpmJcd\*irhaConrrucbrl9licn\cdprsuanrrorh.Cont(kr'sLic.nscLiu)
<br />lrn,.r.trrt rnJ.. S..rnD I|.\l'( l,trlhar.rvn,
<br />Irrtc O*n.r
<br />.ttllBtr[tss]rauffNt Ilox
<br />IlEcldaauo!
<br />I hcrchy !rairm undcr lr.nally.lp.rjlryom orrhc trlowirs dcEInlrlions:
<br />I hoec rnl will minllin ! Ccnificrrc or Consenr ro Sclflnurc ro, wo,leB mmpcnsdbn. as ,ovid.d lorhysc.rion r7m orth.
<br />Lahr Codc.Ior rhc |crformncc oflhc *ork f{trwhich rhcl)cnnir ! hsucd
<br />_lhalc anduillmainrai! workcn compcnsarion insuran.c. a\ rcquted byScrbn:r7(xrofrhc lihorCodc, ru(hc l,crrormM.c or
<br />rhc work li)r Nhl.[ lhi\ pcnnir i\ ]\\u.,1 NIy conrl[fsrri,rr irsuraD.c citri.r , d F)li.y Nnrhcr rc
<br />I ccdityrhd in rhc p.rfornuNc olthc for shih rhir lcnnn is irsxcd. I shrll nor cmlloyany pcr$tr in rny manM
<br />m r ro hccom suhjd lo lhc e c6 mn{rnsalion lars olcaliforn rnda8rcerhllifI sholld bc.om suhjucr t,rlf
<br />woltcn conrlcnsationpovhionsolsccli 3700 ol lhc L0tn Cod.. I slEll. lonh*irh onrDly uith lhoc pmeiionr
<br />WARNINC: Philurc to $curc wo.kcs' mmpcns,lion corcinec is unlawtul. and shrll su rn .nrnloy.r ro .ri ',rl p.mlri$ rnJ
<br />civ nncs up lo o.c hnndrcd rhousund do
<br />Sc.rion.1076ofrhcljt . C'r)dc. inrcrc{ Md
<br /><7-,/ L tK
<br />I hcrcby rfinmnndcr lcn0hyoilciury th l 0m lienscn u.dcr provhio. of ing $irh SNri{'n 7(XX)) ol Divi\i(,n 1
<br />of rhc Bu\i'rc\\ rnd Pn)fc$risCodc. d nrylic.n\c is lillnnr nd rflc.r
<br />(-0 olQ;r
<br />rO!S-I!.t!Il!2llJIl2!t(n-r!(iII!L
<br />I hcrchy anirfl under [Enohroalcrjury rhlr thcE t a con(rudkfl hndinB oScmy for lhc
<br />issu.d (s*.1097, civ c.).
<br />nceorrhcwork lnr wlich$il Fnnil is
<br />A.TPI.ICAILDEII,ABAIION
<br />I ffi)y dflnn undcr penak, ofFrjury onc.frhe folL*in8 d<hralions:
<br />Demlirion Pcrmih'Asbestos Norificarion Fcdcrsl Rcslhtn,ns ( l illc 40. P.n6)
<br />-Rcqund
<br />Lctts of Norifi carhn
<br />-l
<br />ccniryth.t rhc ltdcml rcSuhlbns rcBrdinr $hcslo\rcnFvrldc nor apfltablc b rhis lmjd
<br />ion kcomd lxErcct,.omtlys[hnllCirtdndCounry
<br />ordinrmc\ rtrd SI,. Iiws (lrr irt k,
<br />ih^c nEnri{cd rFncny rnr n.kd
<br />I
<br />Appltcrnr or AE.nr Si8roruEl
<br />Pemile n.rr I prino: y'
<br />hn ild iU .on{tu.rii,r. arri ho'i7.rctrc\ciix.v.\ofrhRCiryj.d(ttrtr ylocnrcrtrponihc
<br />Itt
<br />,.,.,2/!_/'Z
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dam pers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Transformers
<br />Torquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />8/(r/!4 ^a
<br />Rough klb/6 ,rJ'6'b
<br />Service Meter
<br />FINAL 'l/zt /iz 5\gx
<br />Notes, Remarks, Etc
<br />Meter Flelease
<br />L.ndd s AddEs
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<br />I c.nili rllr lhrvc rcndihis rtflirar on rd {ar.rhi thc hnr
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