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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS OWNDN DUILDER DELCARAIION
<br />, hcrcby rlfi.nr undcr Fmlry or Frjury rhar I m.rcnrrr ln,n rhc Cont&r.rs Licctr* rjw for lhc followin8 rclson (Sccroll5
<br />lrusincs rnd Profcsiotr Codc)r A.y Cilt or Counry which rcqurci a tcrm{ rn ondrucr. 0lr(. imnrnlc. demnl'.;h oi ttnt at
<br />{tucrua. pri.r ro ns isulncc- aho Equirc\ rh. aprltonr for such rErmir ro fik r signcd {arcft.r rhar h. o. sh. is li.cnsd pursmr
<br />ro lhc prcvisnnrs ol rhc cotrrraclols Li.cnscd tjq (ch,plcr 9. comnrNin8 with Sccrion ?mo of Division :l ofrh. Burin.$ and
<br />Pmic$iotrsCodc).rrharhcorshcisexcnrlrhcrcfrorrndthchNisrbrrhcsllcsc.lcicr,,rt,n.AnylidurionorSdrhn70:lI5hyrny
<br />dpIli.i forafcdir \rbrc.krhc applicunrrorcivilr.mhyofnorfrxcrhsnfivchundrcddolltrs($50O)
<br />-1.
<br />as owncr oarhe rmFny, or ny enpk,yces wirh wascs as rncar sok ofrpen{rion, will do ric wdk.,xl ttE stnxrE is mt
<br />in'cndcn .r ofcrcd tu st (5(.7044. Busin.ss dd Pror.ssions Codc: Thc ConlEcbls Liccnsc tiw drcs nol arpl, ro an owftr or
<br />rtc pFpcny wtn &rild\ or in{,r.B rhcdn.
<br />"Jd
<br />*ho d*s mh worl hi'ncl[ or hcr$lf or rhouBh his tr h.r oen cq,loyc.q
<br />[ovidcd th,r such impmrlmnls N mt inlcn6 or oiicmd for st. ll howq. rlE huildiry tr intmrcm ir sld wirhin unc Fd
<br />of onplcrion. rhc O*ftr Buiud sjll h!rc th. lrr&. o, ptolios rh.r h. or slk dil mr hri! .r in{mE Ue ptutdy for lhc l{rpos ol
<br />LL as owM or th. pol.dr. m crclusivcly conr.d ing wnh lien$d contn k)n ro onslrucr lhe pmrcl (s( 7{}r4. Il$rtus\
<br />a l Etrf6sion Codc: The Conrrscror'r Li.ensc 1!* &'c\ mr apnly k, sn ownd .r prolx y who builds or inprovcs lhcrcon,
<br />and who ommds ror su.h f,ojcds wilh! Conlacb($ li.c.scd puNa ro rhc Coaiructols Liccnse ks),
<br />.8. & PC lorrhtrrcJstr. f-
<br />I
<br />*"7bolr( ,**. (-F--2f v\"*ffi*
<br />I hcrcby afliifr und.r p.nJtyoflEjuryonc oidc ldloqin8 delmrnrs:
<br />-lhulconlwillnEnliDoCcniftolcol'Co.\cnrloSclf.lnsurcforwortcFconrpcn\arnrusprovidcdrarbyseiion3700ollhcL$o. Codc. for rhc psfolnancc or lhe Nrt lor shich thc pcnnir is issucd.
<br />, hnv.lnd sill mainrai'r wo cs comlr.srrion in\unn..,.! rcqtrncdbyscriotrlTlDoirhctihorCodc-rorrhcperrormn..of
<br />rlr rork f.i whi.h rhis Frmir is issucd. My workds .onrpc.srtn nsura..c mtriq and policy numbs arc:
<br />WARNINC, I:lilurc ro scurc sorkcF cor.p.n\lrnnr.ovcmsc is unla$rul. and \hrll luhj.cr rn.mFk)y( to. niNl pcnrhic\ Mtl
<br />civil fincs up lo onc hlndrcd lhous.ml dollan ($100.fi)0). in lddirion lo lhc .osr 6fco t'r.Pg!.iaE ecs trs r'rcvidcd rot rhc
<br />Sccri ,n l(,76 ol rhc tibor C.dc. inrcrc{ and 0ltom\'s rce
<br />;"':" r,.I; <"
<br />^'";;'D='^"
<br />LICEXSD-(ONIA^CIOB
<br />IIECIAf,AIIA!
<br />uru\
<br />I hcrcby afllimx.dci lcn rtofpcrjurythd Ionr lia.scd undcr r$vision ol Chnplcr 9 (om'mEins wirh S.LJion7000).lDivision l
<br />ol rlr Businesqrnd Pn,f.{si.ns C.dd.8}1 nry liccnsd h ii tulllbrcrdldcffNr
<br />-Liccnsc
<br />Numbcr:
<br />Conttulor:D.t.:
<br />loxsmlcuaNu:NDMilQ[Ntt
<br />,(ru.d (s.c .r(D7.civ c I
<br />AIILICANLOECITIBA.IIoN
<br />I h.nhy limun,tcr pcnalry otp.rjury onc ufrhc roln,wnra drcl,rrrbns:
<br />Dcnrlilnnr PcirnirsAdrnos N.ririclri,)n FcdcrrlRcsulari,n,s ('lirlc 40. PanO
<br />R.qutcd lxrr.rolNorillcJr n
<br />I arliry rld lhc rcdcrul rc8ulAtions rcB0rni.E rstEsiosrcmDvolrrc nor aptlicoblc lo lhis pFt6'
<br />ffl {niry rhar I haw rcod rhis ap icdion !r'd srare rhlr rhc atnrc intumrion hcorel.l ls6 ro cof,l,ly sirh lllciryond colnr,
<br />ordiMnes rnd Srdc ti*s rcLrin-! ro buildins consrru.rinn. ad herct y lufRiqtceo'ati!.s orlhk Ciry lnd Counly ro cntcr upon lhc
<br />r( nrtrr'.n.d pmp.ny l.r 'niFdis{glo$\. - ,r\
<br />rppri,,nr * rg"nr sis-r,*( ,F-*uL vvu **
<br />Pemh*nsm.,prrn,,: - ?Aut r.- t\fiv
<br />llultt
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Condilioners
<br />Rool Top Equrpment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service l\/eter t
<br />FINAL ,ta/oz///.ffi?,-)
<br />Notes, Remarks, Etc.
<br />tlr *rry,r',, ,,r" *-,r""run!c orrhc w.rl r{ nhtrh lhis p.nnir n hsucd. I sh.ll nor.nrploy rtry FcAon in ant
<br />'nrtrncr'v, r ro hccnnE ub(rr r, rhc {ortcA run'ntnutr,n la*\ ofCalifomir. dd ag(t rlrr( ilI \h.uld b.aonf, subirl ro lhc
<br />worlc*.onFnsain,npnrvhbnsofSNrionlTlrcofrhdbborC(xic.lsh.ll.lorlhq'ilh.omllywirhth,sprnrisions
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