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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DI'I,CARATION
<br />I h.rclry rtnm rnd.r F alry (,, Frjury rh I dn cx.mfl fi.m rh. conr,clor' Lik_nsc uw lnr lh€ followins rcact (sft 70.11 5
<br />Bunncis llal Profc$ion Codc): Any City or Cou y qhich equtcs r psnrir b mn(dcr. rlr.r, impdf,. dcrmlish or rclun otry
<br />{rucrlrc. triff b ir\ is\umc,,ko Equirc\thd applicmr for such pci,ni o fil.a sign.d ndcnf, rhit h.or shc h liccnscd nurunnr
<br />ro lhc pmvhions of rhc Conlrocrols Liccnscd liu (Ctat'lcr 9. Commncins wirh Secrio. Tulo 6r Division I .f rlE Businc$ and_
<br />Prcfc\sionsC.nc)orrhar hcor\hc G cxcnrfrlhcr.tiooaid rheh\is ror lh.nll.Bcdcxctrl ior. AnyviolllionolSccrion?0.11.56y,iy
<br />,pl,li.m(r.rap.rmnsubi(krhc.pplicanllo!cililpc.,hyo'notnntrcrhnnfivchundrcddollur\(S5(r))
<br />_1. !s owncr ol the prcF-n!- or
<br />'ny
<br />cnDloF.\ wirh wasc\ r\ rlri. v,h c.'npetrs,tion. wlr do rh. $oA dt rtE (Mlurc n mr
<br />n{dfrLd or ntt.rcd tu eL (SN.7(E!. Bnnmsr ind Ptufcsions Cdl. Th. Conkrcrois Liccnsc tiw dcs norapnlr ro an owkrof
<br />rhc Impcny rvho hoildr o. inarotrs rhcfr)i. ,nd who dcs such sork htn\cllor hcr*lfor rhiox8h hit or hcr oln cmrl(,ycc1-
<br />ptuvnhd rhlr *u.h nnflovcnrnh m ml inrcndctl or ol]!rcn ln sL li howcv.r rhc hildin! or irpnrcnE r i\ $ki wirhi| oDc yctrr
<br />ufconuhrio.. rlrc Ouncr BrikLr willhtrr. rhc hord.i dftsvin8 rhrr hc.ishcdal nor t{ild or imDmw lhc J,nllcny l rtf, puqxx.ot
<br />I. owNr ol rhc lrrotrny, dn cr.kNiuc lr .otua.rine sirh lirctr*d .unrdcxns ro .onsru(l rh. pn,jccl (Sec 7l)4,1,3u\inc\\
<br />od Pmlt\\ir(i c lhcContncrois t,iccnsc l.aw d.cs nor atpllro .*nc'oftnipcnywhotuildsorimfmvcsrhcrcon.
<br />rnd sho conkicr\ fff s!.h pn)j.rt\ trnhr CbnrNui(\ ) li.rn{d pnnunr h r hc ConrrNrtri l-i.cns ltrwl
<br />I rmc\r |, u nl.r S.rri,)
<br />Dot: ()sn..
<br />woRxFia-oNrPF\aAfi)N
<br />DErt xallQ!
<br />I hcr.byrftlrnu .r p.nahyorFrjuryo col rh.lnllowirgdc.lrrrions
<br />I havc a8i *all mnnrin a Ccnifi.ar. ol clonen! ro scll- l.suru ior sorksr om{Ensal hn- !s pn,vidcd aor hy s.ction 1700 of lhc
<br />bbor Code. lor rhc pcrfo@rc. ofrh. w.rk f(tr *hkh rhe lEmn i! issu.d.
<br />I hrvcand willnlri.iain workcra .ompcnsdion insuiakc. r\ rcquncd hy SNt iotr :l7m ol lh. ltrbo. C.dc. f.r rhc lElfirtruncc of
<br />th. rork rar shich rhi p.nnir is hsEd. My workerl compcns0l ion iNurancc cariq old Fnicy nun,t c' d:
<br />PolicyNun,6.r Exltcs
<br />-l
<br />Ndily rhrt h rhc lcra.rmnce ol rhc *o,k tu \'nich lht pcnnir h issocd. I shrll no' ctrPk,! nnt l,cron in lny mlnmr
<br />$ ,\b h.r{ft subj.d ro rh. wolkcF con[.nsarion laws orc.lifornia. ond asrcc rhal ilI slDuld lf,om bj.{r ro d.
<br />woik.6 omt nqrion folisionsofScctiotr:lrmofrhc rjhr Codc.I (hrll. aonhsirh NnDly sirh rh)t tm\ isions
<br />WARNIN(; I'rihrc k *curc *orkcr a .o trDc n $r ior .o rern!. i\ nn[*li]I. a d shrllsrhjdcr a[ cnrfloyct to crinritrrl ncu]rics ard
<br />.ivrl ftr.r tr,' t' ork hutrdrcri rh.usnnldo h\ lSl0o.r)(l(r). in {(l(liiitr ro rh.N .rcoNtf,tr{lnnr. d.n$8cs os lmlidcd lor rhc
<br />Sc.li({ rl)76 olrht l- i'Codc. intercn lnd lllorncy s lccsv
<br />I hcrcl'yalfirnD cr p.nalryorFrjury rh l nD li.rnrd u.d* E.vision ol Chn,'ls 9 (commmins snh Sdirn 7000 ol Divhion l
<br />.l rhc Busincsrnd Pmfcsions Codc- unl ny U.cns t inflll rn.c ul rffccr
<br />t/z {..**.. K.
<br />I h.rchy sttirn!nd.r Fnalryorpcdurylhd lhq. h{ co.sl .lion Lndir! r8cncy for lhc p€rtormrcc ofrhe s.rk for rhich lhis Frmil t
<br />issu€d (Scc. :t1,97- Civ C.).
<br />LcnCcis Ncmc:
<br />-
<br />lrdrirtrhxrrh( Ictlcnl rcgtrlrnonr rctirlllD! ish.{o\rcn!)ulirc D.r r|]flicrbl. k, rhis pn,l.cr
<br />larin8ro buildins consrrucrn,n. uld hcrcordimnccs md sr{lc tiws rc
<br />dhJrc nrnri(,n.d ri0p.dy fD
<br />Applicrrl or AB.nl Skmlu r(,***-:r,w;:-
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER ALlb,it /Y@ (L)
<br />Transformers t vt t u\
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />ft/eter Release [,lLl/4'iL 'rruta/.2r-)
<br />Ill UI
<br />Rough
<br />Service Meter 4
<br />FINAL slt{l(An q-'qvo '*r)
<br />Notes, Remarks, Etc.I rur :
<br />- 11-/u^,.tLd./vb €uet P I
<br />UN - Altltdvgh ltbnt tro-Lh1./f (n, n|l*./2-I lc >-l L-L/.!t zz->5 c.,4.rt/^\7
<br />Site-Work
<br />AES,ICAULIECI,IBAIO!
<br />I lsd,y a,Im uNlcr p€nalr, olFrjury oN oarhc roU.wing dftlddri.ns:
<br />Dcnblilion PcflnnlAsbcios Nori6crtion Fcdcrul Rcsulalhns (Tillc 40. PLrl6)
<br />-R€quncd
<br />Lclrcr ol Nolificalion
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