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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />S igns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueing
<br />Air Conditioners
<br />Flool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />It/eter Release V?4/;6 SD6Y
<br />Rough yts/E 5b€6
<br />Service lvleter
<br />FINAL 6/4/$>S 1'6
<br />Notes, Remarks, Etc
<br />OWNER AUTLDER DELCARAIION
<br />I hrrchy rf,inn undcr Fnalry of p.rjury rh.r Ln rx.npr fnrtr rhc Contad.6' l-tcnsc La* for rhr followinS rcr$n (SN.?tlll t
<br />Blsincss lnd Prufcsion Codc): Any Cily or County whkh rcqnncs a ,.nnit tr cotrnrucr alt.r. iml]'ovc. dcnnhh .r mnln ony
<br />srrucrurc. prhr to ns issulmc. ol$ rclruircs thc opdicanr iorsuch Frmil lo filc r si8rcd turcmlr lhot hcor shc is licen*d puBuunr
<br />lo lhc tnJlkions orlh. Conracrocs Li..nkd k* (Chafl$ 9. Conmcn.i.g silh scclion 7uD or Divhiotr 3 ollhc Busincs rnd
<br />Proicssions Codc) or rhat nc orshe texcmpl lhcEfofl,trd thc baris lor nE rllc8cd cxenl,tiotr. AnyviolationofSdionT0ll5 hy any
<br />,mlicinr fff! ncnnir srhjccn rh. arplicd (,3civilrcnrlryofnor lBtr€ rhdn fivc hundrdd dollus (5501))
<br />I..sowmrolrh.Fmpcny,orm,lmploy.cswirhwrtcsasrhc nnc .otr'p.Nar ir)n. will do rlE eork dd thr srtrtm is nol
<br />inrend or orcrcd rbr slc (Sa.7044. Burinc$ ond Pmnsions Codc 'fhc Contnclor's l-iccns L{* docs nor lprrly ro a.o*dcr or
<br />rh. nn,Fdy *h, hoilds oi inpross rhcNn. e, wh. d(h .h*orthim\clrorh$$lforrhrcu8hhhorhcrowncmpl.yccs.
<br />lr.vidnl rhar such nnpRrk'Enk m mr i,n.ndcd d offcd tbr eh ll hokE. rh hui nE .r iirtn*rnEnr t bk 'nhin om ,en
<br />orcotrqrEr io.. rhc Oan.r Blild€r vill hlE rhc lndcn oa Fovios rhar lE or \hc dil er blill or imprck rhc rrFiy r.r rhc ,!rFe or
<br />I. \o*ncro{rhcprotcny.arcr.lusivcly.oftrc(ing(irhliccnsrdcotrtJLttr\h.oi{.rrh.pi(icd1Sc.r(}U,llu{trc$
<br />rl{1 tlirlssinr aodc lhc (ontrucl.is l-icn\c l-ur docs not lpDlyti rrosf.r ol'Dn)0cny$ho huili\or nnpnxtsrhcr.oi.
<br />akt *ho co rnrr\ tur su.h pn,jc.r r sirh I cuft&kn( s) li(n\rd Jrtrrnr o rh0 cifir ncrof s l-dis. Lrw).
<br />I amcrcnlpt undcr S..rio
<br />]!!)BKD&!:CAU[ENSjTION
<br />D!:ELA&IUAI
<br />I hcrcby rlnnn u d* l. rlry of lcrjurt otrc ol ihc Llk)*irs d.ckrton\
<br />-l
<br />hrvc drl willmdinlai.aCcnific{rcol Conscnr ro sclr.lnsur. ntr aorkcrJ .omFnsarion. is f^}vidcd lnr hySccrt'n:17(x)oilhc
<br />ubor Codc, aor rhc FcrfonMee ol rhc work tr which lhc lcrmil is ns&d
<br />Y*.
<br />is G$cd My *or*crr.nr nl.bsario. iDsuritrc. .lrdcr ond Flicy numbcr arc
<br />-{)t
<br />Ic.nilyrharinricp.rforronccotrhc*ork,nr*hichrhispcn r is i\sucd, I \hrll orcnDbyrny|t otr r rtrynDtrnct
<br />s $lohroih \uhr:rr t)rhc workcr conf.n\di(,n hssofcalifdnir, n r!r&rhrrill shonld h.coor shjcd iorhc
<br />workc( co 'r.nsrti{,npmvhiotrsofSc.ti.n 37(X)ofrhc IitsrC.dc.l shall. n rhwirIconrdywirhrho*pnrvhii]ns
<br />WARNINC: Failurc to surc workcs comnensolion coverlsc n unh*lul. lnd shall subjccr an cnplor.i
<br />'o
<br />diminrl lEmhts 3nd
<br />civil fincs !p ro oic hnndrcd thotre.d d.ller (3100.000,, rn rdd ion rn rhc cn{ .r .. ftp..I$r ion, d,nE8c\ r( tovidcd ior thc
<br />S(ron 10?6 o, rh. tin Cdlc. inr.rd nnd a o,mt\lcc\ A
<br />D.,e: 1 -V't6^*,-.,, CU->ed-
<br />LICENSED C(INTNACTOR
<br />DECIdMIIIJN
<br />I turcby lmifl u.dcr l.h,hy oi pcrjury rhd Lh liens.d u.d& p.viri.n ofCh{prcr 9 (comnrNing vith Scdio. T(Xx, oiDivtion l
<br />of thr Businc$ dnd PDfession. Code, dd ny liccnsc k in flll for. rnlclfc.r.
<br />cq0 8s_g toq*l-a- r{'fis (a
<br />!1)!sl!rl-ul2\!Jll.ll}!-t1ir.}(r
<br />I hcrchy rllirD unicr p.nrlry olpcrjury rhrr rhcrc i\ r mn(rudion lcndin8 r!.ncy lar rhd p$fornDn.. ofrlr work hr qhichlhn [Eflnil n
<br />hnrcd(Sc. .1097. Civ. C )
<br />AIPI.ICANTDECI/IAIIQ!
<br />I ho$y afiim undcr Foallt of |rctjlry onc ofrh€ rolhvin8 dccld0lions:
<br />Dcmlirion P&nir$Asb.ios Nolifrcalion Fclcal Rcgul,rions Gnb40, Pd6r
<br />-RcquiNd
<br />tlxcr of Notifi cllh,
<br />-l
<br />cenilyth.t lhcltdcralrcsuhtionsrcB.rdins !\hcslos rcnnval .rc oorrppliclhlc t,, rhispn,Fr
<br />I.cnilirharl ltrlc rcad rhi\ artlicarhnand $rcrharrhcrh,vc itrrornurnrn i(.orccr lr8reloconl|lywirnallCirrrtrdC.unry
<br />odinamcs rnd shrc tjss nhrinE ro buildir8 .on{ru.ridr. .Jxt hcsht.urhorizc rc|rcsnIlrilcs ofrhh Ciry a.d clrnryb dmd of.n rh.
<br />H:[:#::";;W,t*d ".,., 1'3- tt
<br />Sub-Panels
<br />lA
<br />uYl
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