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ELECTRICAL.INSPECTOR HECORD <br />APPROVALS DATE tD/stG.COMMENTS OWNER BUTLDER DELCARATION <br />I hcrcbt amrn und.r p.nalry of F jury lhd I m crcry)r fmn lhc Conradon Li.cns Ijw lor lhc lolloains Endo ( se.70] 1 .5 <br />susirc$ flxl Prclt$ion Codc): An, Cny or Counry whkh rcquir.4 , p$nril lo connruci. altcr, t.provc, dcnrlish or rc|Dn iny r <br />\rructurc- I,h!ro irs hsnancc.,lso tuquircs thc trpplhanr i.r such Fanil lo filc a \isncd sdrsmnt rh{t tEo! shc h licctrsd Purtuanr <br />r(' rhc Fovnions of rhe Conrr&rol\ t,i.cnsd ljw (Chsflcr L comnrminB qilfi Scclion ?000 of Divisbn -l oflhc tsusine$ and <br />Professions Codc) or lhar hcorshc k cx.frpt lhcrcfroNnd rhc hasn lor lhc rllcsed cicnPridn Any vi.hrion of Satbn ?01I 5 by rny <br />appli.anl tor a pe.nir subjc.hrhc dtpli.rnl to 0civilFnrhyofnor rmrclhln five hundEnd.ll i(g5m). <br />-1,dsoe@r.frhctblrny.ornycmlloreswnhwoBcs!srhctElcoopcnunr,qilldolhcwokandlhestndmhnorinrctrdcd or ondcd lor slc 1Sa.7044, Bliitsr aid Pmac$ions Gldr: Th. c.nrnclois Liccnse Lzr do* ..r amly to atr o*rcr ol <br />$c ptuFny uho builiis or inpmlcs rh.Nn. !i wk) &Es suL_h $* himsclforht*clrorlhrclehhhothcrownemploycc\. <br />pnridcd rhsr suci inDmhftds m , inrcodcl o olTcrcd for $lc ll ho*ck. rte htilding or impEEftnr is sld wirhin o't ytlr <br />otconplction, rhc OBmr Buius *ill hrv. rtb burdcnorpruvine d rEorshcdil mr t{ild or itnrm,ve rh. ln,Fiy lor thc purlnEof <br />-1. <br />as owrer.a rhc pmp€.rn s'n.x.lurivclt.onr&ring wirhli.ctr*d conlracl on nr .on{ dcr rh. pmtNr (scc 7014. Busioc.\ <br />n l P$fAsa,nC.ilt: ThcContractnis Lic.nsc lrw dmsnoratplyh anowncrofrrol.nysho tuildsor imFovcr rh.rmn. <br />ud who conr8 Isi, su.h Eo,cck wnh a Co"rrddon, lacnsd Nnu.r rolieConrd.brs Li..nsc bw). <br />-l <br />amcxco,|I unJcr Sccrio <br />Dol.: _ Orrcr: <br />$oRI(ERs coiitiNsaroN <br />DICLASAIIQ! <br />t h.r.by aflirmundft r..,hr of p.qury onc of lhc follosins dcchrrrions: <br />Ihiv.,ndwillnBinlrraCcnilictrtcol'ConscnrroScli:ln\lrcnnworkcn compcn\atiotr. rs tmvidcd for by Scction ]7m ol tllf <br />l,!hrOde. tor rhc Frrornm.c orrltr work lorwhichthc psn n i\sucd. <br />I hrvc ,nd will nDn ain wortcrr conrpcns{n,n nrurakc. a\ rcquitud by Sat ion lTtX) of llE L!&tr Ad.. ror 6c Pc.ion*mc ol,,,.6[ <br />0c8 <br />o t'7 4 <br />I ccnify rhrr in rh. pcndnni.cc.irhc uork for which lhn pernril i\ i\\ucd. l.hull trd c\roy rny Pc^on in a.y trrrtrtrcr <br />n) rs ro hconN hj(r to lhc uorkci\ compcn\rrtui ln$lol Crlif.nria. rnd rgsc rh r itl should ht.. rc strhl(r rolhc <br />workdr con{cn\nti.n provtions olSccrion.lT(xlolrhc l:txtr Cod..lshrll. ionhwilh conrtl, *irh rh.s !mvisions <br />WARNING: hihre to scurc workch omp.ns,tion covcmSc n unkwtuL and \h.ll subiccr n .mPlortt ro sininal Fdkis and <br />civil fincs !p lo onc hn.dftd rho$rli dollas (Sr0o.0oo)- in addilion ro rh. cor of.omPcnsslion. domscs a3 nmvidcd ror rhc <br />:;:: --Yt Ufr <br />*" "i-""::,,;" 2* .24--,-, U(ENSID!}iflA!A)B <br />DECI.ABAIIN <br />I hdrbyafirm und.r pcnslry of lcrlury rhlr I am lian{n onde, prcvision .l Ch.pls 9 (co'nmncins wilh Sdion ?000) olDivhtrn:) <br />of rtu Au\in s\ rnd ltola ssions c{dc. nnd mylicctrs is ir lull nrcr adrrrer <br />(Zo E41L 6q <br />.-,-^*.>< .&'. fut- - <br />CONiIAIJIJIONIINI}IIIi-&GENT:I <br />I h.rhy dnnn lndcr l.nrlly of I'c Ury litrl rheE t a con(ocrt'n Lndins ascky fttr lhc lFrl'onumc of rhd {t,k for $hich rhis Ilcrnil !r <br />issud (56. 3097. Civ. C. ). <br />trndci! Nrm <br />- <br />AEELICANLDECITISAIIO! <br />I tu, atrm undcr Fnally of perjlly one of rh. folh*irg deh..ri6nr <br />Dcmhion Pcrmns-Asb.{o. Nolifi.lrion FcdcEl R.sllctions (Tillc 40, P!ri6) <br />-Rcq!ircd <br />Ldl.rof N.tiaslion <br />- I .d <br />'ry <br />rhar th. rcdn.l rcElhrDn\ rcge{ing Dhc{o\ Gmvtl m nor rPpkrbk ln lhs I.FJ..| <br />Vl enrryrhd I how (adrhi{pflic nn n {rrc lhar thc rtrlc informdion is @nd. I aem lo cooply *ilh all Cily.rd Counly <br />oftliLtrr.c\ rfrt Srxr.l.r*a rchrnl8 ro hui]constfl.tnnr. drd hcrcbyrulhorizc rctlc\cnrrrivcs oirIis Cily ond <br />rli,vc rmnxoncd fl opcrry lor itrsp.dnn <br />.\pplionl or ,\g€nl SiEnolure: !( <br />P.m .etuftr(pnno: X 4) <br />'";/z'Lili <br />Site-Work <br />Underqround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Lile Salety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <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 Rouoh <br />Ceilinos (T-Bar Rouoh) <br />Meter Release <br />Rouqh <br />Service ltrleter <br />FINAL I llbltr @Alo*tn z/ <br />Not Remarks <br />I o e^.+1 a vr.-lt <br />-t <br />Etc. <br />T