|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hercby ltfirm und.r penalry ol Frjury rhar I d crenpr fod rh. Contn hs- Li.cnE tjw aor thc followins rcN,n (sr'7Lll 5
<br />Busnh\ dnd Porcsion codc) Any City or County wni(h rcqutcs a ltnnil ro conntuc!- atr.r, improvc, dcmlish or rPin rnt
<br />(ructurc, Fior ro its bsuaftc, !l$ rcqutcs thc 6prlic{.r lor such Frmn ro filc. siln.d {dcmnr th0l rEor shc is licc.scd punuanl
<br />ro rhc pn,rili.ns ol thc Contra.rors Li.cn*d L,w (Chrpr.r 9. c.mmcrcins wirh Sccri.n 70(x) oi Dilisbn :l orrhc Busin.s ,nd
<br />Pmfcssn,ns Codc) or rh.l hcorshc isexcmfl lhercfromand lhc hosis r'or lhc {llcsedcrcn/t,n Anyviolari.nofSdion?0ll t hr rny
<br />oppliclnl l'or a pemir \lhjdrr rhc aptli.rnr h a .i!il F.ahy of .or 8,. thl. ,lvc htrndrcd dollar ($50)
<br />-1.
<br />as owncr ol rh. porcny. or my €nulolccs *irh wua$ as lhct $lc dnnlcnq nrr. will do rhc wo ondlh.srulmn nor
<br />inrcnnc'l or oilcred fo. sllc (So.7{r44, Bu{irf,s{,nd [tof.*i.nr Codc: Thc Conrrlclors Li.cnsc lj* dtr\ noi apdy i,1. owtrcr o,
<br />Ihc nmtidy whot ilds or imprcrcs lir@n. od {h. dms sxh *ort himi.lf or hcscll or rhouEh hi\ or hcr own cmpkJyccs.
<br />prolidcd rhar such iry,fl,vrftn* m Bl inc ld n oncrcd ror sdk. Il lrs.rtr. rhc buillins or imtt,h Eni ix $u wirhin nm Fd
<br />of.omplcthn. lhc o* Rr Builds vill h!rc lhc hurden ol povirs lnd tt or std did nor huild oi nn bvc fi. pmpny fd thc IdIT{E oI
<br />L ns o*kr of r hd ntuF*dy. ,n cr.lNivcly co rrdcrir8 *ir h li..nql conrrcroF ro con(ru.r rhc pmjc.r (SL\. 7014. I]lrirrcs!
<br />rnd l,Itrlsshn 6dc:1hc Conrlldoisl,iccnse l,awdocs nor lpplyro ouncr or fhFnt wlr bu ilds or nntn,vc\ rltrr.otr.
<br />and wtnr conrEcrs ttr skh tol..r\ trirh I conkkbno licciscd por\uam ro rhc co r.clols Licctrsc tJw)
<br />_l ancicmpr undcrsNriol .B &PC hrrlisrcr$r
<br />.ITA&XE8ILI;OIIETTIAIIO!
<br />DECIaIAdIla!
<br />I hcrchyoiftmundcrpcmlryotpcrju.yoNorrh.roll,)$i'rEdklnn nnrl
<br />-l
<br />hrvc and vill mainrsin r C.nificdc of conscnr ro sclr-l.su€ for qort.N anrlEtrslion. fls F,vidtd for by setion ]7m of lhc
<br />ljbor Codc. for I hc ,e'{ormncc oa rlt work ror which .h. ,.rmi is trEd
<br />fl h.r.Jnd r'llturnrdrn worlcr' cnnrlcnsarinn NrtrNc. ss rcquircd by Sd n n :Um oa rh. libn cod., lor lnc pcdrnmmc of
<br />rh. work lor *hich lhir r..mil i1 is$cd. My wo cB omp.nsoliotr insurancc c! cr a.d p.licy nudbc, dc:
<br />*poDtA
<br />57tb7DL 'dD
<br />I ccnily rhrr in rhc FrronDrn.c orrhc $ork ror ahich rhr Fnnir n kn'cd, I shull nol cmpb, an, pc^o. in lnt nEnkr
<br />o .s lo b.rorx subjd lo rhc wollcs' compcnsal ion laws ofCallforni!. lid asio rh,t irl \buld rnom srb,cd k'lhc
<br />workch c. !,cnsdnon [ovisbns oI Sccriotr ]700 of lhc ljhor Conc. l stull. fonh$irh .o'ryly wirh lhos rrovnions
<br />Wr\RNlNc: Frluto'ro *curc workcn coDrp€trsotion covcrisc t unla*lol. rnd rhrll subi.r ,tr cnrploler to qiminrl Fiahics Md
<br />.,vil fincs up ro otrc hundrcd lhousrRl do
<br />s..ri.tr trrr6.rrlf, Itrbr r6d. i' c,c{rnd,"," qllq lr8
<br />^
<br />llnrs rsl00.rxJ,J). h trd(liri0n or.o'nFtrs tun. dinn8cs ar nrcvidRl i(, rhc
<br />I hcrch! dffinnnndcr FnDhyoltciury rh l am liccflrd undc.hion oiChapicr 9 (.on,mn.ing \ [h sc.Lon 70llr) oll)irhion:]
<br />ol rhc llu\i'r.s! ral l)i.li$nnrsCodc. ndd niy l'.tn\r N d lullJ,rc n rl.lii.r
<br />la tv
<br />I hcrc$y rlilnn undcr 0ctrrhyofn rjury rhit lhcrc is a connrudion lcnding racn.y r{r rhc FrrDrnuncc ollhc uork ior which rhi\ pcnrir i\
<br />issrd (S.c 1097. Civ. C )
<br />L.(lcis Namc:
<br />-
<br />l..difyrharthc lcdcral rcBU hi io ns rgord ins o shc(. s rcnFrul lrc nor {dicahh io rhi\ Pn,r.d
<br />_l r.ni[ rrrd I hJ\c,cdJrhnofflicJri.,1 M{]rcrhdrh.infoi,norion h corer I ryNro
<br />Ey authoric rcprc*ntulivc\ orionli',rn.c\ rad Srrr.l:N\ rchring n) h!lldifIr.f
<br />nhrvc nrnln,md rn,Nrly lor i
<br /> ppli.rnl or Ae.nl Signnlur
<br />Se fl 4
<br />'omply wirh rll airyand Orutrry
<br />htrCtryondC^utrrt r. cnr$ urnnrhc
<br />*,. 1l ,ql$
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under SIab / Floor
<br />Bonding / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release
<br />Rough
<br />Service Meter /A
<br />FINAL ln.g '18 \-rl.llQ
<br />Notes, Remarks, Etc.\J
<br />Translormers
<br />.20 b
<br />4+
<br />AIILICANI.DEqdAAIION
<br />I hotrly afm onder p.nalry or,.rJury onc oflhc folbwnE dNLmlions:
<br />Dcnhlirion Pcrmirr Asbcioi Noiinczrioo Rd..rl R.gulalhns (tirlc 40. Pan6)
<br />-Rcqd
<br />ncd lrn.r of Nor ifi.alion
<br />I
<br />I
|