Laserfiche WebLink
ELECTHICAL.INSPEGTOR RECORD <br />Rev. 013-0'7"::fl 1 li; <br />APPROVALS DATE ID/SIG.COMMENTS owNER ltutt,t)liR l)lL('ARA'l loN <br />Business rn(l Proli\sh)n (ixle)i Any City {tr County which requircs a ;rrtrit l(r con{nrcl. rlter. inll)rove. rlerrx,li\h 0r ft'ltir nny <br />!) the provisi(nr\ of the Crrntrrctrr's L.icense(l l-aw (Chtpter 9. Conrn)cncin8 rvilh Seclion 7()(X) r)f l)ilisir)n .l i'[ tht' IJU\inc\\ rnd <br />applicanr frrr a penrir suhiecr\ rlE ilfplicnnt to i civil penrlty of D(x m)re lhna lil'e hun(lre(l (lollilh {$5{x}). <br />_1. as owner of the pn)Jtfl y. or nry emnft)yeer wi h wiger il\ lheir srle conwnsat irrn. $ill (lo the $orl itol I lr slnf,lure is tr( { <br />theFroJtny wh)hoiklsoritnnr)le\tlEBin.rfrlNh)drEssuchurrrkhinrrelforhrr{clfrirthftnrghhisorlrrownenrpft,ycr'{. <br />ofcompbtk)n, rlE Owner BuiUer will hrve the hurtlen of proving tkl he or she tlil n([ huikl rtr itnprNc thc pn'Fny trtr tlt N(r)sr ltf <br />$le). <br />rnd who c(nnracl\ irr such Ifi,itlcl\ wilh r Contrac!l(s) lirflrsfil pur\uxnl !) lhc (lrDtrtclrtr s l-icol\c Lils'). <br />-l <br />arn exernpt un(ler Section-. R & I' (' li)r lhi\ rcil\r)il. <br />Delei__()$ilrr <br />$'oRKt-RS' COt\il'I.NSA l l( )N <br />DIiCI,AIIAI I()N <br />l hereby nffirnr under penalty of priury rrne of tlre frrlirwing tlcclararionr: <br />_l hilve ilxl will nuintrin x Ce(iliun(. of Crnsert lr Sclf-lnsure fitr cltrkcrs conr|ftr\xlion. rs pn,vided for bt Seclirtn .l7lx) rtf lhc <br />trtxrr Crxle. frrr the performrnce of th€ wrtrk for which (he perillil i\ is\ull. <br />thc work li)r wltich rhi\ pcrnrit i\ i\{re(l. Nly workerr' c()nrpdrsrtion itr\urilncc crrricr rntl policy ntrnher rrcr <br />l'rrlicy I rpirrs: <br />_l cenify thilr iil the pcrlirrilrnnce ofthe lvork for which this ferrnit i\ i\\rrcd. I shrll nrl ernphry rny persril iil :rtry iltrnter <br />rr as to heconr suhjecl kr the workerr' c(xnlen\nti,n lxws 'rfCfllifornir. rtrd ilgree thnl if I \hnrhl hec(inle \rrhicct to tlF <br />workers'compencitionpn)vi\ir)[sofSecti')n.17{xlofthelrlr)r('(trle.l\hirll.li'rths'ilhcrtrilllys'ithlho\elnivi\iixr\ <br />WARNING: Failure il rcurc workers'conll*n$rhrn mverrSe is unlawful. ond shnll \ubiect itr efqrlr]er rr cirrinal pnrhier and <br />civil fines up to rlnc hundrad thousnnd dollnrs ($llxl.lxx)). in arhlition to ltr $rsl of c(rnlrensrtion. dinrr8et is proli(lc(l firr lhc <br />Sectirn l()76 of th. Lltr)r (ixla. interest nnd ntrormy s fee\. <br />Darc:- npgrant \(d-'rd( l7---- <br />LI(tNSED CON'I'RAC'I'OR <br />t,ECLARA'I'ION <br />I hcreby affirm undcr pcnxlty of perjury that I am licensed undcr pftrvision of Chnpter 9 (cohtrtncing with seclirrn 7(X)()) rtf l)h'i\ir)n l <br />of the Business and Pnrfessions Code. nnd my licen* is in full force flnd effe.t- <br />License Cluss:-License Nunrher: <br />- <br />-.r.*i- cun ono", Wl>.u'G <br />W <br />I hcrcby affirm undcr Fmhy of Frjury (hat th.re is a con{rudi)n knding ugcncy for thc ;rrfomnrce of tlE work lirr which lhis lErmh k <br />issued (Sc. l(D7. Civ. C.). <br />[-ender's NanE: <br />[-ender's Address: <br />APPLICANI' DECI,ARA'I'ION <br />I lErehy alllfln under penalty of pcriury ilne of the firlk)wi18 declnral ir)trsi <br />Demrlitir)n Pernlits-Asbestos Nolificrlir,I Fe(lerrl Regillalions ( l itle 40. Pnrl(r) <br />-Required <br />l,etler of N({illcnlirxr <br />-l <br />cef,ify that lhe I'ederrl regultlir)n\ reE0r(ling nshesh\ renxrvxlttrc ntl rlplicthl!'to lhi\ Ir,iect. <br />ordinances and Stxtc Laws relntinl trt huikling constdclir)n. fl[d herehy rurh,rize rcnrc\enlilive\ of lhis Cily rnd (irtty lo dn('r ilxrn lhe <br />ahove mntir)ncd pro[Eny frrr irrspetrirn puryrscs. <br />Appttcan. or At.trl s rr*run, - kfu -12 <br />nrmitF mm (pdnt,: _ . <br />l)illr: <br />Site-Work <br />Underqround <br />Pole Bases <br />Lioht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltaqe <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />U:derSlab / Floor I I <br />Gonornd / e6[ndina[/ UFEB \ lt4 Yl/l\tvt <br />Transformers\r v t- t I <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rough <br />Ceilinqs (T-Bar Rough) <br />lVleter Release , l.I <br />Rouqh dt <br />Service lVleter l(,tr.+^tvTv #1 <br />FINAL '$/t\l ,t4 <br />Notes, Remarks, Etc.7 <br />tlHlff