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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUTLDER DELCAR"ATION <br />I hd.6, afrm undd pcnally ol pBjury thal I m .xemlr 6on the (bnt,cro6 Li..ns. Law lor rhc hllo*in8 r.Mn (Ss.70l I 5 <br />Dusinss ed Prolsion Cod€): Afly City or Counry which r.quir6 3 n66ir ro co.sttucl, rlrc. imprcvq ddolish "r rcpan any <br />srruclre rior to irs issuMcc. atso r.quir6 $c appli.d lor such pernh ro nb a sig.cd ststdrot $al hc or shc i.s licdsed pdua <br />'o <br />rh. pmvisioB oirhc ConlBcloas Lic.nsd kw (ChEns 9, ComocinB *ith S6lion 7000 olDivirio. I of th. BGi.N dd <br />Proacsio.s Cod.) or thar h. or sh. is .r.mpt rhq.fror drhch6isfortheau.!deidrrio..Anyriolalio.ofsdrion?01l5byany <br />applica.r lor o p.mn subjErs rhc a$li.oi ro , cjril p@hy o I nor mo€ ihd 6v. hon&ed dolltrs (t500). <br />l. s o*,ner oflh€ prcpcny. or ary cnployt6 Bnh s ar6 a their sole comrGarion. vill do lh. Nork and lfic slrucl@ G m! <br />lnrod.ri or ofised ,br sl. (56.7044. Bwinss ed Proasions Cod. Th. Co rlclols Licas Law do6 not ,0ply lo & oMa of <br />rh. FDpdy *ho tiik or nnpr.v6 tlsotr .nd who do6 such wo* hims.llor h.Mlf or lhoush hit or hd oM.mploy.6. <br />provid.d lhat such improvdd ft ftr inrdd.d 6r olla.d ao' sE I[ hotr6d. th. b{ir.]{B o. nrFovclmt is sll wnnin oft Fr <br />olco'npkion. lh€ O{rr Brildg $ill havc rh. hrdd orPIoviog rhd h. or sh. did nor hild or i,npmv. d. F!F1-r tor lh. purpo* ot <br />_l.6ovhdoarhc pror.ny. m .xcl8iv.ly conra.r i.E wnh lic*ed conrftciosro colnruclrh. pmj61(56 704,1. Bci.s <br />ad A!ftssin Cod.: l hc Cooldcroa, Liccns. Latr do6 nol apply lo e o* ncr o apoFny $ho builds or ihprov€s Ihson. <br />dd who enrdft ror su.h ptujds rvnh a Conhdo(s) li.m.d plRuml b $. ConrEclors l-iccr ti{) <br />I an.rdnfl undd sdion .lr. & P.(' lorrhis r.don <br />]!98{!8S-lA}!fEl64llOX <br />DECIA.8AIIQ! <br />I h6.by amm md6 pdahy of pdjury onc ot th. aollosios d4lr.lioE: <br />I hav. and will nai.t.in r Cdific.te ol Co6mr to S.ll-lNUr. for @rke4 omp.nerion, 6 prorid.d aor by Selion 1700 oflh. <br />Lahf Codq lor Oc pdfomdc. o ath. work for which th. pmil is issucd. <br />trU.una"itl.u.ru'n*o*c4conpcG.lFniBur.c.6r.quircdbySdrio.3700oath.L.b.rCod€.forlhcFforl1ecol <br />thc{orlf.rtrhichrhir!.mrrss.dVyso'rdtomnGal'.n'DudrrrmderlFrhrtnumb6d.' <br />._o, ald e-r\.1\c\i c (lc,^"t) {r.rs...*AiZtr z--zE r 8o I u \t'r (,r <br />_lc.nirylhatinlhepsiorrru..olrhcwortrorvhichrhispdnisissu.J.l3hallnoloployanyp.soniney6.d <br />$ 6 ro b..o,n. subjat to rhc q!rl6' ompqEalion lars ofcalifomia &d as@ rhd il I should h..om. sobjd to lh€ <br />sortEs comp€.srion provniod oasario.lT00 ofrh. tnbor codq I snall fonhwith comply rvnl rhos prulDioB. <br />IVARNiNG: Failur.lo suc vorkgl enDsslioa cov€Esc is unlasful. dd shall subjet m mplors lo sidinal FElti6 and <br />cilil fin.s up to onc hnf,dr.d thousd dollss ($100.000). in additioo lo lhc cosl of comp.Nrion, dmB86 6 provid.d for $c <br />slaltun.1076 olrh€ tihor code imdd md <br />o*.1o I Sor',.{Posl <br />DFCI,ARATION <br />I hs€by arm unds pcully of Fjury $ar I d li€nsal @dd Fovision of Chrlts 9 (ommdcing wnh Sdion 7000) oa Div6ion 3 <br />of th. Busins sd PmfsioN Codc ad my lic.E ir io lull ao(c ad df<l <br />(z-t (48 <br />o.,.,rr IZol rB .",,-[^Qrrrq dt cr$r.a-,t <br />caNirBl]cuaxtElD.llc-acllcy <br />I hqeby amm unda F.ahy ol psjury thal rhd. t a @6ttu.1ion h.din8 ag6cy for th. p6fomuc. oalh€ mrk aot *hich lhis Frnn i! <br />issu.d (Sd.3097, Civ. C.) <br />ATTI,ICANI.IECI,AEAIIO! <br />I halty atrm undd paahy ot pdjury on. oflh. followins dclaalions: <br />Dmolnio. Pmils-Ast<los Nolific,lion F.dml Resularions (Till€.40. Psn6) <br />R.qnir.d Ldid of Notific,lion <br />-l <br />c€nify rhar th. lcdcral rcsulalioN Esedins sb€sros rcmoral de nol arplicable lo rhis protdl <br />-l <br />cslify rhar I havc rad r his applicdion dd stare fiar $c ahore inlomlrion is codd. , asle lo co,nply rvilh all Cil r tnd Counlt <br />ordinanc6 od Stalc L.ws,ehtins ro buildinr consrrucrion. &d ho.byaurhon,r r.FMialiv6 oarhh City d Counly ro orr urs. thc <br />aborc,nmrioncd pmpdy for i <br />Appli.itrl or genl Signst <br />-(P6r-+ <br />\6 <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unrt <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL 21 /r/za."z */.r-) <br />Notes, Remarks, Etc <br />Pole Bases <br />L.ndd ! Ac&* <br />- <br />i <br />--------r------ <br />I