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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hs.by amm undd po ty ofp€iury rhd I d.&mfl tom thc Conlmdou Lic€N L€w lorlh. followinS r€&. (Sd 7031.5 <br />Ausin6s and Pr.fsion Cod.): Any Ciry or Counry $hich r.qut6 a Dqnit lo coNlrud. ahs. nnlno!., dmlish or qlir my <br />srtucrue, Fior ro irs isu c.. also Equt6lh€ applicful lor slch Fmi ro 61. a s8ncd staloncnt lhal h. or shc is licga.d tusulr! <br />lo lhe provisioN olrh. Contractors Li.cnscd Lrw {Chapls I, Com,nencins wilh Sdion 7000 olDivisio.I olttc Busi.N md <br />Ptu rc;iois C.d.) or rh, h. or sh. b .r.npl ih6.iiom e; lhe bass lor rhe Etlcrcd dmr{ion. Any viohlioD of Sd ion 7()l 1 5 by oy' <br />applicant for a p6En subj(B rhc appli.d to acililpemhyofrcl morc lhu tivc hu.dicd doll4(1500). <br />l. 6 ow€r oi the propcny, or hy mplorB wilh $a!6 d lh.t sle comp€.slion, will do drc work and Uc nrudrc is nor <br />inlov:l€d or o!I6€d for sa]c (56 7044, Busine dd Prclsiore codq ]'hc Conlmclori l-i.sc Lr* .106 nor +Ply ro d oMo ol <br />rh. Dmp6'y who boil& or inprcrGlh@n. ad *ho dod su.h *!rt himFlf or n6clf ot thoush h's or hd om mPlor6. <br />prcliddl rh,t such imFovms 6c mr i qdsl or onsed ror et lr, ho6G, rh. htilding or inprcvmt is sB wnhin one ,a <br />ol conDl€lion. rhc Ownd Buildd will hav. rhc bdd6 oaFuin8 lhrl h. or ehc dij ml hrild or iqrov€ lhc p,opcly lor rhc FtrFos of <br />k*,olrheptp..ry.aflerclusirclyco,acrins{irhlicd*d.ont..routoco$ltucllh.p.ojecllSE.7044.&ains <br />Codc lheConrr0ctois l-icensc l.aw do6 nor aptlyro dosnd olpropglywho builds or improvcslhoon. <br />and Uho conrracrs aor su.h projfik sith a contmdo,l, licm$d pUBU I lo the Codracroas Li.dse ljs) <br />DECI.ASAIIQ! <br />I hqcby afiiiln undcr p.nah, of pdjury...of rhe followinB dcclaratioN <br />Ihav.ddwillroi a'n a Cdificale ofcoMr ro sclfin$rc aor rorlss comp.rod ion. d Fovid.d ior by Setion l?00 oarh. <br />t tor Code. lor th. Flolr@cc of rh. woik aor wnich fi. pemit is isucd. <br />I havc .nd will ,mi.tain wolkc6 comp€malion iNUEncq 6 requn.d Uy s.ciion 1700 of thc Labo! Code, for lh. pdfomd.. of <br />Ihc {ork fo! shich lhis p.mrit is is6u€d. My work6 codp.tuarion n6ure.. cnia and !.licy nlmbd ac: <br />-l <br />calirylll.l in rl& D6lor6anc. of lh. work lor vhich this pdml h nsucd, I shill nol @ploy any p.uon in my nmB <br />$ d lo b.conE subjNl ro lhs work6s' comp€nslion laws ot Calilooia. dd agrec $d if I snouH b€com€ subjd to lhc <br />work6'comF6alionForisioEols.dionlT00olrh.tiborCod..lstBll,lodhsthcomplysithlhorprcv6ioN <br />W RNING: Failurc ro secu. sork6'comp€ssalion olmrc ir unls*ful, md shall subjccl olFlolt to siminal i8dli6 od <br />ciril lin6 up to on. hundred lhousd doll6 ($100,000), in lddnion to <br />'hc <br />cosl ofcompc6alioo. d.ia!.s 6 p{ovid€d for rh. <br />sarion 1076.frh.l.alnrCodc i.ttrsi url dromv s <br />[&claBAua! <br />I heby afim lhds paalry o f pdjury tnal I dn liccrccd undB FnvGio. olch.pld 9 (comoci,8 wnh Salion ?000) of Divirion 3 <br />ol rhc Busine md Proleio.s Cod., ed my licm. is itr tull forc. ald effd <br />ATTIICAIII.DICLAAAIIA! <br />I ha*y afrnn und.r paslty ot p.rjury on. oflh. lollo*ios dcle.tiobsl <br />Dmolilio. P.miteAsb6tN Nolificorion l'cdsal R.sular ioB ( ritl. 40. Pd6) <br />Rcqun.d L4uo ol Norifi..rio. <br />_l cdify rhar thc acd60l r.sulalioN r.gdding dbBtos r@oval e. no! rppli.able lo thie poj€.1. <br />L-Erdiry rh6r I h!,. @d Oi. applicarion md srar. thar thc abovc inromrioo G corer I alrd to comply w h all c'ry aod county <br />ordinm.6 od SI.rc Ijws Elalins ro buildins co.$ru.ii6a dd nd.b, a!$onrc rcpr6dlaliv6 oflhis Cily ed Couty lo 6lr ulon rfic <br />abo\c cnlionsl prcpcny for '-*, , br/.ou <br />Site-Work <br />Underground <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor-- <br />Bondinq / G-roundinq) UFER Vzz,4)fZc zt ) <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Condltioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rough <br />Service Meter Z/zt/z o I?L Z', <br />FINAL A/z z-Utvr't 'zjt r4O <br />Notes, Remarks, Etc <br />Rev. 08-07-2015 <br />I n ex€n,Dr un,t6 S rin <br />o"" r r/3 / /cu 'o <br />L(.cc Nmb.r <br />qOIEIBIJCIIAIIIINDITC.AC.EICI <br />I hd.by amrm und€r p.nalry olpsjury rhar Ihft is a .on$rucrio! lddlng r8.ncy lor lh. psfomdcc ofthc Md( tor s'hich lhis pabir i3 <br />i$ucd (sc 1097. Ci!. C.). <br />t nd6 s Ndrc. <br />L6dd s AddrBs: <br />-