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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DET-CARATION <br />I hd.by arm udB p6aky oI ldjury rhat I d qcnDt lrom $. Conttactou Lic.M t w ior th€ folloviq r.&n {Se.703 L5 <br />Ausin6s and Prolsioo Codc): Ad, Cily or Counry rhi.h rcqoir6 a Fmil lo olqruc1 als. inpov.. &inolilh o. i.r6t ey <br />srtuctu., prior 1o irs i!sumc., aho r.quir6 lh€ applicet for slch Fmil to liL a siSn d stalmal lhal he or sn€ is lic€.s.d p6uant <br />ro lhc Fovisiod ofrhc Con[&ror'. Lic..*d l,w (Ch.flo 9. Comcncins \ilh Setion 7000 olDivtion ] oarh. aosins md <br />Prcf.sions Cod.) or lhar he or sh€ i, €rmpl thrcfrom and lt€ b€iis ioi lh. all.rai .rdlFion. Any violalion ofS.clion ?011.5 by uy <br />applicafl for a p@il rubjers rh. oppli.dr to acivilpcn.hyoiml morc tne fivc hundrcd dolls ($500) <br />I. N owr ollhc Fo!.ny, or E, .hplorc with sag6 s lt n eL $mpas3lion, *ill do $c worl atxl llE dralu€ is nol <br />inrod.d or ofided fo' slc (Se.7044, B6i.e &d PlbrBios Cod.: Tnc Contraclor's Licft. Law do6 nol ttply to M oMc of <br />rh.pmrdly who britn or irlrov6 thq€n, ed lho do6 such mrl( hins.lr or h6s.lfor thmulh his or hB oM dnploy.6. <br />provid.d thar such ihpsr@nrs e mt inorH $ or6d for sl. It nosds. lh. buildine or irForddi ii $Ll *iLlM on. Jar <br />ofcompletD'! rhc O{rd Build{ wil ha!. dr hrd6 oaFoving lhol h€ or shc did rct huild or idFov. rh. pmFry lor th. pt Po* oa <br />I, s oM6 ofrh€ pmprry. m cxcluivcly cor Eclins wirh licos€d conrracrou to coNtucl lh. prcj..l (56. 70a4, BGin< <br />and EDfrsion Coder Th€ Contmcto.s Lic.e L.w do6 nor apply lo u o{na o f propdly who builds or imptuvB 1h66.. <br />and *ho conl.a.ts fo, suci trojccG with a Co.rrado(s) licasd puEuni lo lh. Conlracloas Li.d* t w). <br />-l <br />d ddp{ @d6 Sdiio. , B. & P.C. aor rhis r6on <br />Dtte: OMd: <br />]IOBKIEi.CAMfINTAIIAN <br />DECTdEAIIO! <br />I na.6y arm under Fmlty of pqjury onc of th€ lolloNing &.I&.rioB: <br />I hav. dd willinaimai. a Cdilicat. ofCoNa' ro S.lf-lNu!. tt'r *o116 compdsaliod. a Fovidcd for by S6tion 3?00 oalh€ <br />tabor Cod., aor in psfo,rMc. of&:; <br />for thc pdfonnoc. ofthe *ork lor whichlh. p€mi n Bu.d <br />will nai.taio workcB conp.sarion i6uran..,s r.quned bySalionl?oi)otlh. <br />which rhis p@nir ir Lsued My wor 16 comp.nsarion insuroc€ cui6 od Dolicy n <br />'V/F 60.ar a,t/t?tu1tu(U Q-Oqzl/ o6 3 //7D <br />t cdiry $ar in $. Ffomuc€ of thc vork for which lhis p.dil is i$ucd, I shtll mr any p€uon rn anym ncr <br />s 6 to b€.oh. subjel lo lhc ror(dj conp@lion laws oacaliaomia md asre lhEl it I should b.tom€ subjdl $ rhc <br />wo 6'conpljerio.provisiomoasaliof,lT00ofthcLaborCodolslEll ronhuih.onptr sitt' lhoF Pmvisiom. <br />hc Litnr Co{lc inrrsr and artrms\ Lcs <br />Xr". <br />,2, (y',/ t .,ctfromna,t <br />!!(r$-u_Qrtlltclaa <br />ulcLr&ulQr <br />I h@by afm !nd6 p.nally ol pstuy thot I m lic.ced unds pmvision ofchafld 9 (codno.inS wilh S.ction ?000) ol Division l <br />of rh. Busins md Proa6io6 Cod., dd my lictrc is in tull rotc arxl.lI.tl. <br />Xo"",u /rqf z 6,2 <br />I Zo L.)/ rt*lnPen 'lU <br />COIiIBIJCIIANITNDINIIEENCI <br />I h6cb,.fam! u.d.r poElty olp.lury Ihat lh4 ir a conslruclion lcndios asdcy aot rn pdfomMcc oathc vo,t for which lhis p6mil ir <br />issu.d (sd. 1007. civ c.). <br />rxndeis Addrss: - <br />affllcaxlDlcL aallar <br />I hqltyaffmundrpoalryolrrjury o..oarn aolloei,B ddldations <br />Ikmohion PmiteAsb6los Norificalion Fcddal R.gularion. (Tnl.40. Pd6) <br />-Requncd <br />Lalaof Norilicrio. <br />s moval -. nol applicnblc lo lhis prejdr <br />lbovciiiomarionis.ond lasreroco'nply{nhaUCiryardCoudry <br />n. ud hocby adhonz. r.rrcsrativ6 oadis city ed county to olc upo. Ihe <br />a apDlic6nl or As6r sign!(u..:L1-Zolr/ <br />Site-Work <br />Underqround <br />Pole Bases <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 Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Meter Release <br />Rouqh <br />Service It4eter <br />FINAL 3/3/?O <br />Notes, Remarks, Etc. <br />) <br />) <br />Rev. 08-07-2015 <br />WaRNING: I,ailurc ro su€ workrJ comrEtrlrion cor€6s. is unl,wtul. Md shall srbjal dnplorq lo qnnin.l peuhiG sd <br />civil fin6 up to onc hundrcd lhousd doll6 ($100,000), ii addnion to rhc cos of conp.Nlion. danas6 a povidcrt lor rh.