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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER EUII,DER DELCAR 'IION
<br />I h6cby amm und6 poahy ol pdju'r-l rhar I @ .rcmpl nom thc Cont6to6' Li.de Ij* aor ri. follo*iry ,.e. (sd 70ll 5
<br />Busin6s dd Pr6a6sio6 code): Any Cily or Couoty Nhich r<pn6 . p.nnir ro conslrucl. ah6. ioFove d.molish or Epair .ny
<br />tu.r@, prior to irs issnncc. so r.qun6 rh. appli.&l for sNh lEmil lo lil€ s sisn.d .ltrenot lhal he or sh€ is liccisdl pur$tnr
<br />Io rhc provisio.s of rhc Contactois Licensd Lsw (Chapiq 9. Coon.n.ins sirh Sstion 7000 of Division I oathc Dusin6s d
<br />Pmfrsions Cod.) or lhar h. or sh. is €rmpl ths€liom dd rh. t6!is fot lh. .ll.8.d cxml,ion Any liolation of Sdion 70ll 5 bv anv
<br />appli.afl aom p.mn strbjdsth€ applica toacivilpe.ahyolnor'norcrhmfivchundr.ddoll6($500).
<br />I. ar d{ne of rhe p,oFny. or my chpk'rs s'llh $a!6 6 rh.t $1. corposnion. Nill & lhc *od( ed th. stndue 5 nol
<br />imdial or oltdcd fo! sl. lS-.7044, a$i.B and Pmf6ioN Code 'tne Conta.lois LicG. l,tr do6 nol alply ro M o$d of
<br />rh€ pmrdy sho huilds or ihprcvB rhoon- ed who do6 sch trlrl hims.llor hmclfo! throush his or hd oMdnlloy6.
<br />prolided ihnr such iip.ovmrs & mt ir ad.d ff oltali [r slc I f. lros6d. rh. buildi4 or imlxolornl is sB wnhir one ta
<br />of&mddsn. rh. (r6d aor!]6 will h.!c !h. turdo oaFovinr lhal h. or shc did frn ttuild or imFor c lnc FDpdy lor th. p!.8'* of
<br />I. 6 .\,nd of lh. roFeny. am cxclusi\€ly conlracri.s wirh licm.d o mdoF to connrud lhe proj*l (Sd 7044. ttusmN
<br />d lYof.ssh Codc Thc C.nta.tri Li.c6s. Law do6 nor apply k' d oNn< o itropcn y \vno builds or inprorcs rhdmn.
<br />and $ho.omhdsaorsuchprojrIs\yilhaConr@to(rliceNdtu6udrtorhcCo'nracloisl.icoscti*).
<br />voBKEElIllMMNA-rl()r
<br />ll[c&Aaalll)I
<br />I n(cby affrm undq pcElryofpdjur_von.oflh€ follosin! d$lrarioB.
<br />Ihov. dvill mainlain a C.nincal. olconsot lo SclllBur€ lor*ork6 coEpnetion. s pmvid.d foi bySftlion 1700 ofth.
<br />Lrbor Code for rt p<lomecc oflhc rvott aor which rh. tonn n isu.d
<br />'(l havc md wiu nrainrai. { ork6 conpmsalion insuranc., 6 r.quii.d by Selion 1?OO o I lhc Labor Codc, for $. prfontroc. ol
<br />lhe ,r l lo, {h'cl- rh6 rnnir is isu&l V} \^rt6'comrNdt't n 'nsuan(.cnri6,"". q( $6;"1il -I*Ca^ra^tr- \,'*?"^f
<br />Pc,,.)N,nbd 'f1G oz 66'l!31 c J r )A?.D
<br />I cenil,irhar in lheperforman.eoflhcworl tor whichlhis pq'n is iss!.d,I shall not cmployanyp.6on in tnymanncr
<br />$ 6ro beonE 3ubjdt lo thc sortgs conpqsation lavs orCalifomi,, and aSre lhal ill should b..ome subjdt lo the
<br />Noll6 comnc.eriotr provisioB ofS..lion lT00oflhc litFr (nd.,l null fonhsith comply snh rhr$ pblisions.
<br />WARNINC f0ihrc ro ssurc $t\c's compmtrior .o!6age is trrla\lul. and shall lublNr an mployer 10 d'ninal t6.nia dd
<br />civil nn6 up lo on€ hundEd thousd doll6lll00.000), in addilion to co$ of compcnsarioa. damscs d ,iorid.d for thc
<br />S(tior 11076 olrhe llbor ('od{ inh6t md .lbm.r's fc
<br />'b?n
<br />DECIABAIIO!
<br />I heeby amrm ondd pfialry of rsjwy rhar I an licarsl udd Fovkio. olclRplgI (coin i.trS wnh Sdlion ?000) olDivis'on l
<br />ol lh. B6ins dd PEf6sios Cod€. drd ay li.ce B in tull for.. dd .II(l.
<br />l0 o
<br />c\l.Ltl2"2-^ ."",."",".K
<br />CONS'TRUC'NON T ENDING ACENCY
<br />I hd.by altrm ufld6 p€uhyolpdjurylh rhac i5 a conin.lion Lndins asocy lot rhc Faomdcc oalhcqorl lor \fti.b this lEmit ir
<br />islo.d (Sd .1097. Civ. C.)
<br />APPLICANT DECT-ARATTON
<br />I nolby afiim xndd pdahy ofpsjury on€ of$c fouowing deldrions:
<br />Dcdolition P.miB Asbdros Noti6c.l io. Fed60lReul.lions (rnb 40. Pd6)
<br />R.qoircd hts of Noli6@tion
<br />lc.rnayrhar rhcfcd.ralrelul.lioDs res{dina sbcslos rero\alrc iorrndicatle ro this pFjsl
<br />(r..',,r,,t .l I hiverad tht sppli.ari.n and$a.rhar1h.arsr.infonnarioniscorccr I asrd to compl! sith nll Cnyand County
<br />trde I a\srclilingn, bu,l ,n!md h.rcby.llhorize rcpr6or,riv6 ofthis (-nyrnd Counlyro.nrd uBr. rh.
<br />dr,'c 'nci,Nnc,r eoecdr rur msst'
<br />Appli.rnl or Agml Si*trrlure ./,,,", ull2'iryk t-r-Pem ir.e ninc {I,rlnr):
<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 />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Ivleter Release
<br />Rough
<br />Service Meter 1F|NAL 3/9/?4 -.D ?-r, / /
<br />Notes, Remark!, Etc. - f/"
<br />Under Slab / Floor
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