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ELECTRICAL{NSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Ownd-Buildlr D.cl@lio
<br />I h.Eby allim und.r pallry ofpqjurr rhal I m.rmpt fom ilc Co.lrrcros Li€nsc Lw aor rhc aollowinS rcao. G€.7031.5 Bu!i.s5
<br />rnd Pmfdio Cod4 Any City or C@my which r.quir6 6 ,cmil ro costru.t. ak.r, impov., d.molish or r.plir uy str!.trE. lfid ro iB
<br />ksuuc., ilso r.quir6 thc lppli@r id slch Fmi to fi1. . sign.d rtllft rhat h. d rh. t licds€d puRuet lo thc provisio$ ol$.
<br />C@ll.adois Lt.N.d L5w (chapts 9, conm.ncins with scclion 7000 ofDivision I olfic Busio$ dd PrcfGsions Codc) or thlt h. d
<br />shc is .xcmpl rhdclrm dd th. bsi! fo rh. .ll.8cd .r.nprio. A.yviolalio. of S.cion 70lr.5byey applidl lor. pcmil subj@u thc
<br />.!pli6t ro.civilpnahy ofnot moE th fivc hun&cd dou6 (t500)
<br />I.a o$cr oafic propcrry, or hy.mployas wilh wagcs d lhcirsolc cohpc aion, *ill do thc work dd rh. snacruc h nol inkndcd
<br />or oiIftd ad s.1. ( S.c ?0.4, Busirs ed ProiNions Cod. Tnc CotBctor's Li@. L:w docs nor apply lo ,n o*n.r of rh. prcpcny
<br />who builds or improvd lh@on. ad vho do.s slch vork hr@clro, h6.lf or through his or h.. ovn.mploycd, providrd thar such
<br />ioprovco.nrs r. not ihldd.d or.fldcd for sal. If, how.vd,lh. buildin8 or improvcmcnl is lold wittii onc ycarofconpl.non, rhc
<br />O*n.rBuildawillh.v.th.bud.nolprovinslhdh.orshcnorbuildorimprov.forttcpurpos.ofsalc)
<br />_1, a ow.cr of tG proFriy, ffi .,.lBiv.ly contudng *nh lic.ns.d co"lmcron to co.slrud rh. projEt ( S4. ?044, B6in6s ed
<br />Plof*ion Codcr Th! Cmr&rci r Li@ns. kw dG ror .!ply ro e ownr of propqry who builds or iEprcv., !hu.o , Dd who
<br />com.B for such pmj4t' with a coir'&ro(, li@$.! pu@dr ro rh. confactor' Lien!. L5w )
<br />_l m cxcmpt undd S.ction _,8 & P C. fo rhir G6o.
<br />WOR(ERS COMPENSATION DiCLARATION
<br />I h.reby aafift undcr p.nalty of Frjury on. of lh. followinS delutioE
<br />I h.vc ed willmaint.ji. C.nifi€arc ofCons..t ro S.lanslr. foreork.ls mplnsalion,6 pEvidcd for by S.clion 3700 of$c
<br />L.bor Codc, for th. p.rf@dcc ofth. woIk lorvhich thc Fmil is iisucd
<br />_l havc dd rill mainhi. wdtc6' compcnsarion insurdcc, a rcqutcd by S.crion 37O0oath. Labor Codc, for th. pcrfmec. olfi.
<br />work forwhich rhh pmir t issucd My vorlcE' comp.osalion insurancc cdnd dd policy rumb.r a'!
<br />PolicyNuhba: EIPi6
<br />lThis s.crion n..d norb.compl.t.d if $.p.mn k for On. hlndr.d dolle 1ll0o) orl
<br />24'r, nn -.r. o-" *,.or$.ro,k lor wh\h ths Fm tEsu.d,I
<br />b{ffi? rubj.d to $. wo .E comp.n$tio l.ws olcallmrL Md asr rhar
<br />compcns.tion provhions olS.crion 1700of rhe Lrbor Co<t, I rhall,
<br />) -'2-s-
<br />WARNING Failurc io saur. workrE comp.nsalion covcrag..cl.n.mploy.r ro qnminal plnaldcs ed crril
<br />lin6 up to o.c hundr.d iiosed dolls (l 100,000).in .ddiim lo
<br />thc Labor Codc, int.Er ud alromcyt fG.
<br />damaE6 6 provid.d for th. S.clion 3076 of
<br />I h.r.by ltlm und.rp..ally ofp.!uryrhar I m lic.ns.d ond.r provision oiChaBd 9
<br />$. Buiin6s &d Proicio.i Codc, ud my lic.nr is ii rullforc. aod.ffcc!
<br />I hd.by afiim und<r p.n.lty of pslur, tur rh6c ii . .oi5rtu.d6
<br />isucd (Scc.1097, Civ. C).
<br />APPLICA]YTIS DECLAR,ATION
<br />Ddolirioo Pmil5-Asb6r6 Noificarion F.dcr.l R.8uhi6t (Tidc a0, P.n 6)
<br />_ R.quiEd L.n.r oaNotifddon
<br />_lc.ni9Ad ttc rcdsrl,qul os Esed,ns
<br />!41ry,hd I hr'.Gad'nr rpDli.rion hd to cmply wnh Ciry -d Couniy
<br />ordiiecG dd Sl'l. Las! rclalis to buil of !hi5 Ciiy dd Counry lo .nrd lpon rht
<br />abo!. mcntion.d !rop.d, fd in+.crion
<br />o6
<br />Site-Work
<br />Underground
<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 />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Sofflt Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />EJ(FfEr ri
<br />Rough
<br />Service Meter Fe.E = I i '0t9
<br />FINAL (fl 0"4s. zqn ,
<br />Notes, Remarks, Etc.
<br />knd.l! Addr6s: _
<br />tl
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