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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS Own.rBuil&r Deldarid <br />I heby afiim und.r p.nalry of pdjnry lhat I d cxdpt fom th. Conrr.cloB' Liensc ljw for thc lollo{in8 Eso, (s.c.701 I 5 Bsinds <br />Md Prol6ion Co&): Any Ciry or Coury which EquiB , D.mn b corfuc! altd. improvc, dcmolhh or rcpair &y shdu., Fiq ro 16 <br />nsuec., al$ r.qutd fi. appli@r ts sucn Fmn lo filc a sig.cd nalodl $ar hc or sh. is licfiscd puBuet lo $. rrovkiMr ot iic <br />Cd|r&lofs Licded La* (Ch.fld 9, C.mmddng with Sccrion 7000 of Division I of rh! Bui.63 d Profc$io.s Cod.) or da h. d <br />sh. is cx.mpl th6.from snd d. b6is ad ih. .ll.!.d .xcnplion Any violadon of S4id 701 I 5 by .ny applicel ftr a p.ftir subj.cr th. <br />rpplidnr ro a.ivil p.nalry ofnd md. ihd fiv. hlndr.d doll6 (1500) <br />_1. a omd or thc pro9.rty, d my cmployg with wa86 6 dcir rclc .ompcn$rion. *ill do th. sork dd 0r srlct@ is f,ol inradcd <br />o ofi6.d fd sal. ( s.c 70,&r. Buha tud PDt$ions Cod. Th. CdEtoas Li.ai. Llw dc nor apply !o u oMd of rh. prorc.ry <br />who builds or imlfovg thcr.o, dd who dG such pork hircclf d h6.lf or rhrcu8i his or hr N. @ployc, p.ovid.d rhar snch <br />improlddt a. not intcndcd d off"ad ld salc li how€vq, th. building tr improv.mdt is sold wirhi. o.. y@ of compldro, U! <br />OMq-Buildcr will hav. lhc burda of proving th.l h. o. sh. nol build or impovc for $c puQdc of sal.) <br />_1, a own.r oa d. prcp.rty, m qclaiycly @nr&tins wnh li.as.d cohr&rm b cd$!d rhc !rcjat ( Sc 7044, Bsin6r dd <br />Prcfesion Coda Thc Conr&ior! Lic.e Ilw doe nol apply b M omd ot prcpary who buildi d imprord 6qen . Md who <br />cdtr&E for such prcjccrs virh . c6rr&to(, limed puBuor 10 thc cor&lort Liccnsc Lav ) <br />I m cxchpr ud.r Secion B &PC rdrhis@on <br />WORXERS COMPENSATION DECLAITATION <br />I hcrcby alfim undrpaairy ofpdjlry on. ofthc follNing dccl 6lids <br />I ha!. dd will mainhin a Ccnjfiqtc of Cms..l ro S.lfin$r. aor work.6' compc.ratioo, 6 plvidcd ror by S@rion 3700 ol rhc <br />Labor Codc, fd rhr p.n{mdc. of dc woi{ fo which th. p.mn is issued <br />I hav. od *ill hainlain wqk.E' cmFnstion insumcc, s r.quircd by Setion l70o ol rh. Labor Codc, fd lhc pdfmdc. of lh. <br />wdk for *hich this prhit is isucd My vorkm cmp.roation insurme ffia ad polic, nunb.r &c: <br />Policy Nonb.r Erpn6: <br />(Tht s.criot nccd nol b. compld.d if th. p.mit h for On! hu.d,.d doll6 ll l00l or 16) <br />I c.niry thal in ltc p6f(mecc of rhc work ao which lhi pmit is htucd I shallnot mploy ey p.rson in dy ndncrso s to <br />b€cs. subj.d lo th. wor6 ' @Fr6i o la* of Califomia, od a8rc. lha if I should b..m. subjer to thc wskcc <br />comp.nsalion prcvisions ol S.clion 3700 of th. L.bd Co<L, I shall, fonh*ith comply vith th$c provtions . <br />on", *'-.21 ,./.. e/ eppricar I . <br />WARNING Failurc |o !(urc *o.kcB' @mp.nsarion covdlga is unlawful. sd shall subj.cl & cmploycr to diminsl Fnalrics &dcivil <br />nn6 up to onc huodrcd l])ocdd doll6 (l100,000),in lddidob ro $. ccr of mmp.oraton. ddag6 d provid.d for Ih. Serid 3076 ot <br />thc Labor Cod., inl.6t dd dtm.y s 16 <br />LICENSED CONTRACTORS DECLARATION <br />I hdcby aliim undd p..rlty ofpcrjur, 1har I d lic6s.d und.r pmtisim of Chryi.r 9 (connaci.s with Sfttion ?000) of Dilisiofl 3 of <br />thc BGinas Md Prof6ions Codc, dd my lica* is if, aull a@. dd.f.ct <br />CONSTRUCTION LENDING AGANCY <br />I h@by dEm un.ld Fnahy.fp4rury $.1the b. @ trucdo t.ndinS lgacy ftr tnc,qfol@cc of $. wqi ftr which rhb pcmn i3 <br />isu.d (s.c. 3097, civ. c.) <br />alrllcAtrtitDEcldaarroN <br />D@olido. Pmnr-Asb6tc Notific ie F.d.nl R.Sdations (Tidc 40. Pfi 6) <br />_ RcquiEd L.nr oaNoiificldon <br />_l ertify lha! thc t d.El rcBulrtims rcBudirS Bberos rcmov6l dc not applicabl. b $is proj@t <br />_ I cdil, that I havc rcad tht apglic.lior d sdc thd lh. abovc infod.rion is cdcct I aslE ro comply whh all Cily ad Cou.ry <br />ordinuc6edStat Lavr ..l.ring ro building cdsrrucrio., md ha.b, .ulnoriz. EpBdradv6 ol $is Ciry ud Co@ty lo cntq rpoi orc <br />abovc ncolioncd prop.ny ftr insp.ciio. purrcd <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 & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough EATIlal =L' <br />Service Meter FFhal an {n <br />FINAL rEtJ u <br />SAMC 8-43, 290, 556. 667Notes, Remarks, Etc. <br />L.nC.ls ACdrN