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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.GOMMENTS OMd-Buildd Dc.lerion <br />I hdcby aflim undo p@alty ofp.rjury lhal I u.xdpt aom thc Co.lr&lon Liensc lrp fo. thc follo{itg Bo G4.7031.5 Businss <br />od Prcl6sid Codc): Any Ciry o Comty which EqdB ! p.mn ro consEuc! alt6, imprcv.. d.oolirh or rcpan ay ttuctur., pric to its <br />i$,ec., also rcqut6 rh. $plicer lor soct pcmir ro fiI. a sisn.d nat€mdt rhar hc 6 sh. ii li@s.d pu6nMr io rh. ,.ovniom of th€ <br />Contradols Licdscd Law (Chapd 9, Cmmocine *irh Saion 7000 of Division t of ttu Buind &d Prcfdions Cod.) or 6al hc d <br />sh. is .xmpl th.Elrom dd rh. b6is fc lh. allcscd cx.mplion .Any viola{on of Sccri@ 703 I s by @y applicmt fo a p.mn subj*l3 rhc <br />appliml ro . civil P.nalty of not m@ the 6v. fiundrcd doll6 (StOo) <br />_I, q ownd of rnc Fopdry, or hy cmployd qirt w.a6 s thct solc @trlpcniltion, will do rhc vo* Md th. idcr@ ir nor inrod.d <br />or ofiad f8 sal. ( Se.?044, BuBinds dd Prcf.$ionr Cod.: T}. ConE&rd's Licdlc La* doq nor .pply to s ownd of lh. pop.rry <br />who brild! or imFov6 d@on, ed who d€ such wort hitu.lf or nddf or thrcu8h hil d hd owr mployB, prcvid.d lnd 3uch <br />improvhdts dc not inbd.d or offn d fd srlc If, h@cv6. rhc buildi.g d imprcvn .t it sld vilhin d. y.d oa compl.t@. rhc <br />OMa-Builds will h!v. th. burdm of proving lhar h. 6 ihc .o1 build or iop*ov. fo. rh. purpsc oa s.i.) <br />l. a owoaof ln. proFny, m.r.l6iv.ly conhring with liccns.ddhcroB t onsdd fi. p(ojd ( S.c ?044, Bsine &d <br />Prcfdid Cod. Th. Conretdt Lien* llw d.€ not.pply ro d own.r ofFopdty who buil& tr inprovB rha.on , ud wlo <br />conkou for such Drojcts with a coE clo(s) Ii6s.d puEur ro rhc coDEacrors Li@nsc Law ) <br />_l m.x6pr udd S@ri6 .B &PC ftr tht (aon <br />WORI<ERS COMPENSATION DECLARATION <br />! hd.by amm undr p.nal9 6f p.rjury on. ofrn. followin8 d.cldrio,3 <br />I haec md eill maintrin . Carifid| of Conr.r ro S.lf lnrur. for work R omp..satim, a prcvid.d ld by SEtion 3700 of6. <br />L:bor Cod., ts thc F.fl],r@cc ol thc wdt fo rhich thc pcmn is isu.d <br />_l hav. bdwillmainlain wstc6 cmpcmation insurucc, 6 rcquircd by Sction 3700 ol lhc Lsbor Codc, for $c paf(mr.. of i,!c <br />wort for whi€h this pmit is issu.d My wort6' cmp.N.tio insurucc tria ud policy nunbd &c: <br />nor b. ompl.r.d if (h. pmn k aor On. hun&.d doll6 {J l00l or 16, <br />lbc p6foi1]Bc. of thc work fc which rhis pcmn h issucd,I <br />b<dc subjei io rh. sorlcs ' @mpchrati@ laqs of C.l ifomi{ ed aer.. thar <br />compas.rion proaisios of S6tio r?0o oithr Labor Cod., I shall, fonn <br />/Go b <br />WARNING Failw ro s6uE wort6 comFsti@ @va.g. is .mployd ro aiminal po.l <br />fi.6 np ro on. hmdr.d tno6od dolld (t I00,0m),in addnio ro lhc cGt oa cm <br />thc Labor Codc. inrcrdl ed .tlm.yis fc6 <br />&mag6 d prcvid.d for rh. selio.10?6 of <br />I-I('l-ISED CO\I'RA( IORS DECI,ARATIo\ <br />I hdcby amm mdd p.nahy of pdjury $al I m li.as.d undd prcvisio of Chapld 9 <br />$. B6iner ed Profari@ Cod., ad my lic6s. is in aull lqcc ud dr€cr <br />-n -ol, <br />I h@by .fim und.. pa.lly of pdjury th{ dE ii a @strlcti@ I <br />isucd(Scc a0e7, Civ. C) <br />.eocy for th. p.rfme.. oa ln. wot fd *hich lhis D.mn is <br />APTLICANTTS DECI,ARATION <br />D.moliliM P.mi|'-AsbdG Norifiarin F.{t rdl R.aul.lids Gnlq 40, Pd 6) <br />_ RcquiEd kt6 of Notificltid <br />d. f.daal !.8ulations !.8rding ab6l6 r.noval rc iot appl <br />t thst I havc rcad thh applicarion ed sBt thar lhc abov. in <br />ordindcA dd Stllc La*s r.laring lo burldinS conirructid, d ty and County lo dtd upon thc <br />sbov. hcntion.d prcp.ny for insrqion pu.p66 4-(41 <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 />Communicalions Cable <br />Bu ilding <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 E,!1ETT I tl.lr <br />Rough EFR. I 2ntq <br />Service Meter <br />FINAL ,}llvl\, O-+J. Zs u, cco, 66/ <br />Notes, Remarks, Etc. <br />APPROVALS <br />Lada 3 Ad&B <br />f------T------