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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Omc.Euildq Dlcl4tio
<br />I hftby rfiim undd padty ofpsjur, r,\8t I m.xmfl fm rh. Cont6cro6 Lic.ns. L3w for th. followin8 Eson GE.?03L5 Bqin*
<br />..d Prcf6im Cod4 Any Cit, or Colnry which aqlird . p.mit ro conrtrucl, .lk, improvq dmolish o, rcAai. ey rtacl@, D.id !o il!
<br />iss@cc, ilro r.quir6 $. .pplic.nt for 5!cn p.mi ro fiI. c li8f,.n slatcm€nr lh.t hc or shc t liccnscd pu6(dr to l,). Fovisio$ ol fic
<br />Conlrelort Licdscd L.e (Ch.ptcr 9, ComDocio8 with S.dio. 7000 oi Division I ol thc BuritrG! ud Prcfgsios Cod4 or $st h. q
<br />sh. is dmpr $.Efrm ud 6. &li3 fd ln. all.Scd dcnprion Any viola on of S* on 703 I J by uy .pplimt for . pdirir tubj.ct Uc
<br />agpli@r lo a ciril p.halty of f,ot mm th& fivc hun&.d .lolla (t500)
<br />_I, d ownd of rhc propdt , d ny cmplores wiri wag6 a thct solc .omp.mrion, will do ln€ work ud lhc slruclu. is nor irto&dq oifaA id $1. ( S.c ?0a4, Busin@ ed Prof*iod Codc Thc Corua.to.'! Licos. trs doa n.n aDply lo u omcr of $. propcn,
<br />who huil.I! or imprcvB tt.@n, dd who dos sah work him.lf or h6clf o. through his d h.r wn @ploy.6, prcvidcd d.tsu.h
<br />improv.ho6 rc.ot iorod.d or ofIdd fd r.l. l( how.va, rh. buildinS or improvm.nr i5 $ld wilhin orc y@ of conpl.n@. $.
<br />ovn*Builds *ill h!!c th. bu.d.n ol provin8 tut h. o sh. ror build or improv. for $c purpsc or elc).
<br />_1,6 own.rof$c p'op.ny, e dclBtcly coit'&rins qith lic.nscd @nra.tos to c@rEud $c proj.d ( Sa 70.&, Bcind ud
<br />Profqsion Cod.r Thc Corn&rort Li@nsc Lle d6 nor +ply to e oMa of propd'ry vho buil& 6 inprcve drdtu , 6d who
<br />onEacB ror such proj.d! wirh a cdlIeb{, Iicd.d puBuer to thc conmcror's Lictu. Law )
<br />_l m .r.mp1 und.r Salio
<br />IOBKE8'COMIENSAII9NIEELAEdUqN
<br />I h.r.by lffim undc! p.nalty oi!.rjury on. oflhc followins dccld6lions
<br />I hav. Md will rainlain . CdifiBic oi Cons.nr b S.lf-lnsur. ior work.E' comp€nsatid, 6 providcd for by SEti@ 3100 ol$c
<br />Labo! Cod., forln. pcrfm cc ofdtwort fo!which thcp.mit is issu.d.
<br />_! hav. ud uill nrinrain wdt6i @mpoaation iNudcci a lcquircd by Sccrio. l?00 of thc L.bor Con., for $c pcraomec. of rh.
<br />work lor which this pnnir i! h:ucd My wdl.R'c6pcros1id insurd@@ir ed policy iumbci d.
<br />Poli.y Nlmbd: i Erpic
<br />#d;ior b..onpld.d ift\c pdnn is for Oic hu.&cd dollc {1100) or 16,
<br />lnc pcrfm ccoalhcNo* fq which rhis lcmnlh. work6 ' .ompdiaiion lsws ofcalifomi!, ed
<br />L.bor Codc, I shall, lonnwilh
<br />WARNNG !n cmploYd lo cnminal pc..l
<br />fin6 !p ro on. hundrld thouted dolld (3100,000),in .ddido.
<br />rhc Lrbor Codc, ior.cr &d !nom.r'i f.d.
<br />dmag6 6 provid.d lor thr S.ctio.10?6 ol
<br />LICf \SED CONTRACTORS DECL,\IIATION
<br />I hcr.by amm undcr p.nalry of p.rlury thal I m lictrsd und.r prcvision ofchap'cr9(in8 wnh Scc'ion ?000) of
<br />thc Busi!6s d Prol65ios Cod., dd ny I is in full i(re.nd.lI@1.
<br />lhal lhd. t a conslruction p.rfoma.c. ofthc e6k ld which rhi5 pcmt it
<br />tsud (S.c. 3097, Civ C.)
<br />A.EIUCAII]iDEELAAAI]ON
<br />Dcmoltion P.mirs Asb.$os Notification Fcd@l R.sulalions (Tnlc,lO, Pan 6)
<br />Rcquir.d Lcn.r of Notiliqtion
<br />I ascc rocorply wilh all Ciry ud County
<br />abovc m.nlioncd propcny r* inspcclion purposG
<br />0
<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 />N/eter Release
<br />r!
<br />Rough
<br />Service Meter EF l-.l201!
<br />Notes, Remarks, Etc.liAM(J 0-.4J, 4VU, p00, OO/
<br />Ldde s Add,sFINAL
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