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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARAArcN
<br />I hdcby afrrm undd paalty oa pdjury lhal I m cx.mpt fion $c Clmra.tou Li.ft. La{ ior thc follopins r.&n (56.701 I 5
<br />Businss and Profsion Codcj: Any Cily or Coufly which rcqut6 a p.fln lo cons:lrucl, al6, inprolc, d@o[.n or RTan dy
<br />srru.ruc rrio. ro its issuMc€. also r.qukB rh. arplic r for su.h Frmn o 6L . signcd stdmdt th3l hc or slt b li...s.d pcual
<br />to th. prcvisions ot lh. Conlraclois Liccnsed taw (ChaPrd 9, Com,ncncins wilh Sdlio. 7000 of Dirisio. I of thc Busin* ed
<br />Prcf*iotu Cod.) or rlrar ,E or sh. ie dmfl thq.fion ed th. bsis ror lhc allcsal .xmplion. Any violalionofSe.lhn 7031.5 by any
<br />applicanl lorapmn subi€tsrhe arnlicaorio.cililpenallyol.olmorcth fivc hundr.d dolld ($500).
<br />l. 6 omq olrhe popcdy. or ny cdplolrd wnh raB6 6 th€i sle onpqsation. eill do rhe wo* md ihc ('uctw is aot
<br />i.led.d or o ff6c{t aor sl. (s-.?o44, Brsi66 Md &of6iod Code Thc Conrdor's LicN Law do6 nol apply lo d oMd oa
<br />th. pmpsly vho boilds 6r imFo6 thd6n, and who do6 sch Nrt hiN.lf or hmlf or rlmuBh his or hs oq dployc6,
<br />provid.d rh such inrproEmls e ml inlqdcd or oll6.d rot st I( howd6. thc h]ildins or impmv@nl b $ld wirhin on )a
<br />ofcomplciion. rhc O"rs Aui[:!E vill har $. hndo ofFovin8 ti, hc or shc did ml h{ild or iapolc lhc pNFry aor th. purpoE oa
<br />I, s ow,s ofrhcprcp€ny, m er.lusiltlycontfri.S wilh licded conlElo6 to @nslrucl lhc Projar (S( 70,14. B6ins
<br />ed Foa6sion Cod€: Thc Contrador's Li.c6. ttw do6 nol lpply lo d ownd olprcpdy sho boilds or inprovd lhdon,
<br />a.d sho conracrs rm such prcjcds wnh a conrE.lo(, Iictu.d p6@r ro fi. co.rEcrors Licc@ kw).
<br />-l
<br />@.x.mpt uhdd S.dion-, B. & P.C. for rhis l.Mn
<br />Ornd:__
<br />WORKERS' COIIIPENSATION
<br />D[Ctd8AIlOd
<br />I nd.by ailrm undq p.nflhyolp6juryonc ollhc follosing dddalio6:
<br />I hav. and will mimain 0 C€nific.lc of Consnr ro Sellldlc lor work6 @,npNlion. s pDvided ior by Sdion 3700 of rh.
<br />Lrbor Cod., for rfic p6lomMc. ollh. wort for {hi.h lhc pdnl n ias!.d.
<br />ft r,.'" -a *irr oaine i, *ort6 .o6p.Ntio. isu'mcc. s r.qun.d by s<rio.37Oo orrhe L.bor codc, ior rhc psrolr@cc ot
<br />lhe sork tuwhEh tnB Fnnil is issucd MysoAcs .onpms.lion in!!arcccuE dd !.li.y numbc dc:
<br />,,,,,,., AWJ"V I cotn ?o(| (-.v1wLsol uor3 ozo
<br />I cdify thar in inc psaommc. olrhc rork for whi.h lhis pdnir is issued. I nrllnol mployeyD6on in y mmn6
<br />$ s lo b.comc subjed to rh. work6 compmalion laws ol Califomia. das@lhar ill should h.comc slbjtrt loth€
<br />woi(s @npds io. pmvisioB of Scclion lT00 otlhc titrr Codc l shall. aonhwnh comPly silh lhos ptovbions
<br />WARNINC: Failu.. ro suc *0116 conp4ation .ovdrs. is unlawful. ad shrrl subjd m mPlortr lo oiminal pqEhi6 d
<br />cnll fincs up t, onc hundtu{ rh.used
<br />lnl^.\ftaffiR \croi f Iv-
<br />I hercb, aflinn ndcr pqahyo|prju.ylh.l I an licaEcl Md.r Fovisior olchapld 9 (ehndci.8 wiln s.{ion 7000) ofDivision 3
<br />of lhc Busin6s od Pmi*ioN Codc, ad oy Ii.@ is in tull forc. ed €fI61
<br />Cl'e qA47<1q"
<br />tlt?lt,Yt-o c..,.,"'"', Vtv\Nf SoLa(z
<br />caNilaucuoN.trlpllc_acllcl
<br />I hscby rmrm und6 ,.naly o f psjury thal $dc i! a @dtu.liod Lndins lsdcy lor lhc Frollmc. of rh. wotk for Ehicn $is pdlDit G
<br />isslcd (SL\ 1097. Civ. ( ).
<br />I cdif, rhd rh. Ld6al r.gulalioN r.Bardins db6ros r@oval d. tur applicablc ro this poj€1.
<br />U.{rd ify that t havc @d rhis applicarion dd sl!l. rhar $. at ve infonnalioo is cordr.I.stdio complyPnh.U Cilyand Counly
<br />.rdnmnc* md Statc liws relariry ro buildinr ofthis Cnyond Connlyro 6t6 upon lhc
<br />abouc flrmrioned propely lor
<br /> ppli.{Dl or AEetrl Signdur.
<br />+-r\
<br />1lr+luta
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Bu ilding
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter t J /
<br />FINAL //.</> ),C rHeb,t'
<br />Notes, Remarks,'Etcl
<br />Rev.08-07-2015
<br />DATE
<br />s<rion :1076 olrbc bbor Codc- inls6l ed auomy s 16.
<br />*,", t Il]lzPza
<br />ATIIICANLDESASAIIAN
<br />I h6tby a]Im undq pdally olp€.juy o.. of rhc followi.S dele.tions:
<br />Doiolirio. P@ns^sb€tos Norificrtior F.dml Rcsularions (Tirl. 40. Pan6)
<br />-R.quircd
<br />t,lr6 olNolifi calion
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