|
ELECTRICAL.INSPECTOR RECORD
<br />DATE IDiSIG.COMMENTS OWNER BUILDEIT DELCARATION
<br />I hdeby afi.m u.dd pdalr, ol pdlury rhar I @ q@pl Eonr rhc Conr.cros Lic.ns. La* lor lhe aollowins r.sn (S& 70l l 5
<br />BNinBs a.d Prolsion Cod.) Any Cily or Cou , which r.qune a psmn ro coNlrucl. ahs. improrc ddnolieh or r.pon uy
<br />stldsq rior ro irs isuoc.. al$ r€qun6 rhc applic r lor suc,r Fmit ro filc a sisn€d sraloc rhar hc or shc is lico$.d p$uut
<br />lo lhe prcvirions of lhe Conlrsclois Liccn*d ta{ (Ch,pra 9, Corm.d.ins *irh Sdlion 7000 of Division I oalhc BNin s &d
<br />Pof*ions Cod€) or thar hc or shc is ercmpl thsclio,n d th. b.ris for thc alhs.d €rnpliof,. Any\iohtiotrols.clion7011.5byany
<br />appli.ant aor a pmril 3ubjeh thc .ppli.a lo a civ il pcnalty of ior moE rh& Iive hddrcd dolla ($500).
<br />-1,
<br />6 oM.t oithc ,torEny, or oy .dplo'6 wilh {as6 6 rh€ir ele compc,slion. will do rhc woA &d lh. srruc1u. E rcl
<br />inrmd€d or orftd lor s.lc (Se.7044, Busin* md Pro lNiotu Cod. 1h. Conrracrois Llcos. tie do6 no' oDply ro o oNncr of
<br />rh. poldy who hil& or imrovB rra6n, ad *ho &E such st* hi'*.ll or hGlf or rhmuBh hi or h€r oM.nploy6.
<br />Drovided lhal such inprc\'ffils e ml inlo& or olTe.d lor eL lf. howd6. fi. buildiq or iqmr€mol is &ld * hhin on. y@
<br />ofohpldiol! de olmd Build6 will hrv. tlc het, oaFolins ['d h. or sh. drl mr hiild or ioproQ O. plDFIy aor t5. Brp.e of
<br />-1,6owncr
<br />ofrhc preps1y. m dclsiv.lyco racli"Bsirh licG.d contncroE lo coNtrucl lhc projrr (Sd. ?04,{, Buss6
<br />and P$faion Cod.r Th. Contraclois Li...sc Law do6 nor apply ro mownd olprop.ny sno bxilds or ihprovB thdotr,
<br />and sho conrBcls for such Fojcds {ith a CorrBcio(, ltdal puB@r to rh. Contrc.rois Lic@ Lav)
<br />I tuncrcnrpr unJ6 Ssrioi , R & P( (riht ros.n
<br />D.lc _ _ OrnE:
<br />woRKrRs, c(lnrPEiisATKN
<br />trtrcirABArla!
<br />I bocby alrtrm und6 poaityolFjuryon.oath. aollosi.s ddl*ado6:
<br />I h.vc rnd will maihrain r Cdinc.t. ofcosan lo s.lf-lcui. for rorkdr 6nrp.ns.lion, d provid.d for by S6lioD 1700 of th€
<br />t4or Codc, lor rhc pdfomd.. o I the rort for which th. pmil ie isu€d.
<br />56-r and will nainlain wo&.E compeNalior iNurance 6 rcquned by Sdion l?00 ohhc Labor Codc. lor lh. pdfo,r@.. of
<br />the wo,k lor which lhis pmit is isu.d. My erl.rs comp.tratio. iNuoc. crun6 trd policy nu'nbq &.
<br />A ?al z c-t
<br />(-2-o t-
<br />_1.€nifythal in lhe Ffom,nc. of rh.*o lor \ hich rhE Frmil 'r ssu.d- l sh,ll nor onploy any pd$n in sn, r ner
<br />s a to l,e.om. sbjdt io ih. Mlk6' comp.nsalioo l.ws of caliaomia. Md 4r thal il I should be.on'c bj*l lo lhe
<br />trortm.omp.nsalionprovisions.fSdtionlT00olrh.Ijborcode.rshall.aonhrvilhcomplywithlhosprovisrcns..
<br />\VARNINC: Flilur. kr Fcue qtrlcB .onpasaxon corcragc is unla$ful. d shallsuhj(r o qnplolt b oninal ptnrlri6 tu
<br />lo onc hundEtt lbous d dollm {5lO0.Ul0). i. addil i, d@as* a provid.d for $c
<br />Sation :1076 olth. l,bor Code id.r61 ad
<br />DECIdSAIIQ!
<br />I hd.by alIm unda F@hy ol pdjury rh.r I d liGs.d uodd Envision ol chat 16 9 (conm@i.g eih sdiotr 7000) oa Divnion I
<br />ol lhc Buils &d Pofsio6 Code, and Ey lic.N i! i. aull ao!.. ed cIIe(.
<br />*.',* .- 5'
<br />*", jlr
<br />clttlrL.u.l_LLtllltllQLJcr
<br />I hd.by.ITm ondq F.aIy of pdjury Oa rt@ i! a coGrtu 1ioo hndirg rgo.y aor tne pcfol]fuc oaln rcrt for phich lhis Fmil is
<br />isucd (Sd.1097. Civ. C.).
<br />ATEIII:AILIIES,AAAUA!
<br />I hqlt y rifm undd poalry of Fju.y on. of Oc lollowi.s dc.l&ationsl
<br />D.moliriotr P6niG-Asb6los Norificarion Fcd6.l R.,rulations (lirtc 40. Pa16)
<br />-R.quir€d
<br />ldlsolNoli6c{rion
<br />I cdify $ar fic la16.l rcgulaiirB eeedins dbcror rdorrl e nor rpplicabL b thG poj.l1,
<br />Lll -riry tU t t r". ,*a ,tu rpplicsrion md lhrc rhd ln abovc inaomaI0n iscotral.I agre ro comply wilh oll cilyand coury
<br />ordir.trcs tuld Shrc IjN rclar !cr.66ta1n 6 oi rhis Cil, ud Counr
<br />Oclz
<br />;;'7,""
<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 I "24-t YlSt)
<br />Egnding / Grounding / UFER l,/
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough),1-.lg u \q.1u
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough IL I t ct4fur^
<br />Service Meter l\\
<br />FINAL l-3s-t7 V;NLII)}VNotes, Remarks, Etc
<br />f Z.Y /t^l o{
<br />-+
<br />APPROVALS
<br />I
<br />ldo
<br />---T------
<br />I
|