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ELECTRICAL.INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OW\ER BT ILDER DEL( ARATIOT <br />I hrcby alfim unds pmalrr ot pstury rhd I m c\enpr Eom tb. Conlracloc' Lic.ns. La$ for lh. aolloRine r@n (Sec 7031.5 <br />Businds tnd Proreiln Cod.): An) C(' or Counry vhict r.9ut6 a Fnnh to .on(dcl, .1t6, inpro!., &mlisn or r.pai! ey <br />$rudu., prior <br />'o <br />irs Gue... also requiB Lh. rppli(d for su.h Fdnn kr nE 6 sirn.d $acodt rh,l h. o. shc u li..ns.d p6u&l <br />ro rh. Fo\isio ol rk Cotrt..ror s Licn!.d Ljw rchaptq 9. Co'nmdcins $ilh S.clion 7000 of Division I ofthc Bsincs &d <br />Pro tNiotrr Codc) or <br />'har <br />h. or sh. is .\mptlha.from dd lhc bas$ lor rh. .llcs.d c\mption. Any liolarion of S..rion ?0.t I 5 by oy <br />tppl(anrforap<flntrsJbrtrcrhcapfhcorroa!ivilp.Mhlofnormorrhsn\.hdndrcddoh6l$ruu)V,i |!r. * """. .r, r'. p-p.n). o, mr onployc s irh { arc d rh.n $t conFd"rarion. will do rh. work md rh. $ruclw b mr <br />inrnd.d or o rT6ed lor elc I Sc 7044, tsB'ns dd Prea6sioN Cod.: nE confuloa s Lice b* doe not 8r,ply Io e owna of <br />rh.prlpcny who hrilds or improvE thoaq ard who do6 suct Nlt himscllor hc6€lror lhough hb orh6o*n cmploycs. <br />provid.d rld soch iDFo€mrs e. @r i.rodol or oltqld lor sle.ll ho*d6- rh. buikiing or imlroGcin is eld rithin on. )@ <br />ofconDt lion.lhcOMd guilda vill ha\.lh. Utrd.o ofFo\ing thal h. or sn did iol blild or idpmvc 6c potcl! lor $. purporoi <br />_ldnr\.nrpr unds secrrcn_, tl &P( inihisrcdotr <br />(,"" ll -rq- \ I J**^{\/dD\rotr(tts, (oNtPENsAl]()N <br />!EeL!aar!a! <br />I hscbyamrnr und6 pdally olpsjuryonc olrhe follo\rio8 delarariofls <br />-l <br />hatc ed will Dainrain a Ccnific.rcoacoNor lo Selr-lNxr. for uo st conrp.n,ation, a pmvid.dforbySdion1700olrhc <br />Labor Code aor rh. p6fomec. oflh. sort for shi.h th. p<ht ir tsued. <br />I have and will mainlain s ork.ra co,npens.tion imrance. 6 requi.d by S(t ion 1700 of thc kbor Cod€. for rh. pqaom&ce ot <br />thc r ork lo, *hich lhis p.flnir is ilsued My wor[.8' comp€nelion iN!,mc€ csiq md policy .udbr ac: <br />-t! cdri rhd m rh. |{yhro!. or,h. tr^rr for shtr h rhis Ddmn b i$ual. I shall nor drploy an, !$$n in any mend <br />dr sto bec"m. sJbi6! b lh. tr 0116' comFnsr ion iiu{ofr'alfomi0. Md +E rhar irl 'hould b(.m. 'Lbjd o <br />'h.vort6' conp.nsalio" provisions of Sdiotr l?00 oflhc lrbor Cod.. I slEll, fodhrnh conply wirh thok pmvisions.. <br />WARITNC F ihr. to sa. korl6' conpcnetio. ovdasc i! unla\tu|- dd shall3ubj<{ & mplord ro anniml Fuhi6 dd <br />civil fn* up ro on nu.dred thoGmd dolls ($100.000). in addirion ro the co$ oa conp.@riod. da@a6 a povid.d aor rh. <br />serion:1076olrhe Ilt[rcode. inrcrsl dd arohe.- ! 16 vw <br />KD.., t\-tq- \g 16 4 <br />I |( t,tNst:t) ( ()N rRi( r{rR <br />DECI.AAAIION <br />I hftby arm und6 p60lty of pdjury lhal I e licosd urds rmvbion of (napl6 9 (co, nocingwilhS.dion?000)oIDivision3 <br />ot th. BosiB md PmfBioB Codi ed my lic.ffi ir in tull lore od clt<r. <br />LiccN CIN <br />-Lic.N <br />Numbcr <br />Drt. conr .tor: <br />coxtrBltcllo!-tElDMlcElsr <br />I nd.by aitum undr p.nalty ot pcrjury thal lhqc is a codtuctiod Lndirg ag6cy for lt pqfo,rmcc ollhc wort lor shi.h lhd pdmn b <br />issu.d (S( 1097, Civ C.). <br />af[r,lcaNr.lEcla8.euo! <br />lhdlbyammundd porhy ofpdjury onc ofth. follo*ing deldalions: <br />Dmolilion Pdils'Asb6ros Noxficarion FGd@l R.sulalions (Tirle 40. Pd6) <br />R.quncd Ldl6 of Nodicaio. <br />, <br />-l <br />cdiry lh.l the lcdsal rqubl ioN resddin8 sbGtos rooval de nol applicablc lo lhis prcjd <br />1{,.-rr,no, , nu,.,*0,nts appL(ar'on dd 3rdcrhar th. abovc infomdion is cod..r.I asE ro conpl, $irh all city md cou.ry <br />od.nc6rdSra'ek*srlnin€lobu,ldin8co6rruclion.ddhd€byaurhonz€r€pr66rariv6olrt'isC'tyddCou.tylodrsuroorh. <br />Site-Work <br />Unde rg rou nd <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Si gns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communicatrons Cable <br />Building <br />Under Slab / Floor <br />€onding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Roof To p Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilrngs (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />FINAL ,*ts q \rAcl <br />Notes, Remarks Etc <br />V <br />) <br />\ <br />APPROVALS <br />Air Conditioners <br />Service Meter A\ <br />_1.6o{erofrh€ rropqry. mdclsivcly conrraclins wilh licNd conrracloGro consrrucr thc rrojd (S*.7044. B6in6 <br />{d ft!ftsbn Cod.: ThcConlraclois Li..M La$ do6 no' lpplrro Mosi6ofpiop.nywho huilds or inpo!6 lhE6..and \rho &6'6cl3 fd ech Foj..rs with a ConrEcror(s) licosd punuui ro IhcConrracrois Licmc La*). <br />.L,S A g A z&," tr- t{-\8