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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hs.by rmm un.td l)6alry ol pdjury rh,l I m .xmq 6on rlE Cor racro6' Lic.ns. Lrw for lh. lollowing r€i$n (Sd.7Ol , .5 <br />Busin6s md Pmfsion Codc): Any City or Counly which requnB a lFdir lo cocrtud. ah6, imprcE .lsmolish or rqoir ony <br />srruclue. prio! to irs isuuce, aL,o rcqun6 rhc appli.dl lor su.h psmn ro fi1. a sisncd stardnot $ar h. or srE i! li.sMn Pumet <br />ro the provirions of th. Contrarioas Lic.n3ed L!{ (Chapl.r 9, ComencinB $ith sdrion ?000 of Division I ollh€ BsiN dd <br />Proac$ions Cod.) or thar h. or shc is er.hp lhd.fiom d$cbsis lor lh€ alles€d donflion Anyliolaiionofscliotr70ll5byany <br />applica aor a pmit subjsts thc applicant lo acivilp€aahyofnol rh,elhd fiv. hund..d dollds($500). <br />-1. <br />s o$rd olthc pmp.ny. o ny mplolc lnh wr86 6 thct slc comp.traion. {ill &, rk *oil( md E iddurc is ml <br />i dded or ofircd aor slc (Sa 7041. B6ios ed P,ol*ioG Cod. Th. conirlctoi s Licmc L,w do6 nor ap!|, o an ownd ol <br />rhe lmpdly {ho hi ds or inpro!6 don. ed wh. do6 such s.k hios.lf or h@lf or thmush his or hq oo emplor.6. <br />p,olid€d thar such improvoE.rs a. @r ir6!!d or orald fo, ek.I[ ho$d6. thc hliHin8 or iq,ovcMt is ek*nhinoi. ]a <br />of conpldiorl $. OMo B{ild.r will ha!. lh. buda ofFovinB thd h. o! sh. did nol build or inlrot tic porfiy for th. purpoF of <br />-1. <br />somdoarh.Fop€iy, m.xclusiv.l, contr.cline rvith licmed codracloBto odtud $€ projel (Sc. ?044, aBi.e <br />and holissir Co.tc: Thc conr$d6a3 Li.c6. t!* do6 ool ,rlply ro d ownd o lpro!.rly vho builds or iiprovcs lhdon. <br />dd who comnc'ts aor srch ptuj.ds wnh a Co mdo(r licds.d puBunl blhc Cotutdols Lic.M kw). <br />I aneremfl undd s(rion .lt & PC rrth" 16$r <br />WORKER,S' CO]IIPIiNSATION <br />o&ct Mrra! <br />I h6.by amm undd pdalry oi Fjury one oathc aollosing d(ldalio.s: <br />I hsv. and will m.intah a Cqlificatc of Co6ar ro S.lr ltuue lor pork.c @mpenerion. 6 provided lor by Sdlion 1700 of th. <br />tibor Code aor lhc p6fomoc. olth. m* for which lhc pmn b isudi. <br />I harc and will mainlain work.rs' .onpc6arion isud.., s r.quncd by Sd ion 3 700 oalh. Laht Cod€. lor th. Flommc ot <br />3t- t1 <br />-l.cnirylhat <br />in theDdtood.cof$c worl for whi.h lhir pd,trit is issucd, I shau not €dplor.nt pden in any meno <br />$ 6 lo b.on. subjdl to thc wort6' ompaEaliofl lavs otcalifomia. ed taE rh,t if I should baomc subjdt lo $c <br />sork6'compeqrionpovisiocolsdlionlT00oflhcLaborCd..l3hall.fonhsthcomply$'nhlhosptoYisioft. <br />WARNINCT Failurc lo s6c {ork6 .onpcnerion .ovdaqc is rnlarvaul, md shall $bj(r u 6rlo)tr 10 diminol FEltid sd <br />civil fin6 up ro onc huu&.d rh.u.dd dolls ($100,000). in .ddnion ro th. cosl of co6!.Bation. dm.86 6 Providcd for lh. <br />Serion 1076oflh€ Lrbor Cod.. inrsGl ud rnom.yt t6. <br />(",,",rt-tq-rG <br />DESJAAIIAT <br />I h@by amm unds p.tuhy of pdjlry dal I @ li...!.d u.do !.olision olchaptg 9 (condtuin8 wilh S6lio. ?000) of Division l <br />oa lhc Bcios sd Pm l6io6 Cod.. a.d fty lk.B G in lull ao.c. ed.itel. <br />('*. <br />\"" <br />B ?t5oto <br />Lt'tf-t€c""r*a,..A*: <br />colsraj]cuo!.tlNDlNc.AcEdlr <br />I hcrcby .Iljm un<td p.nally o f r.glry rh6t the is r coNrruction kndiflB ascncy fo, $c pdfom@. of th. work lor $rtich lhis poni b <br />isu.d (Sa. 309?. Civ. C.). <br />AII TCANLDECIAAAUAN <br />I holby afEn !.dr p.flohy of Frjuryon. ofthc followins d(lmlions: <br />Dmolilio. Pcmil3 asbdlos Norili.alion F.dnal R.Snlalioa (Tiil.40. P.n6) <br />R.quncd krrd orNori6cdian <br />-l <br />cdify that rhe f€dcral rcsulatioB resadins dLBros .qnoval dc nor .pplic.6L lo rhii prqd. <br />-l <br />c6lii, IhaI I ha!€ cad rhi! rppli.arion ad rlal. lhd ih. obov. inaomrlion is corsr. I agrd lo co'nply wiln all Cny and Counly <br />ordinancs d'd Sral€ Llws ehlins lo building .onntudion. and hd.by aulho ze rEr6€r dn 6 oflhis Cily ed Coumy lo cnts upon lh. <br />abov.,ndtio..d pmp.ny for iNp.clion pupos <br />hpprkonr or.rsor sisnar <br />V,^r** "to""t 4tcLz. - / taoh{'C/cone <br />- )1-D <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 />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar RouOh) <br />Itleter Release <br />Rouqh <br />Service [Vleter <br />FINAL / / /z?ll { --&4) <br />Notes, Remarks, Etc /(,,/ <br />N <br />wc 337-.t24 <br />T <br />-------T_----- <br />--t_- <br />I