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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS O\I1\ ER BU II,DDR DELCARATTON <br />I h@by alTm undd pouly of p€rjury lhat I at crmpl frod lh. Conlrrclors Licosc tlw fo, $. lollowin8 ffin {Sd.?ol l.l <br />B6irs ed A'oa6sion Code): Any Cily oi Con , khich rcquird a p€rnil to coBrru.r, alld. inprov.. do.olth o' rcpat dy <br />slrucruo FBr ro ils isuMc., rlso r.qunB lh. aPplica,l lor such pcrni t6 nl. t 3[n€d sl.lmdl thal hc o, sn. b lico!.d pm@l <br />h rh. provisions of rh€ Conr.,clofs Licensd tls (Chaprd 9, Cormcncins with Setion 7000 of Divbion I ollh. Baincs ed <br />Prcf6sions Codc) or rhar h. or sh. i! .r@P th6.6om ed th. b6is for lhc alkgcd d@piio.. Ary viohlion ofsdbo 703 I 5 6y my <br />applic&t for a p.tril subjeb the applicet lo a civ il pcflally of not mor. lhd nv. hun&.d dolles 1t500). <br />l. 6 orws olrhc propeny. or my .nployd wilh w.86 s lh.n eE conpdsaion, sill do th. *ort ed lhe srnr1@ i! ml <br />iirddaj orolr6.d aorele(Se.7044. Ausins ud FroadioN Co{t Tnc cDnlracloi s Lic€e ttw do6 .or .pply to dn owE ol <br />rhc pNlEly q'ho builds or i6ptuv6 fidotr di who do6 such srt hi'.self or h@lf or thrcush iG or hd oM dnplov.6. <br />polid.d rhal such iDpr.tlMb d mr i dxLd or oif6td tot eb. l[ no\d6. rh. t ildins or mp.ovmt a $U wnhinon.,a <br />of.onqrldion. rhc Owncr lloiE6 Bill harc ftc hrda ofrovi.s thrl hc ot sh€ did nol hlild or irpor. rh. proFty for fi. pupo* of <br />-1. <br />a own6 oath. propGty, m .rclBiv.ly co aclins wnb ltoe.d codncloE lo codtucr th. F.rdt (Sa. ?04r, BdDe <br />d ttolGsir Cod.: Thc cont clol s Li..m. L.w do6 not apply lo d ownd oaprcp€ly who builds or ioprorc th6on. <br />and wno oDlds ior sut pmjds*ilh o Codnclo(s) licar.d Puuuanl tolht Conrtdols Licw t w) <br />_l &n cranF unds Ssr <br />1!ORt(DfI' (]OMPENSATION <br />DEC!A!AIj()! <br />I hcrcby.iIn. undq p.n.ltyof pqjuJyoncof rh. aollo*ins decldations <br />lhav€mdsillmainrenaColialar.olcoBmrtosclt-lnsur€lorqvlers'conrP.nsolion,6prelid.dforhyseclionlT00oatlE <br />hbor ( od.. for rfic pqfomdc. otlh€ \ oii for sii.h lh€ !o,nn ie isucd. <br />I havc and uill mainrain solt.rr comp.Narion iNurance, 6 r.quned by sdrion 1701) of rn. l,abor Cod., fot thc p<fom ceof <br />tlrc $ork ror \shi.h this pdnn is i$ucd My worlat comFNlio. i6!rdc. cei6 ud policy nurbq a. <br />S lalz ;.Alr3, <br />-l <br />cenify Oar in lh. p.rlom c€ ollhc work lor rvhich lhis pd( i3 tss*d. I shall nol .hploy dy p6on in anv m4ne <br />$ sto b..om. bjd lo lhc wo.t6 @'nposdio. h{.ofcalifomi!. md asr thd ial snouB h{ome subjd to th. <br />work6 @mp.rsslion ptuisaoB olsdlioh 3700 oflh. bbor Code I shlll fonhwith comply wilh lhos pevilioB <br />WARNING: Failor.lo su. wo oa compd&rion cov@g. is xnlawtul. sd slsll subjd m dployd lo dioin l dElri6 dd <br />civil linB up ro onc hun&€d lhoMd doll6 (t100.000). i. .ddnion lo lhc cos of .ompft{ion. damsd d provil.l f.r th. <br />Scdnn 1076 ofrn. Lab.r code. <br />urt;ts-ur_(oft&l(jaaD[rl,^8rua! <br />I haeby aflrm und6 D..ahy ot paiury rhn I m li.as.d und6 Fovision ofchdpld 9 (comacins wilh S..lio. ?0o0) of Division ] <br />oa th. BEin6 &d Pot6io6 Cod.. dd my licm. is in tull forcc dd €il€cl <br />4 c o 4r)-#J <br />c*"*..s{ -+' <br />CoNSTRUCTION I iNnltlc ACENCY <br />I heby srm uodn pnully o f Fju.y lh.l lhm b a onslNdbn knrir.s agdcy aor lh€ pqloftdc. ollhc $o* tot shich lhil,orir i5 <br />issu.d (S.c. 1097. Civ. C ) <br />Af,IIICANTDICIA8AIIOIi <br />I lElt! arm unds pc,Ally of Ftut! o.c olthc follosin8 dEldalnrns: <br />D.nolilion Pqnirs'Asb6tos Norifi .dion F€d6al Re8uldions (Till€ 40. Pano) <br />-ltaluned <br />I.ller orNotindion <br />I .6tify lnar th. a.ddal resulatioB Egedin! 6b€ros ranoldl de nol applicabL to lhis prcjai <br />-l <br />c.nifo rhar I hrvc red rhis apDlic6tion &d arclh ln€ 6b.v. inlomalion is coned I agE to conply $ih all Cty and Countv <br />ordi,&c6 md Sral. ljss Ehrins ro blildidg cotrnrud ion. e'd t<cby adbortc rcFc9l.lir6 of lhis Cily dd Couni, io 616 u?on fi€ <br />abole NLltrioncd propcny lor i6p*ri6n !ur!.s6 <br />ADDli.inl or,\scnl Sisaalure <br />f{-lr(,r r(t.i,rll, X &4t /-o- <br />? <br />Site-Work rUnderground <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 / Groundino / UFER 1L-n4A,4€-2-) <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 />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release "a/o.4 s ,r#s <br />Rough <br />Service It4eter 'Z,/ap 4 r tt)6{ -FINAL t L ,(,(/(rs. <br />Notes, Remarks, Etc I <br />-/7-tc d.. \rj,e _ <br />L.ndc''s Addr s: <br />- <br />=t-