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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNf, R BUILDER DELCARATION <br />I h6ehy !flir6 u.dr Fn,lry of pdjury thol I m .xcmpl nonr lh. (.onkicto6' Liccns lr* for ih. lollovinB rwn (s4.70]1.5 <br />Busines and Prolsiotr Codc): Any City or Cou y whtrh rcqur6 a poni( ro consrrucr. ah6. 'mprorc. doolnh or rcpat ey <br />srrucrue prsrlo irs issuecc, alro r.qdiB rh. ,ppli.d lor tuchFf,nirto fil.s sEncdndsn rlharh.orifi.b1rc6s.{ puEuad <br />to th. pmvisioN ofrhe Conrracroa3 Li@n3.d liw (Chapt6 9. Cosmdcins \rith Sslion 7000 otDilisio. :l oflh. ausina md <br />Prorcsions Cod.) or lhal h! or sh. B crsF fis.from dd lh. basis aor thc all.r€d cr€mplio. A.y violario.ofsdion?0115 byaoy <br />amlic&r for a pcmil subjsB Ln applic l to o civil pdahy o a nol mor. th& liv. ht.drcd doll$ ($500) <br />-1, <br />6 osn€r oflh€ prep.ny. or my anployc shh \r+6 4 $en $le o'np€Ml ioo. will do lh. sor{ a.d th. nnrclu€ 6 nol <br />iddddl orolId.d a.r el. (Sa.7L'44, Busings d l\oisions Code Thc conttccloi s Licr.N kw doe not apply lo d ownd of <br />thept$psry rvho hrilds or itrwov6lh@l! ed who do6 su.h $ott hin*ll or fifi.llor rhoush hG or hd oM €nlPloy6. <br />prcvidcd rhat luch inForgMG tu mr i ardqi or oirded lor s61.. Il how66. lh€ htildi,s or ir+iovmdr is st wnhitr on. )€r <br />oacompLlion. lhe OM6 Build< MU h.v. dr hi'j6 or prorins $a he or st. did mt build o! impo. th. Iropely aoi 0. prpos of <br />l!aa&8Illa!88!raf!9x <br />oEcta&lIll)tr <br />I h6€by amrm und6 p€nahyoapdluryorcoarhc aollowin8 dsl&.tio$: <br />-l <br />ha\caadwnlMi rjn a Cfiin.ate of co6d lo S.lalNurc lor $o.k6a .onrp€.!ario., a3 provid.d lor by Salio, 1700 of rh. <br />hbor Cod.. lor lhe pglolrMc. of rh. *!r( for which lh. pahn ! iss!€d. <br />-l h,!. &d will ,nai.tai. worksr co'npcGatioa insuronce. s r€quncd hy sdr ion :r 700 oarh. kbor Cod€- io, rhc poiom&.. ol <br />rh. sork aor which rhis pmit is isucd. My wdrkeB compsMlion i6ur4.. .mia &d polic, numbs 6e: <br />)lI cErify rhar inrh. pglormanc.olrhc wort ior whichlhis p.mir is issu.d. I shallnor cmployany F6on in any muod'$ 6 ro b.ron $bjer ro rh. woll6' onposlion la$ of Califomia. ud a{c rhar il I should lEom. subjal lo lh. <br />wolt6 comre.erion provisioG ofSe.lion 1700oflhc l,bor Codc I shall. aonhwitb comPly wnh tho$ provisionr. <br />WARNINCT Failurc lo suc Lvo*6 Nmp@rion .ovdas. is unlasful. d shall suhj(r & dplors ro nin nal Pdahi6 and <br />cilil nn€s up ro onc hutujred rhousdd doll6 (S100.0o0), in lddiion lo lhe co$ of cooFMlior <br />sdi.n 10,6 ollhc tibor ( b'le rnrd6l dL,anornE r16 <br />d7snNdatuthc <br />""...- t//i, t/ t s <br />PICLiliuX}n <br />/-*I hcr€try aflim und6 p.lahy ol pdjdry rhar I m licdts l und6 provision ot ChaplE <br />oa rhc Busin6 and lrclsiore Codc. dd dy lrcds. is in full lorce and cfidr <br />in8 snh Sdnrn 7000) of Division l <br />C-lu,Q<r31d <br />tt/o/ /1! ".*."..2i ')-? /1<Z77 <br />CONiIaUcIItllENUriCrIC[NcI <br />I n€Eb, affmn ul'ds p.na]ty of psjury thal lhs. ir a connruclion lading a86cy for lh. Ffot]mcc oi lb. srl for shich tnis panit ir <br />issu.d (Se. 1097. Ci!. C.) <br />A'ILICANLDICI.A8AIIO! <br />I hody alrm unds pdahy of tajury o.coarh. aollo*ing ddledions <br />D.molilion PmtriG-Asb6tos Nolificarion F.d@l R.gll,lio (Tnh40. Pan6) <br />-Requt.d <br />lrldof Notifi dioo <br />-l <br />c6lit 0lar rhc fcddal rclulatioB rcgardins 6b6tos @ovd tre nol arpl@ble to lhis pmi4t <br />Q4 .ditl thst fiN.pd $is applicsrion dd srar€ rhar $c abovc nfondion s codd. I a8re ro onply s'llh all Cxy md county <br />ordin.rcG sd Sr.t. Laws Elarins ro buildins coisltu.rio( e9-!4.b, alrhou. rcprMr.r 'v6 or lhE Cty ud Counry ro and lpon fi€ <br />rb.ve nHrion.d grop€ny lor iNr(lion pqrc6 <br />!.\ftlic. r o. Agt lSiE ilr.r ),(. <br />a?C* 1/tka <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 t/.u-tg _)--6lnQ ) <br />Transformers <br />Torqueing <br />Air Conditioners <br />Roof Top Equrpment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />lvleter Release /t-7n-/8 ..Ua!olor v0 <br />Rough //-?n-16 ,D.(,J-o ,:.ca <br />Service [t/eter /L7,o-lr..U.G4af 'ro <br />FINAL /-8 - /?/Jc (*P--ry\ <br />Notes, Remarks, Etc. <br />-+ <br />COMMENTS <br />Sub-Panels <br />l. s owM orlh. Fopsry. m dd*ivcly .oouaclirg {ih lica*n co.lr.cioB ro codttucr rhc prcj.d (S*. 7044. B{siB <br />and hlt sir codc: Th. co.lrrdols LiclM kw do6 ror apply lo u ownd of propdy who bnilde ot inprcvd lhd@., <br />and who odrracls for such prDjds wnh a Co.lEclo(s) lica*d p6u. rc th. Conlrrcld.s Lic.e bw). <br />lmcxmot mdq S6lon .a &PC forrhsr6"n. <br />Drt€: Orn.r: <br />\* <br />tt