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ELECTRICAL-INSPECTOR RECORD IDiSIG.COMMENTS Own.FBuildo D.cle.tion I hcrcby afiim undcr porlt, oapdj!ry tha! I m d@p( fom rh. Conl&rm' Liccns. Law for rhc lolloqing..son (kc 7031 5 Burin6s 6d Prof6sion Codd Any Cit, or Counry which r.quiG . p.mil lo .onsruc! ahd, imprcv., doolish or rcpat rny srrucrur.. pnor ro rri i53!&c., llso r.qut6 thc appli@nr ior su€h pqmit ro filc a risn.! srarcmdt th hc or sh. is liccns.d puBudrtolh.provisionrof!h. Coitaddt Liccmcd Llw (Chapd9, Commc.cing wnh S.crion 7000 ofDieirion I oftc Blsines sd Ptoi6s,on! Cod.) or ar hc or rhc is cxchpr lhdcflom d thc b6*lhl allcs.d cxcmplion Any viol,rion orScdion 70ll 5 by m, appli.ul lor. p6n subjeB rh. applicanr lo a civil p.n.lry of nd thm fivc hun&.d dollds (1500) , dny coploycd wiln was6 d lh.irrol. cmp.nsation. wrll do th. worl ad rh. rttucrE. rs oot inrcndol ?04!, B6in6 ed Proa6io.5 Cod.: Th. Coihcror'r LieN. L.w aG trd .pply .o u ovn.r of thc Fop.ny daon, ud who &.s sEh *o.k hiNclf d hoclf d thrcugh his orfi6 @n.mployr6, Fovid.d lhar such nradcd or of.r.d for sal. Ii howcvd, lh. buildins or improv.mot is $ld within onc yd of c6pl.!o, th. will h.vc thc burdd oa prcvinS lhar fi. or sh. nor build or improv. for tu purposc ofs!lc) d o*nr of in. prop.ny, m .x.lqiv.ly .onE&rine wnh lic.ns.d co.rdo6 to coisttud $. prcjat ( Sa '70!,1, Buins ed ission Code Thc Con!'&toir Licms. L.* d6 ior .pply ro & owi, of prcpriy who buil& or inprovB dd@n , hd who conracB aor such pmj.ci' with r Co.LEro(t li@scd ro $c CoirB.toar Licchrc Law ) It I h.rcby affim undcr pdalty ofFrjury @c I havc dd will m.inrain a Ccnifidc ol Coiscir ro s.ll-ln!ur. for sod.6' compcnseti@, B rrolidcd for by sarion lT00 ofrhc Labor Codc, for lh. Frfomecc of lh. work ior *fiich lnc p.mil is ilsucd _l hav. md willm.inrain wo*.6 @mpasation iaurdc., a r.quir.d by S.clion 3700.i th. L.bor Co.L, ao, thc p.rfom&cc ot rh. *ork lor wnlch lhis pmir ir ilsu.d My wo*!ri' comFsitio i.lurDcc cai.r Dd policy numb.r acl iot bc cooplctcd ilihc lamir is for oi. huidrcd dolla {t100} or 16s) iry that in lhc pcrfomacc oilhc *ork for which rhn ir issucd,I sh.llnotcmploy uy pcEon in lny m.M.r!oa to bnd. subj@( (o $. worl6 ' c@paiation laws of Cali foh, S.cion3700ofrh. Labor WARNNG Failur.lo sccurcvorkcB sholl subjccl M .hployd to qiminal p.n.1ti6 ed civil ,i.6 up lo onc hundr.d lhoGnd dona (l l0O,O00),in lddnio to 0E cGt of @mp.is{ion, (llma!6 s prcvid.d for rhc Setion 3076 of lhc Labor Codc, inrd6r ud lnom.y's f6. UCEISED.CqNIMCIAB&DICIA lq! t h.rcby.inm unddFndry ofpajury ddI m licccd uid6povi6im of Chlprd 9 (cmmdciie wnh Sc.lioi 7000) of Divirio I ot thc Businst ud Plof6ioN Co.l., d hy liccne ir in full forcc Md.il6t Cqd9IBIC1|IOU,EEDIXC.ACIICI I hd.bt amm undr p.n.lty of p.rj!r, $al thft ii . consEu.rion lodiDs rsocy rd 0E lqfcl@a of rh. sdt lor *hi.h $ir p.mn i3 i*ucd (S*. 1097, Civ. C.). APPLICANT'S DECLARATIOI! D.nolitioi Pcmils-Asbets Norillcaiion F.d.r.l Rcgulations (Tnlc 40, P5n 6) _ Rlqut d L.n.! of Nolifi6li@ _l cqliay that th. a.doal rcsddins 6bsts Enovd u. nor applicabl. torhis proj.ct calion d starc thar rh. .hov. inlom.tion i5 6rer I agrc. ro conply wirh all Ciry and Counry auihorizc ,@r6c arive oflhis City ed Cluty io cntcr upon rh. q.lru loa I Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service Meter FINAL 6its/ar J '-2.""2 ,_6/r;"Jrh4 Z;r"CZ.,a Notes, Remarks, Etc 1-od ) APPROVALS DATE Sub-Panels Md 6Er. rhar ifl should Lic.nr. CIa _Licdc Numbd_ D{. _ClnEctor