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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTS OI!NEII BT]ILDER DI't,CARATION <br />I hs€by amrm trnds n€nalty ol ndiury thal I 6 €x.mpl 6om rhe Co.badoE' Li.e$c I-t$ for fic aollowins rasn (Sc ?011.5 <br />Busi.6s ed P,orci{ioi Cod.) Any Cir, oi Coudy $hi.h rcqtrns a pdmn Io consttuct. ahd. inplo\t. &ool$h or r+it oy <br />sltudurc, pmr <br />'o <br />ils isuanc€, also.€qon6 the applicml lor such p€mil lo filea sign.d{.lmor rhal h.ot &\. is licosed pusuMl <br />ro lh€ F.visio.s of rlE Contraclo.s t,ic.ns.d lju (Chopld 9. Commcncins *nh sdlio. 7000 of Dirisiof, I oaihc a$ines &d <br />Prof.seions Codr) or thar hc or sh. n crc'npt thq.6om and rhc basis lor Oc aller.d .rmprio. An, violation oas.cli]o 7031.5 byany <br />applicanrlorap.,nnsubj.*rh.applicaorloacivilp.nalryofnorno,erlffli!€hun&.ddoll s{$500) <br />l. 6 owasoalh.prop€ny. or my cmployG {irh s.ss as thor $lccoDtd$rion, $ill do th. $ort dd lhc slndu€ b rcr <br />inrodol or ollded lor ele (se rcq4. ausinBs Md Pro&ssioN code 11l. ('onlractois Licdsc l{w dos nol apply ro d omE of <br />rhcpFpdy who h{ildc or imprcvB lhdon. Md who do6 srn Eodi iimscll or hdwll or lhio+h his or hd ow. .mFlo}.6. <br />pftrvid.d rhai su.h impr.lhmrs o. rot ir oldcd or o'rqo.l lor slc. lt, horv6'q- tne bt'ilding o, irFovoEd E $ld wnhin on. ) d <br />ol.onpldion. rh. Ownr BrUs $ill lh. fi. hrrd6 .f Eoi.s rh, h. or sh. did nol hild or imprc\! thc FoFly flr rhc purpos or <br />l. N ownd oalhetnoreny. am.rclusirclyconr,acrirs snh licenscd conrmdo6lo comlrucl rhc rfrj<t (S( 7044, ausins <br />and rrlfBthn Codc: lheConrracrois l-ic€nseL.rvdo6 nor applrro an 0\16 olpropcrlt who btrildsor improrcslhseon. <br />.nd sho .onrads lor sxch prcj s tr nh 3 Conlrach(s) licsed pursurnt to rh€ Contraclois l-icdc Law) <br />I &n cxemfl rndd Sdiot <br />!!)4l(!:as:(aut!!sA-ra.r <br />DEClA&Illq! <br />I ho.by amn u.de poalty olD6i'rryon. ollhc follotriu d(ldalios: <br />I harc snd \vill mri.rain a Cslific.i. ot Co.ml ro Self-lNurc lor rvorkC .onpdstion. a Fovid.d aor by Sdion 1700 of lh. <br />tibor Cod., aor $. pafomec. o f th. woll aor *hich th. panir b issued. <br />ill have .nd will maiiraii work6 comp.Narion n6u!amc. s rcqut.d by serion 3700 of rh. Llbor Cod.. for rh. p6fomnc. of <br />ihc work for vhich lhis p.mn is isu.rl. My vork6 co'npsation iGurdcc carid tnd policy .ombd de: <br />cmid: C-< u\ FoR <br />^ <br />!.(q.-t <- C2 e\rlz-.46 -q.,s-s.-rr \- o l- l6 <br />lccdifylh.l inrlEpda.nnanccollh.$ork lorNhich lhispcrmil is issud.l shallnol @tlorrnlPnon i6antmend <br />e d to bccome subjd Io lhe so*6' co'lpctrqn n b* s or Calilomi.. ..d +t& 'hat <br />r I snould b.{ome ubjd to lhc <br />rvorl(J comp€Ntion prc\ isio6 o f S..lion 1700 ofrh. I nhor Codc. I 3hall. aonhsnh comply *irh rho* plo\ isions <br />w RNINC Iailur. ro sur. tr.rl.u compdeti.n .o!drt. is trnlasftrl. and shall <br />rivil fin.s ut ro on. hundr.d thousand dollm {$100,000), nr iddnion ro lhc cosl ol <br />an onloy< ro omi.al !.nal'i6 and <br />pcNarion. ddnases a tr.vidd tu rhc <br />serion 1076oarhc Ilborcod., inrerd md arorney s rs <br />2w <br />!.!!.!l!!L(])ll!r:!cl1)! <br />DECLARATION <br />I h@by amm und6 p€.alry oa pdju.y rhd I d liccB.d und6 prolilion of Chapld I (commmcins with S6lio. 7000) oa Divbion l <br />ol rh€ BusinBs and PmfsioB Codc. dd my lictue tu in tull forc. dd cff.cr <br />L,.Nc,* A L(tu.Numbq: (1f \8t, <br />*", t lrrl Iz- "-,."-, l4srtr.rr{ <+sc- lrt t <br />CANIIA!]CUOXIEIAINCACENCX <br />I hNby arm lndd FnaI, of Frjury th,t rhde is . oinrudion lcndinB as*y for lhc pdfoll@cc of rlE work aor vhich lhie p6trh t <br />isu.d (S( 1097. Civ C.). <br />^IIIICANLDIICLAtsAII)NI hotby amnn unds p.nalty of psjury onr of rhe folbsins dc.krarions: <br />Doro&ion P. rir+ ih5r^s (ohlic.ri"n lcdqal Rc{ldi^ns(lnka0. ltd6r-9, <br />--ryequtred r.u6otNoritudFtr <br />I c.rrifrrh nEfcd.ralrerulal[nsrqddinssb.slosiqno\nlare <br />#s:*r,I ha\e rqd rhir applicarion dd sbrerhar (h. ahn e in iscore.l I .8raro comply$ilh aliCiryand Counry <br />al€ l,a*sGlaringro buildi4 comrtudion. and nd.b,rer,6atdivs olrhis Cilyand Cou.lylo 016 up( nlhr <br />$o\c mentioned propcny lor insped ion Durpos6.,"," I 1r\DDli.Nnl or A[ol Sirnat rc <br />S<6\.<>ctJ6; > <br />l.r lu <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 Conditroners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Rough <br />Service Meter L <br />FINAL <br />Notes, Remarks,i Etc. ' <br />APPROVALS DATE <br />lvleter Release <br />{L/E;dU/ / si /:)dd <br />I