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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O\INER BUII,DER DEI,CARATION
<br />I hseb! amrnr undd p€nahy olpsju'r- that I d.xc6pl fro6 th. Co.ua.1.6 Li.dk ljw for rhc rolbwing rNn (Str70ll5
<br />BusinBs acl Prof€ssi.n Codcl Any City or County Nhich (qut6 a t6nn ro con(dct. ahd. imtrovc. ddolish ot I+€i, uy
<br />smduq pmrto irs isuance. abo r.qun6 lhc applic.fl lorsuchFmitlo filc. siBncd slalmst lhsl hcor shc 6li.cis.d tu^ud!
<br />ro the plvisions ol rhc Contractois l-icciscd Lav (Chtrptd 9. Corecncins sith s.crion 7000 of Dnhion I oflhc Bnsin.s 5nd
<br />P.oLsions Cod.) o, rhal h! or shc is cr.npt lhacnom dd rh. b6.ir for rhc all.8€d.xdnplion. An! violalion otsection 7011 5 by any
<br />0pplicad aor a plmn subjea thc applic-l to a civil pm.h y o f nol morc rne 6v€ huldred dollas ($500)
<br />l. &r o*nd ofrh. p6pdr. or nryonplo!6 sith $a!6 qi lhcir sl. comFNalion. \eilldo lhc$o,k drheslocI@n6r
<br />i ddcd orolTs.d lorel.(Ss 7044. Dsinss d Prcfsions Cod.: The Conrlacroas I ictucliwdo6nor appltIomomdol
<br />rhe In)fd1y \ ho fililds or imp.olB rhs6.. dd who do6 such {o* hinscla oi n.Bell or through his or hs orvn .mpl6y€6.
<br />prcvid€.I thai su.h in{rolsn€rns ar nol iarsrlal or oITEd lor sL ll hoR6 d, rh. buildinB or iNprovo.ar h $ld rilhin .n. ,@
<br />oaconplelion. th. (nvn6 B{ilds uill hnvc thc htrd6 of proling ihal hc or sh€ did nol hrild or imFov. thc pr.Fdy for thc purpose ol
<br />l. doMs oarh.Irorlsry, ecrlusiv.lycdnraclins sirh l(oi.d cont&1.rs ro coiinrcl lhc pioj(l (S(. ?04,1. B6iDe
<br />md Aoasion cod.: ThcConlradois Lic.nscLa$ do*not applrro mo$n6orDroFn) qho buildsor improvdthd.on,
<br />and rvho co mcls lor chprcjcclsLvirh.Conrraclo(s)licscdrnGuant k, rh. Conta.roas Licdsc L0N).
<br />I a'! cxempt unds Sshon
<br />Orn.r:
<br />\vONKERS' (]ONIPENSATION
<br />DI,CIAAAIIqI
<br />I ho.byamrn !nd6 pdalryoapojuryon. ollhe lollowinr d..l,ario.s:
<br />I h.!c e rvill hainrain a Carlfical. oacoh$r ro s.lf lNuE for sork6 .onpmelion, 6 Fovided lor by Salion 1700 of rh.
<br />Labor Code lor lhc psfomoc€ o hh. wo.I lor $rrich lhc p6-it G itsued.
<br />J\ I ha'r and sill maiilaii $ 0116 comp..sario6 iBd.nc.. s (qurcd by sel ion 1700 or lh. Labor ('odq lot th. Frolr1@. or
<br />lhc wor! aor shi.h fii! Fmn is isued. My worl6' .onpdsdion insutu . crnia md policy numbs 6c:
<br />p",,",",^r*,14?v 6a1639 tloo ,*n* z- li-2ALQ
<br />I cc.ii! thal in thc psfom.Nc ofttu Nork tor rvhich this ponil is issued.l rhallnol mpl6y tny pdsn in any mams
<br />$ s tr h..oB. subj<t ro $. world comFs"tion lawsofcaliaomi.. sd.se lhal ifI should b€.ohc subjat lo th.
<br />{o.i6' compds.iion pllvisioN of Salion l?00 oflnc kbor Cod.. I snlll aonhrvirh coDply { ilh nr* prolisioB..
<br />WARNINC Failrc ro su. $ortc6 .o p.Bation.ovd0[. is trnla$ful. and sh.]lsubi(l .n snploys ro obinal FEti.,.,i
<br />.ivil nn6 u, t' oic hundr.d rhousnd dollac l!100,001r), io addnio. to lhc cosl or comp.6alion, dan.g.s d pro\idal lur $,..
<br />Scrion 1076 otthe IiborCodc. inl.r6tnnd allom€y s fc
<br />-zo o ^",.Toa<-i.,co Nuril(a
<br />LICENSED CONTRACTOR
<br />D&CI,ABAIIA!
<br />I hmby arn. unds p.nahyofpdjurylhar I m li.osel undd l,olisionofahaptE 9 (co,macins with Sdio. ?000) orDiviion l
<br />ol lne BusinBs ,nd Protsio6 Codc. ud my licdse is h tull forcc ad €Fel
<br />.".*".t*, C-ZO
<br />,,o",/ -A "bZA 6.
<br />.".,.,.,",, sTEUels VA<-
<br />AIfUCABLDICIAEAIIA!
<br />I ho{t4,arm u.der poahy oapdjur} on. oflh. follo*int ddlahrionsl
<br />Dcmolilion Pcrmils-Asb6tos Notificarion Feddal Resulations ( l itlc l0. Pan6)
<br />Requircd l-eltd otNorifi cation
<br />I cdil rhal rh.fcd.'J r.srlrhomr.sed'n! sbd,osrdno\a].rc nor.ppliclbl.lo rh6 prc|(l
<br />ft4 cdiry rhar I h.!. ,dd rhB applic'non ed srare lhar thc ainv. i.romaion is .oft.<r I .gc to comply wirh ,ll ciry and counry
<br />ordiMnc6 md Srar. Lavs rclar ins to boildios coBtruclion. and hcrcby authoriz. ,e?I.srar iv6 o I rhis Cny dd Counry lo drc upon lh€
<br />abov. mmrioned popcn, fo
<br />rmlicrnl o' ,\,ru! si!trnrtr t -.8'e9zo
<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 />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 />lVeter Release
<br />Rough
<br />Service Meter I
<br />FINAL ///49tvu I tfu/h hfra
<br />Notes, Remarks, Etc.coNsrtruc]toxLEtDtxcrcllq
<br />I iftby afiim udd Fraly of pnjury thd th@ is a .oisroclion lodin8 re@y for lh. pcfolmcc ot th. w* lor u4tich dis Fmir i!
<br />isu€d (Sa 1097, Civ C.).
<br />L.ndc's Nnm.
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