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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE OWNER BUILDER DEI-CARATION <br />I hcrcby amirn undd paahy of psjuy rhar I m cxopl liorn the cont,crots Liccns. tlF lor fi. aollowing r€&n ( s( 7tr l i .5 <br />BBin6s and Proa6sio. Codc): Any Cil, or comry *hi.h rcitunB d ponit lo conrrud. ahq. improve. &oolieh oi i.Pon dry <br />srrudur., Fior ro irs isuoc., atso r€qunB rh. arpli.d aor suci Fmir ro filc a sisned $aldd rhd h. or sh. is licdMn pum t <br />ro rhc provisioB of the Cotu0crois Licens.d l.* (Chaptd 9, Conm@i.8 *irh Sdion 7000 of Division I offic Blsin* ed <br />PNLssions Codc) or rhar hc or sh. is.xmpt thdcrrom md ihc bsis torlhe allescd.rcmption. Anyviolalrcn olstclio. T0l I 5 by ffy <br />applic.fl for a p.fl.n subjats th. applicsnl lo acivilp.nahyolnol morclhd fivc hun&.d dollds{1500). <br />-1, <br />s o$nd o f rh. Fop.ny, or ny .nployd vnn sa86 s thcn sb compesation. Nill do thr *ork dd lh. slME. i! nor <br />inrs e.l or ofidcd for slc (Sa 7044, BuinBs od Proftssions Code The conlraclor s Lic..se rn* .106 nol arply to an o*ner of <br />$. poldy who hil& oi inprovs $@tr Md who do€ su.h $od( hi'ns.lf o! h.Blf or lhrcush his or hs oru @plor.6. <br />Fovid.d lhat sucn hlproro@ts (. rcl int6d.d or olTscd tor sk I[ ho$6'E rrE tiildins or irnprovffir is sld rittin on. ]@ <br />ofcornpl€rio( $e O* nd BuildE wil hav. th. hudor of provinB thd h. or sh€ did nor build or inpm\. lhc p(roi, for th. ptrpos. oa <br />l, soNnooflt. prcpsry, m crclusivrlyconE.rin8 sirh lictued coi'Edonb.oi{tud rh. lmjd (S(.704,1. B6rn6 <br />and Ittrtusion codcr Th. Conlructois Liccnsc Law do6 nor apply <br />'o <br />o o$'n6 o,prcpdy{ho builds or i4prov6 rhd$.. <br />a.d who conrs.rs ror such Fojrts wnh . conrado(, lice*.rl puu@r ro rhc ('o.tGclor'x Licsc L,w). <br />_I en cr.mp und$ S(iio B,2 <br />I h.reb, amrm undd p6rnyolpdjurr onc olnE 6lloqi.g <br />-I <br />hi!. dd *ill mai.lain a ccnifi.ate of Cotrmr ro scla-lNrrc lor \vork6i coh,pens nn', 6 prolided lu by Serion I7c\] oarhc <br />L2t{r Code. for rh€ tdfomd.. of rhe ior* for which thc p@n ! i.su.d. <br />I h.vcandvillm.i ain uorkdt co'Dp.Ntion ireuraacc. 6 r€qlncd by Sdr ion 1700 .arh. tjMr cod.. ao. rh€ psfomucc of <br />lh€ work lor $hich this p€mil ie su.d. My workcB' comp@lion iasurdc. .adid md poli.y nu,nbs d. <br />l\lrcy Nunrbd <br />-.U\ti6: <br />_l c€nify Ihal in rhc perlonnanc.oa$c wo& aor shich rhis poflir is issucd, I shall not employ any pe6on in any ndnd <br />$ 6 to b.corDc subjet to Ihc sort6' coflFns.tion la*s of Califomia. .nd asr4 lhn rr I sh.uld bcotu subj<r b ll'c <br />so!t6 conp.nsl ion provisioc of Scclio! 1700 o llhc l,tor Codc. I shall. ronts ith conply Nirh thoe pmrisioB <br />WARNINC: Ir.ilurc lo suc work6s' comp€Nliotr co\a?se is unlarvful. snd shall subjed a. snployd ro dininal p€Mhi6 and <br />ro on hu.d,en rhousad dollas ($1Uo.000). in addiln,n lo of.orpcnerion, daEBd a prorid.d aor rhe <br />sNrion 1076 ofrh. hbor Qrdq intdd ani allomey s lB K4-/, <br />I hcrcby ![ird unds p€.alry ol pcrjury rhd I rovshn ol(-hol,s 9 tcommfl.ins silh Salion 7000) ofDirision.l <br />of rh€ lt$in6s sd P.oftssions Cod., and dy li.ce ir r <br />colllalcllauMDrNc.&cErlr <br />I hercby alltrn u.dd p.nally ol pdjory lhol thr. is a consrfldion k dirs asdcy for lhe pdfomd.. oalh. sorl aor whi.h lhis Fmil it <br />issuql (S8.3097, Civ. C.). <br />ATILICANLDICIJEAUAd <br />I hml,atrm u'dd pfrally oipdjuryon. oflhc follosins dEl alions: <br />ocmolirtun Pe'nirs Asb6ros Nonn.arion F.dd.l R+ularions (].nk 40. Parl6) <br />Rcquted lf, nn of Nolifi calion <br />-l <br />cdilylh.l I h.vc r.ad thn appl <br />ordinancB and Slat€ L.$srcLiin8to <br />n mdsrarcthatlhc.bo\c inlomalion rcord Ialrsro.omplr\virhallCiiyandCounty <br />aulhoria rerre ativd olrhG Cny Md CounlyIo olq uponlh. <br />.bove mflrion€d poFny for .zAppli.rntorA3$lSignnt rc <br />/rct?x-Kni <br />-zg-/? <br />Site-Work <br />Underground <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 Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough 6,1ldrn 1'tffi\h"/{z) <br />FINAL <br />Notes, Remarks, Etc. <br />ID/SIG"COMMENTS <br />Pole Bases <br />Service Meter <br />"*",.- l',b'/1 <br />I cdily rhat rhc l.ddal rs larioB egardi.U aberos Rnold dc not applicable lo lhis prclal. <br />I <br />--T------