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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNI,:R BUILDER DELCARA'I'ION <br />I hreby ,mh und€r p.nahy ol prjury tha I d .rc6pl iion the Co.rEcror' LiceBc La$ lor rhc iollo$ing r6on (!€ 701 I 5 <br />Businos and Profeion Cod.) Any Cir, or Cotrmy shich r.qun6 a p6mn ro connrud, 0h6, improv€, &orolidi o! r.pst My <br />sh.ru., prior ro ns isuoc€. al$ r.qon6 lh. arplicd aor su.h Fsit b fiI. a si8n.d slddol th.t h. or sh. s licaa€d puN t <br />ro rhe Fovtiore ofrk Contra.r.as Licds.d tiv (Chapl6 9. Conoc.cios sirh Scri. 7000 of Divbion I oa$. ausins &d <br />Proasiotr Cod.) or th{ h. or sh. is qc,q,t <br />'h6.6om <br />md r1r bsis for rhc ollcSed eronplion Anyvioktionofse.lbn?031.5 by any <br />appli.ad for a pmn subjd3 rhc applican lo a civ il p.nalry of not iore rhd nvc hundr.d dolles (5t00). <br />I. s ownfl ollh. propcny. or my .mplolB wilh *.s6 s their elc o'npqsnion. sill do lhc \ro* dd lh. nEru. ; mr <br />i oded ororldcd lor elc(Sd.?o44. Bciosud P,or6ioN Code Thc Conmdors Lic@ tr\r do6 nor rpplyio mo$n6of <br />th. prlpdy $ho b(il& or impm!6 thqon. rnd shD do6 str.h \rod( hims.lfor hmlf or lhDugh his or h6 osn onployc. <br />provid.d rh, su.h imlrovdn s d. m( i.rdd.d or.lla.d for elc l[ lh\r&d. rh. hoildinS or improlmot is sold wnhi. on. )@ <br />ol compklion. lhe Orvn{ Buir:E will h.rc lh. hrdcn olrrovins thal h€ o. shc drd ml tDild or idprot lh. plnFry lor $. porF$ ol <br />I. ao(rsofth. Fopd]. mcr.lusivel, contacring Nnh lirmsen.onka.roulo con$tud lhc proic.]1 (Se 7014. lntrins <br />ard hli6sion Codc:'l hc (onlracrois I-iccns.l,aw dos nol oppb to an ovno orpropd, trho tuilds or irflord rh&Nn, <br />.trd sho conrmcrs aor such projsa wirl' a contaclo(, licdsed plNtrel ro rhcConlmclor's Licensc lrw) <br />I m cr6fl udd Serion . B. & P C. lorlhis r6on <br />!0BrEtsl.collrEll6rlo!!!c!d.BArIo! <br />I hrcby allim uodlr pdalry oirojury on. oarh. follo$i.s del arioN: <br />. I havc ad will iainrain a Ccn ific.r. of Co66r ro Sclf-l6ure ror *o116 comtosa'io6. a !6!idel for by Selion 1700 o I the <br />Labor Code tor the pafom ccofth.$orl for which lhe p6mil is issu.d. <br />I har. and \r ill nr.i.iain \.rkds' conrpcNarion imuranc., a rcqut.d by SErion 17(x) o f rhc l,60r Code lor lhc pslom ccol <br />rh. $orl lor rvhich this pnnir i! isu.d ion icnrmce cMis udrolicrnumbs ac: <br />o 7- zol 2-?-/2tzO <br />I ccnirylhar inlt€pcrfonMn.eorlhcwort rors'hichrhG p6!nn is isru.d- I shall nor.npldy.ny pm). in a.y 'n,nmr$ a io be.o'ne erbler lo lh. Nor km conrpdslion la*s oacalilomia. d 0sr€clhar ilIshould b€co'n. subjLrr tollE <br />workos coDFtrarion provisioB olSerion 1700 ollhc htor Code I sh.ll. fonh\ ilh omply \ithlhoseprovisioa <br />wARNING: Iiailue lo $cuE worksC <br />civrl iines up to one hundr.d lhousad <br />.on,Bnsrlu, co\e'ngc is unla\ILl. rnd bi(l an cnphycr t' rhinal !.nalti6 d <br />doll6s ($10(r.lj()o). in addnn,o danascs &s lrovidcd for thc <br />Sftrion 1076.Irh. I:h.' ('ode <br />-/z-/ <br />ricensecras <br />o c^to {oZLLL-4 <br />I hscby amr6 undtr ,.aalty o f psiury $ar lhdc is a coBtruclio. lading agdcy lor lh. p6lon@c. of rhc work for shicfi lht p6mn b <br />issucd (56. 1097, Ci!. C ). <br />AITIICAILD&CI,AEAIIQ! <br />I hdd, .JrDn uid6 F.alty of pajury onc oath. aollo*in8 dalar.lionsl <br />D.nohion Pdnits-Aih6los Notifiolio, F.dml R.lulation (Tn,.40. P0n6) <br />Rcquncd l.ud oaNoliicalion <br />I .diay (hd rhe fedral r.lxler iotu i€rEdin! allsl{s rond\ al r. nor ,pplicabl. ro lhir prold <br />I c.n ily 1tut I ha\ € rcad this applical t n a.d slnre !har t n 'scon€n lagre ocotrlpll \(irh all( irr" and (-ounitr <br />o'nin c6 and Srate hss relaring <br />abo\ e mfllioned p!op.-ny ior <br />ny md Coonty lo dr6 npon lh. <br />!!1?11 <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 />Bonding / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter // <br />FINAL Z <br />Notes, Remarks, Etc <br />Under Slab / Floor <br />Air Conditioners <br />I h@b, ailmn u.d6 paally of pdjury thal I @ lkoldl lndd pr.vtion oachapls 9 (conmocins wilh Salion ?0&) ol Division I <br />ol the Bsin* dd Pmf6io6 Codc. an{ ny licoE i. in tuU rore ald.fid.