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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.COMMENTS Oma'BuilddD(ld ion
<br />I hcrcby affim undcr pcnalty ofFrjury thal I @ cxmpl fom fi. ConEacloE Liens. Law torrh.followinS r.aon (5.c 70315 B6incss
<br />ud Prcfsion Crd.) An, Cny 6 County which Equir6 ! pmit lo conrtrud, altd, inptuv.. dmolish or Epaj, ey sLuctu.. prior b iB-
<br />issu e,.lso r.qdr.! th. atpli@i for such pcmn ro filc. sign.d srat mdt thar hc o! shc ir licc.scd puBudr ro lhc provtrons of fic
<br />conr&ioa! Licos.d t w (Chapt.r 9. Codhcnc,ns with S.cno. 7000 oi Diyhion I oa thc Bsin6! ed Profgrions Cod.) or dEt h. r
<br />3h. is cxdpt lhmfrom ad thc bcis fc t. .ll.gcd .xmpti6 Any viola on of Serion ,0r I J by sy appli@t aor a p.mtr slbjccts th.
<br />applicar to acivil pcndry ofod @E lhm fiv. huo&cd dolls (1500)
<br />_I, a oM.r ofd. prop.ny, or ny.nployd *irh *a!q d th.n rol. comp.tuation, will do rh. worl dd lh. ntud@ is nor iordd.d
<br />or otrd.d lor s.l. ( S* 7044, Buinar dd Prof6sions Codc Tnc Conradoas Lictuc L5v do6 no1 apply to an ourcr of th. prcp.ny
<br />who buil.,s or imFrov6 th@on, ed who dc ruch wdk hiB.lf or h6.lforrhroogh hb orhcr om coployc*, proaid.d lhal such
<br />ihprovmols d. nor inb.Ld or ofa.rd ftr r.l. ll hoscvn, O. buildingor improemdr is loldwnhin o.c y6 of @mplctio. rh.
<br />Owna-Builda vill hav. $. blrdo of prcvin8 thar hc or shc nol build or ihprovc to! thc purpos. of sal.)
<br />_1,6 own.rotdc prop.ny, m cxcluivcly conMing wi$ liccn!.d conta(6 ro.onshcr lh. prq..t ( S.c 704.a, BBin6 sd
<br />Profcsim Cod.. Tn. Conrelor\ !i@s! Law do6 nor appl, to d oMo olrropaty who buildr o. improvcs thd.on , md qho
<br />cono'act! ror such projds wnh a contreto(, li*.sd puBusr ro th. cofiadors Liccis L.v )
<br />_l u cx.mpt undr Sation _,8 &P.C ao. tht asoi.
<br />lqB6EnS_CarUElSAl]ad.pI
<br />I h.r.by,mm undcr p.n lt, ofp.rluryonc olthc lollowing d.clsaiong
<br />I havc md willmainlain aC.nificak of Cons.nl to Sclf-lnsur. fo! work.6! comp.nsarion. 6 provld.d fo. by S.cion l?00ofthc
<br />Labor Codc, ior rh. p.rfmu.c of thc wGk ftr which lh. p.mi t isun
<br />_l h.v. dd will nrinr.i. wdt.rB conpcn.aio. ineurecc, d r.quircd by Sccrion l?00 ofrh. L!!or Code for rhc p.rfmMa of$c
<br />vork aor which rhis Fmil ir isu.d My edk6' c@Fnraion i6u.o..6ia ed policy nunbn e:
<br />c",i", Ao e))
<br />N,-* Da'z. Q,Rouq+qSOY o\ \or\o("
<br />(Thr scction nced nor bc @hplcrcd if lhc pmn iB for Onc hqndr.n dolles 1t 100) or h$)
<br />-l
<br />ccnirythatin thc pqfomsc. of th. wor* ftr{hich (hu\of,n 'i '$u.d,I shall no.nploy yp.Eon'n ymundso4to
<br />b.cm. subj.d lo $c wtrt6'cmporation la$ ofCalifomrl ud asra fiar if I should b.comc sbFd ro lhc wdk.6'
<br />cdpdsatior provirions of Sqclion 3700 oa $.all, lonhwid conply wirh
<br />otnT-P-N' S1O
<br />WARNINC Failurc
<br />'o s.culc wo.k6 compcBari is unlawtul, edshall subjccr a.mploy.r to 6imi.al parlti6ddcivil
<br />fina up to o. hund..d $oudd dolld (l I 00,000),in addirid to lhc Gr of conpdraiion, d.msg6 s prcvidcn au th. Slclion 1076 of
<br />th. Labor Codc, int.rd ed.t!om.y r L6
<br />L!Cf!5!!l!I]At.qO.8!_A!CLA&rIl.qlt
<br />undcrprovisio of Chaptcr 9 (commoci.g wi$ S.clioi 7000) oaDivision 3 of
<br />a?.qe
<br />Afx:lss.-lNc
<br />t h@by afiim @d6 pa.lry of pcrjury it6r th@ ii d dsEuctid lddin8 lAdcy fu rh? !.rfme.c of $. *ol fd ehich |nis p.mn is
<br />issu.d (scc 1097, civ c)
<br />AP?LICANT'S DECLARATION
<br />D@olilion Pmils-Asbcsld Norfi catioi Fcddal Rcgllatiois (Titl. 40, Pan6)
<br />_ RcquiEd Lct r of Notificdion
<br />_ I cenil, rhr I haw @ad lhis arplication dd 3ta1c !ha1 $c abov. infomarion is cor.cr I agE lo conply wnh dl Ciry ud County
<br />ng to buildinS co.strucrion, ed hftby ,u6ori2c r.prdcnutrve ol this City od County ro 6td upon $.
<br />""", 'a lE I oi
<br />EFrJ'Ls1o LJ oN'z-L
<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 I
<br />Torquing ^ol/ A \y
<br />Sub-Panels
<br />Air Conditioners t 1)
<br />Roof Top Equipment \I tx/
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)M
<br />Ceilings (Hard & Soffit Rough {
<br />Ceilings (T-Bar Rough).\.a,\/.S' Y
<br />\(/
<br />Rough
<br />Service Meter
<br />FINAL o/(,c-,/,,- /r,Oi,--^
<br />Notes, Remarks, Etc
<br />/<t /o r 4 t), ",t
<br />_l c.nify thd 1tc icd.rol r.gulalions r.gading absr6 r.moval -. not alplicabl. to this projcci
<br />.><-
<br />tfi,
<br />z\
<br />Meter Release
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