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ELECTRICAL-INSPECTOR RECORD DATE ID/SIG.GOMMENTS OMd-Buildd Dc.lerion I hdcby aflim undo p@alty ofp.rjury lhal I u.xdpt aom thc Co.lr&lon Liensc lrp fo. thc follo{itg Bo G4.7031.5 Businss od Prcl6sid Codc): Any Ciry o Comty which EqdB ! p.mn ro consEuc! alt6, imprcv.. d.oolirh or rcpan ay ttuctur., pric to its i$,ec., also rcqut6 rh. $plicer lor soct pcmir ro fiI. a sisn.d nat€mdt rhar hc 6 sh. ii li@s.d pu6nMr io rh. ,.ovniom of th€ Contradols Licdscd Law (Chapd 9, Cmmocine *irh Saion 7000 of Division t of ttu Buind &d Prcfdions Cod.) or 6al hc d sh. is .xmpl th.Elrom dd rh. b6is fc lh. allcscd cx.mplion .Any viola{on of Sccri@ 703 I s by @y applicmt fo a p.mn subj*l3 rhc appliml ro . civil P.nalty of not m@ the 6v. fiundrcd doll6 (StOo) _I, q ownd of rnc Fopdry, or hy cmployd qirt w.a6 s thct solc @trlpcniltion, will do rhc vo* Md th. idcr@ ir nor inrod.d or ofiad f8 sal. ( Se.?044, BuBinds dd Prcf.$ionr Cod.: T}. ConE&rd's Licdlc La* doq nor .pply to s ownd of lh. pop.rry who brild! or imFov6 d@on, ed who d€ such wort hitu.lf or nddf or thrcu8h hil d hd owr mployB, prcvid.d lnd 3uch improvhdts dc not inbd.d or offn d fd srlc If, h@cv6. rhc buildi.g d imprcvn .t it sld vilhin d. y.d oa compl.t@. rhc OMa-Builds will h!v. th. burdm of proving lhar h. 6 ihc .o1 build or iop*ov. fo. rh. purpsc oa s.i.) l. a owoaof ln. proFny, m.r.l6iv.ly conhring with liccns.ddhcroB t onsdd fi. p(ojd ( S.c ?044, Bsine &d Prcfdid Cod. Th. Conretdt Lien* llw d.€ not.pply ro d own.r ofFopdty who buil& tr inprovB rha.on , ud wlo conkou for such Drojcts with a coE clo(s) Ii6s.d puEur ro rhc coDEacrors Li@nsc Law ) _l m.x6pr udd S@ri6 .B &PC ftr tht (aon WORI<ERS COMPENSATION DECLARATION ! hd.by amm undr p.nal9 6f p.rjury on. ofrn. followin8 d.cldrio,3 I haec md eill maintrin . Carifid| of Conr.r ro S.lf lnrur. for work R omp..satim, a prcvid.d ld by SEtion 3700 of6. L:bor Cod., ts thc F.fl],r@cc ol thc wdt fo rhich thc pcmn is isu.d _l hav. bdwillmainlain wstc6 cmpcmation insurucc, 6 rcquircd by Sction 3700 ol lhc Lsbor Codc, for $c paf(mr.. of i,!c wort for whi€h this pmit is issu.d My wort6' cmp.N.tio insurucc tria ud policy nunbd &c: nor b. ompl.r.d if (h. pmn k aor On. hun&.d doll6 {J l00l or 16, lbc p6foi1]Bc. of thc work fc which rhis pcmn h issucd,I b<dc subjei io rh. sorlcs ' @mpchrati@ laqs of C.l ifomi{ ed aer.. thar compas.rion proaisios of S6tio r?0o oithr Labor Cod., I shall, fonn /Go b WARNING Failw ro s6uE wort6 comFsti@ @va.g. is .mployd ro aiminal po.l fi.6 np ro on. hmdr.d tno6od dolld (t I00,0m),in addnio ro lhc cGt oa cm thc Labor Codc. inrcrdl ed .tlm.yis fc6 &mag6 d prcvid.d for rh. selio.10?6 of I-I('l-ISED CO\I'RA( IORS DECI,ARATIo\ I hdcby amm mdd p.nahy of pdjury $al I m li.as.d undd prcvisio of Chapld 9 $. B6iner ed Profari@ Cod., ad my lic6s. is in aull lqcc ud dr€cr -n -ol, I h@by .fim und.. pa.lly of pdjury th{ dE ii a @strlcti@ I isucd(Scc a0e7, Civ. C) .eocy for th. p.rfme.. oa ln. wot fd *hich lhis D.mn is APTLICANTTS DECI,ARATION D.moliliM P.mi|'-AsbdG Norifiarin F.{t rdl R.aul.lids Gnlq 40, Pd 6) _ RcquiEd kt6 of Notificltid d. f.daal !.8ulations !.8rding ab6l6 r.noval rc iot appl t thst I havc rcad thh applicarion ed sBt thar lhc abov. in ordindcA dd Stllc La*s r.laring lo burldinS conirructid, d ty and County lo dtd upon thc sbov. hcntion.d prcp.ny for insrqion pu.p66 4-(41 Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communicalions Cable Bu ilding Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release E,!1ETT I tl.lr Rough EFR. I 2ntq Service Meter FINAL ,}llvl\, O-+J. Zs u, cco, 66/ Notes, Remarks, Etc. APPROVALS Lada 3 Ad&B f------T------