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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUTLDER DELCARATION
<br />I hcrcby aflirm undcr pcnally of pcrjury lhal I am excmpl liom thc ConrErlor' Ltcns Llw (tr rhc follo*i.8 ta$n (Ss 70ll 5
<br />Busine$ ald Pmfcsion Codc): Any Cily or Counl, *hich rcqlircs a pcrmir lo connru.r, rd, improvc, d.mlhh nr rcIln uy
<br />(ru.rurc. fior ro ns i*u .c, rho rcqun r rh. 'l)pli.ut dr su.h lfrmt ro fih r si8ncd sl.r.mnl thol lEor shc is licctrrcd l}uuuei
<br />ro rhc pmvtn'n\ ofrh Co.tacror's l-icenrd k* (Charrcr 9, ConmNin! wirh Selion 7000 ol Oivision 3 of rhc Busifts ..d
<br />Pmfc$io.s Codc) or rhat hc or shc t.xcnrpl th.rcnoD ind thc basi! forlh. ollcs.d cxemprion Any violalionofscrion 7O:l1.5 by;ny
<br />lnnlicanr tor !rElmir subjcch rhc lmlicanr ro !cirilpenultrolnor dtrcrhan nvc hunddddoll&s (35llo).
<br />-1.
<br />rs owncr ol thc nioFny, or my crqrloyes wilh w!3cs as rhct {nc ompcnsrbi, will do rh. sM* .nd rh {Mm i\ mr
<br />inr..d.rl or ofcrcd lor sh (Sd.7O4:1. BudNs and PtoLsio.s Code Thc C.tua.lol s Liccnr Llw does nol appl, to an owmr oi
<br />rhcpmpcny who btrilds or iqroKs rhsmtr rJxl who &n luch w)d{ hnn*ror hcrslr.r $str8h hh or hd own cmplorc.s.
<br />nrorAed rhat such imllDrcmnn @ d inrcndai or ofrcrn lnr $b lf. lllucKr rlE hitliru or nq'rftrnr t vid *ithin oE ,w
<br />of.rnplcri,n. th. Owmr Au,ttr w,ll hrvc rhc bordcn or lmvidg lhd hc or shc dil mr hild or irrymrc l,\€ pmltny lor lh. pu4rc of
<br />l.asownsolrhcpropcny.omcxclu\ivclyconrr!.linswirhli.cnscd.onrract,\ro.onnrudrh.proj.rr(sc.7044,Bu$nes
<br />Md Pirf*sr,n Codc Th.Contdoi s Li.cn\c Lrs docs nor rtplyio oowncrofprotc yqho huildsor in,)rovcs thcrcon.
<br />ud *ho corrBck ror \ucn rrcjcc( wirh a ConlBcron 9 liccnrd lrnunr h rhc Conk&br'\ Li.cn\c Lr*)
<br />_l an.xcnpi ud$ Sc.rioo_. B &PC torrhl\Mson
<br />]{OBtrE&I..cOMfj&tA.U!]N
<br />PECIASAIIAN
<br />I hcrcby Emrm undcr lcnalry of lcrjury onc ofrhc t,ll,,*ing dccuftrion\
<br />-l
<br />hrvc lrd s ill nuinhin n Ccdific,rc ol Con{nr b Scll ln\urc l(lr *orlcB comj*hurion. is ,ovidcd tor b, sorio. r?c{) ot rh.
<br />Ukn Cod.. for ltE ,Erforrorcc of rh. uo* for which rhc p.nnil i! hsocd.
<br />y' h cJnd w'!lnrinbin snrlc^ .onFn!,ri.n in.urancc. r\ rcquncd bySc.rnrnlTmorrhc tib.r Codc. ror rhc pdrornEk. or
<br />/,'rhc*rlntr*hKl-rh\|crmiri.i..'r.dMlw.rlc,-,n,mFn\rli..nin\u'rnrccJri JJriFnnrnumt\ie'
<br />-o LI
<br />I ccnilyrhd h rhc pcrlonEn.corthc aork lo. !hi.hthnlEflnit k iss,cd.l shlll nor ctrfloy rtry pcrbn in rny mrnnc!
<br />s s k, hcmnE sul,Fl h tlrc uorkclr conEn\al t'n hws of Culifuni3. rnd rsry rhr ir I \lr U h..om {bj..r Iorht
<br />woikcfi co'npcn\arioo pmvisions otScdnrn lT00 otlhn lrhn Codc.l rhrll, fonhwirh.lnnply wirh rho$ flovision:
<br />WARNINC: Frilurc ro sm work.A comp.nsdioh .ovcmSc
<br />civrl fincs u! ro onc hu.dr.d rhous.ri dollds {1100.m0). ,n
<br />scclion 1076 of lhc t2bor Codc. inlcrcn and albrEy\ l.cs
<br />h unh*tu|. and stull subj.d an cflrplortr to nininal rrMhts and
<br />0ddnionlorc cosr olconrp€nsalhn. dom8cs ur pruvidcd for lhc../
<br />l2-l zZ /?-a"P*,-^
<br />DI!!A&II,IAIhrr.hyrlni utrd.rN htorrrju'y rhxr I n nrd undn rornion ofCh0frcr 9 (.omnEncin8 wilh Scctbn ?ujo) olDivhion l
<br />of rhr 8u\inc\\ rnd I'nnc*nnNC.dc. x t n,y licotr* i\ in lnll,nrr ndcllrcr
<br />(a
<br />I hcrcby ol,innundcr lEnolryofocrjury th lhcrc is o onslrucli,n hndins ascmy ror lhc F.ftrtutuc or rh. wo f.rvhichrhisp.rmil ii
<br />irsucd 1S.c.30)7, Civ. C.)
<br />AETL&ANI..PECIAXAID!
<br />I hsby,lim undcr pcnrhy of p.rjury onc oilh! followinS dsllralions:
<br />Dcmolilion Pcrmih A\ti.\ros NotilEarim ltdcralRe8ulutions (Tirlc 40. Pd6)
<br />_Rcquncd bllcr of Notif.urion
<br />_l.cnifyrhd rh. radcml rgularions 68din8 dsh.ios r.mvaldc norapplicsblcb lhG rmjccl
<br />_lrcniry rhar I hlc rcdd rhn.rplicrriotr orld i0rc rhd Lhc ahovc inlbrmrhn h cotrsr.I o8re roohply wirh lll Cny and Counry
<br />onlhrnrc! cnd Sr.rs tj$ rclarlu ro builditrs co!*don.9d hercbyaurhonr rcrrsnralivcs o,rhi\ Cny rnd Countyio.nrd ulln rhc
<br />rblc rnriotrcd l]n,pcny lbr in
<br />Appllcunl or Agenl SigmluF ./
<br />O?Tr'h 5 hc.Y
<br />)z/ P20
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lvleter /I//L/ht( -4FINAL ry14U
<br />Notes, Bemark6, Etc
<br />R{..v OB-07-2015
<br />COMMENTS
<br />,",", l).lL4 2alA conr,o"ro,
<br />Pentrilee nnme ( pritro:
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