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ELECTRICAL-INSPECTOR RECORD a <br />APPROVALS DATE ID/SIG.COMMENTS otvNt;R BUt t,t,l:R Dr]r.cARA'r'loN <br />llusiness arrd I'nlltssir)n C(xle)i Any City or Crxrnty which requircs il lEnnit lo conslnrrl. nlter. irnltnrre, tlcilxrlirh or l,prrir any <br />!) rhe provisirns of tlE Crintrrc[tr s Licenrert [.aw {Chrnter 9. (irnrnrencing with Sectirin TlXX) of l)ivision .l 0f the Uu\inc\s nnd <br />flpplicrnt[orrpcrnritsuhjectsthe npplicantlracivilper)rllyollotm)relhilnfivehrtrdrr(ldollrrs{$5(x)). <br />-1.as <br />osrcrof llElr')|rrty.rtrnyemplr)rr\wilhsa8esr\lhcir{rlecr)nll8r\r[it)n.till([rtlr$1tktn(!llF{rlrlurei\[n <br />rhe prilfEn, wh) hrikls or imlrovei rhereon. flnd wh) {l(r( such work hinr\el[ ilr hcr\ell 0r through hi\ r'r lrer il$1r etr]pkryee\. <br />$le ). <br />_1. as owner ofthc pr)neny. inl erclu\i!el) r(ilnrrcting rvith licen\ed cr)ntrrctor\ til con\tnlct tl* nfiriccl lScc. 7(ll.l. Busint'$ <br />ao(l who contrnclsfr)rruchnrrtir'ctrwitha(irtrlrirckr(s)liccnsc(lnursuilntl)tlBCinnrrclr)r'\l.iccnscLilw). <br />latr|cxcil]plundersfr1i(ln-,B,&P,(.,frrttltisreas.rn, <br />lrate:()$Drr <br />tl 0l{Kldls' C()i\ll'llNs,\I loN <br />Dl ( t.ARA',l l(rN <br />lherehyal'l'irnruntltrDenrllyr)flldiuryoneol'lhclirll)\rin8(lc(lnrrlions:h hille rml *ill trhintrin x Ccnilrille ofConsent to Self In\sre itr Nrtrkers corn;rnration. ar pnrr'iderl for h1 ScctiUrr lTlrl 0flhc <br />rr Code, frrrthe perfrrrrrunce rrIthe work f(tr which the pennil is issued. <br />tlE work frrr shich this pernlit i\ issued. My workers' coill|tn\illit)n in\urrnce crrrier ilnd F,licy nunrhtr ilre:z'-j-,tre frsil oCrrier:_ <br />p"ti,vNu,ntrr, 1o1 Lt/ 4.5-/( z*pn",, 4-/'17 <br />_l cenify thlt in lhe perfotrnrfr. of th. work f('r which thir pcilnit is i\\!ed. I shnll iltr cilrphy nny Jrrsn in nny nrannt'r <br />er as r) he(Irc suhi€ct h th€ workers' qnnlEnsation laws ofCalifrrrilin. {n(l agree lhnl if I \hilkl hecorm silhiecl !r tlts <br />workers'comlEnsatir)nprovi\ionrofSection.lT(xlofth€hhtr(1(le. I\hll. li)rlhwilhuilnplywithth)rnnrviri({\.. <br />IVARNIN(i: l:nilure tr rdr. \r'rlicrs' .,rnEtr\;rtiort corr'tirgc is ilnlir$lirl. iilxl rll suhjtt an cnrpIrvcr tu crirriilrl turirllr('\ rnd <br />civil lln€s un to one hundred thrrusanrl rkrllnrr ($l(xl.lxx)). io r(lditir)[ l('r lx.irrn. tlanngcs il\ fn'\'irlc(l l,r lhe <br />Secr ir)n l(,76 of rhe Lltr)r (ixle. iNere\l rn(l riltrrrey s fee\ <br />oau:2-.-D-17 tppne*: <br />DUCI,ARA'I'ION <br />I hcEby afffn under ttnrhy of periury thst I rnr licensel untlcr prrrt'i\irtn of ('hil)ler I (conrtrncitg sith S?dion Tlxx)) itl l )i\ i\itn l <br />of the Business and Professi)n\ Code. ind nry license is in full force an(l effect. <br />l.icense <br />l)ate:_ <br />8.c -/o nst'Nu <br />-74610t <br />7--z-7-t )tirrf.r"fu.,( <br />i\rued (Src. .1(yr?, Civ. C.). <br />l.cnrlcr's Narrrc: <br />l.crxlcr'\ A(l(l'c\\l <br />APPI,ICAN'I' I'I:CI-ARA I'IoN <br />I lErehy alllfln un(ler p€nalty of 6riury onc of tlrc lirllr*ing tleclarar iolr: <br />l)enrrlition I'ernrils-Ashe\ro\ Nrtificxtion Irc(lerill ReEUlrtion\ ( l illc {(1. Prrl(r) <br />_Required [-elter of Notillcatirrl <br />-l <br />cenify that the federal rcgulati)ns ft8nnlin! nshes()s renrlvnlrre nol ipplicrhle h lhis pnrject. <br />ordinances nnd Stnle Laws rc|iling k) huildinE crtnstnrcligrl tril| herehy aulhrrize represenlatives of this Cily ond (iilrnty to enter lr|irn tlE <br />H:,-ilili::W ,,s,e: z-zz-/z <br />Site-Work <br />Underqround 4,1,o- ).1 J )e5a L-, @> <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Sions (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Buildinq <br />Under Slab / Floor <br />Bondino / Groundinq / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rouqh <br />Service Meter <br />FINAL t-/o -/ I t /d.Jo*(r*) <br />Notes, Remarks, Etc.