|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARAIION
<br />I h€..t! afirm undd pcnalty oa pdjury rhd I m .r.mpr no,n the Conlmclos Lic.6.lrN forlhc folbwine r.Mn (5*.?011.5
<br />Busi.ss ond P(&3etun Cod.)r Any Cily or Counly which r.quir6 a p6hir to connN.r, 01t6, improvc, dsnolisn or r€p.t /rny
<br />struduc F'ior to ns isuoc.- also r.qut6 lhc .prli.dl lor such pamn lo frlc a siBn.d statmenl lhal h. or 31E ; licd&d pcuml
<br />ro rhc prorisiom ot $. Co.Im.rors Licfls.d L,u (Chapt( 9. Conoc.ci.g {irh Sdiion 7000 of Division 3 ollhc Busns dd
<br />Potsions Cod€) or rhat he or shc is .rc'npr $re6oo od rhc b6i! for rhc all+.d .rGnplion Aoy violarion oaserion 701 I s by m,
<br />pp[c.fl o,,pd tubJdF'h. amhc.nr ro,cnilrcmhvolnor rnorcrhan fiL. hundrddolltu\(troolt1
<br />,l.sosnenlrh.prcp€a).orry€mnlo)6$lhsalssth.trrnle..mpfuon.Lqlldorhc(orL.ndlheq(,mtrn^r(r5lo.Ld o! o F6.d aor sl. (s{ 7oc-4. Bu!D6 Md Ptuli6sioB code TtE coni.aclois Lics. l}w do6 nol tpply to d own6 of
<br />f rh. Fipd, "lE h,il& or,mprc6$san. snd qh. d6sMhr.:l him.lf .t h6.laor ihmusn nh or h( oM @ploy.6.
<br />i tro J.J rhar !u.h mprovdmrs m nor miod.d or afi6.d aor el.. li ho*Bd, rh. hrildana or inForllrd is eH Nithin onc ta
<br />lolcompladn,lh.OsnoBuitlawillhawlncbudoofpmvinBlh.ltcorsh€didiolhildorim|rottth.prtrFrytorlhcpurpoFot
<br />I. !r o*rq oarh. pmpdy, m ercl$irelyco.lraclins riih licms.d $.lracio6
<br />'o.o6rtud
<br />rh. pmj€d (S(. 701{. A6ioN
<br />md PNasion Cod.r Th. Conrracloas l.icdse tjrv do6 nol apply r. mosntr of p.op€ny rvho builG ot ihpro!.s rhdon.
<br />and *ho conracls for such pnlds wirh a Conlmto,l9 lic€Ed Pu6ua'r lo lh. Conra.bas Licm L,v)
<br />li r.rcfr lrld S..r.D
<br />D.r. . -) 4' --/-L/J*',, r,.nxr ni'i'nn',iii^ rnrr'_ t)l|( l,\R\ll()\
<br />I n€r.br.ilu undd petrallyofpsjuryone orrhe rolk\!i'r! dtlararions
<br />I ha$ od *ill maimain o Cen ifical€ ofconsl lo Sclf-lnsu.t 16r \york6' coftp.cal ion. s provid.d fo, by S<tion 1700 o f (h.
<br />L.bor Codc, tor rh. poionndc. of lnt vork aor shich th€ p6mil is i:sucd.
<br />I h.v.and trillnrai oinsorkm co,npensalion insuraoce.6 rcqut.d bySdion 171$oillE LaborCode.lorrh.pdfonndc.ol
<br />rh. \rcr I lor which this pflnil is isu€n My *ort6 cohpcBario. i6urin.c cmi€r and Flicy numbs ac
<br />I ccnify rhal inlhcpslornanceoflh.tro,k rorqhichlhis punn is issncd,I shall nol.mploy any ptNrn in tnyn ner
<br />s ash bdohe shj(l ro
<br />'lE
<br />sortds conlpNlion la*s olcslilonia, and asrdrhd ifl should b€.onE subjd ro lhe
<br />\rork6.oftp.Garnrn,rovisioNofSdtun3700olrhcI"&"Code.Ish.ll,lonhNilhomdysilhthoFpmvisioc
<br />WARNING: Failoic ro FUre Norkqd comp€nsarion co\qa!. is unlawidl. Md shall strbjccl o dploF l.r Gininal pdahie and
<br />.ivil nn.s up Io onc hundcd lhosand dollaB (t100,00o). in.ddnion lo lhe cosl of comp€Ntion. dmag6 a prolidad lor lhe
<br />S..riLir tr)7(, .lrli. I ilu l.nc. nr€'({ )ndrrttrrcr \ li.r
<br />DeJ'17 - I apDlldnr' -'_ r.rrirsirx <r.r r rrir1x -
<br />DEC!4AAI(I!
<br />I hs.by.r[rE undd p.naliy o apcjrry lhal I m licens€d undd Fovision olchapro 9 (conrnmcing N n Sdion 7000) ofDilision ]
<br />oa lh€ Busins ed lrof*ions Codc, and my licac. i5 in lull forc. md .ftel
<br />,.ic€nscNunrb6:
<br />-
<br />CONSTRUCTION LENDING AGENC'V
<br />I hcEby atfm unda pcnaty of pdjxry thrl lh6c is s coNlruclion Lndhg a86cy fo. rh. pafot:mcc of th. woIt tur {tich lhi! pdni a
<br />issued (Str.3097. Civ C.).
<br />l.nd..s Nam.
<br />^ l\drf) ria h. f.daa. rcsularioN rclddins 6bG$"\ rcm"\alac i.{ ard'.ablc ro IhE poid.
<br />,fE .-
<br />'O '
<br />n* , ** ,* ,ns applror'on dd srarc r hd $. ablc inronndion is cofta-l I .s,c ro co(pry t irh arr ciry and coonry
<br />-odman.6 ed Sr,rc ks Ela ins ro burldtrs.cot rrudF( &d h6.bl +rhorir rcprslaliv6 orlhi. Cty dd Comiy lo 6ra uP.n th.
<br />t --)r??2
<br />nl{,\c tr.trrtrfrcd .N,r\ l1n nslcdifr Iuyrc!
<br /> ppllci.r o. age rsianrrurc - ,'._,Ll
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor /n\
<br />Bonding / Grounding / UFER _2-7-ru \ ):410
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lvleter Release l*2a-20
<br />Rough
<br />Service Meter \-21-2a
<br />FINAL i-71-',u ,t
<br />Notes, Remarks, Etc
<br />l'U.-'7b|o ^ o[L rEY fu,.<. -1> l-a,]& epr: s+*.co h^4
<br />o$ o() StL')'q' -) b'Gtl2 @E
<br />Air Conditioners
<br />VNAl
<br />t
<br />AETIICAILDDCIABAIIO!
<br />t holby afllm uidd Fn.lt, of pdjury on€ of lh€ follo$inB dslsalio.s:
<br />D.molirion Psmits-Asbdros Norili.arion F.ddal R.golalions (TnL 40. Pu16)
<br />-R.qunrd
<br />I,aldoaNori6cat!o6
|