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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/stG COMMENTS OWNN[ BIJII,I}RR NT:ITARATloN <br />I hdcb.e altrm @dcr tdalry of pdlury rhat I dn .rmg 6om thc Contlclou Liccn!. Law ior Oc lollosin8 !@. (S{ 70ll 5 <br />Busin6s and ProfNion Codc) Any Ciry or Counly which lequiB a poiir lo co.sttud, a[c, imFove ddnolish or Elatr any <br />sttucrue prior ro irs isumc., also requir6 rhc al,plicmr tor such p.mil ro nl. a sis..d sr.rdot lhat l.€ or shc is licds.{ pdusl <br />ro rh. pmvtioE of$. Conlrrcroas Lrc.nsd tiw (Chapt6 9. ColmocinE {irh Sdrio. 7000 of Divi.ion I ofth€ Asins d <br />Pof6sions Cod€) or thor hc or shc n cxonpt thqclioh dd Ihc blsd fn rhc all.s€d .rmption. A.y violation ol Sclion 703 1.5 hy dy <br />applicad for a pdn subjdts rh. applicafl lo . cilil poslry of nor mor. ih 6\. hundreddollars (5500). <br />l. d ownn oathc p oFrly. o ny cnrploy€B s ilh vascs 6 then sE co,ntdsarion. lill do rh. $or[ trd rhe slrud@ G mt <br />i .oded or o,&red lor sl. (sd ?044. B6ine &d Polsio6 Cod. Tt. (-onlructol s Lic6F L.w d.6 nol aDply lo an owna of <br />rh. FUp<ry rho 6ildsor inFov6 th€6n. d s'lD do6 srh nol( timr.lr or h@lf or rhroulh his .r hd own cmployc6. <br />providdl rhai su.h i'nl'ovddB d. mr intmdcl or olrdct aor elc. lt ho"Bd. th. building or iqrovml is eld wirhin one d <br />of..trll)ltlioa Ihc Osnr Bunda vill hav. rn. hrdd ofpmvi.s ih, h. or she did nol hrild or iqrevc thc p'opdy frr $. putFs. of <br />_1, s oMd oaln. propdry, m €xclusiv€ly co r&til8 with lic.B.d contncloE lo con$ruct rhc Eojcl (S(. ?044. BcDe <br />ed hotusion Codc: th. cDnrr.ror s l-i.cns. Law do6 oor apply ro e o\nd oal,rc!.dy $ ho builds or impror'6 lna6n. <br />md Blm coitmls aor socn pmjds wnh a ConrBto(s) lic.ns.d pu6u l to rh. co.trdoi3 Lictu. La*) <br />_l dexmfl udd S6rio._, B. & P.C. for this r.Mn <br />Drrc Owner: <br />WORKERS' COTIiENSA'TION <br />DEC!.AMI!Q! <br />I hdcby alTmn u.dd pdalryofpsjury otr. ofth.lollownS delddiosl <br />-l <br />hav. and sill nai.rain, Cdificrr.of CoMr ro s.ll-l6ur. for rorkdl con,Fnerio\ 6 rrovid.d lor by s*rio,1700 ofth. <br />Llbor Codo lor th. p6fomdc. o f $c wor! for *hich tc pomir is issu.d. <br />-l <br />harr and rvill n\aimdin wo*cis co,np.Barion i.su!rnc.. s r.qtrn d by Sd io. 3700 oalh. llbor Cod.. lot rhc Pgaonnee ol <br />Ihe worl( tor qhic| fiis p.mil i, isued My workeq mmp.Nalion insuruc. camd a r.licy .umb.r dc: <br />PolicyNumb6 <br />-l <br />ccniay thrr in th. pdliman . oalh. worl aor whichlhb pemn is issued. I shallnol mployanyrsson in an,,nend <br />e 6 ro beo,ne subj{t ro thc wort6 conp.reation laws of Colifomi.. 6d .sc rhar if I should be.om. subjsl lo lhc <br />wolt6 ompostion pNvisioN ofSclion 1700ollh€ Labor Codc.I shall. fonhwnh comply wnh tho* provisio6 <br />WARNINC: Fajl8 lo sdc M*6 .onp6slio. .o!6rec G unlalful. d staU subjcl d dnployd ro oiminal FDllis ud <br />cilil nn.r up ro on. nun<lred rhoumd doll6 ($100.000 <br />S.crion 1076oirh. tabor Cod.. imcr ed auonEy's lc <br />). in .ddiiion ro rhc con oi co <br />DICIJAAIIo! <br />I h@by anm undd p..alr, ol p6jr.y rnd I an li.€ns.d und( F.vision of Chapts 9 (.oMocins wirh 5(16. 7mO) of Division :l <br />oi rhc B6in6s dd Poldion3 Cod., ed iny licos. t in full forcc ond .ff.cl <br />4:y/t <br />q)!flaIJCIIONIENDI!C.&GE!CI <br />I hd.by arm undd pe.aly of pajury that lhs. is a .onslruclion lddins arn y for rhc pdfonndcc of rhc work lor which lhn Fnn a <br />istucd (se 3097, civ c ) <br />AITIICANLDEO,6AAIIQX <br />I hddry aifm u"d( p.nahy of prjury on. of lh. followin8 dalralions: <br />D.mo lilion Pdmils-Asb6bs Nori6crrio6 F.d6al Reruld ioN (Tirl. 40, Pd6 ) <br />-R.qun <br />d If,lldof Noificadon <br />I cdif, lhal Oe l.ddal rc{lhtioB rcg6din8 sb€tos rmovd e. nol applicabl. lo thi! proj<r <br />-l <br />cdiry rhar I ha!. @d lhG apFlicaio. ad srar. rha th. ahrt i.aomarion b con d. I .sre lo conply with .ll Ciy sd Cooniy'tr:*xw:"'^';;;- <br />Site-Work <br />Underground qlw lal -o<zf @ <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 / Groundinq / UFER 'll1"l t") .,l^4, (t,t/ <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough)rl <br />I\4eler Release 1t1 t1 .,Ul(r(q) <br />;.. <br />Rough ltq -<//f(D <br />Service Meter <br />FINAL 2 J/dtt *<-r*) <br />Notes, Remarks, Etc <br />,,," q/z.t/t t <br />L <br />l,/, z?2