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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNf, R BUILDER DELCAI'4TION <br />I h@by armt undd poalty of pdtuy rh I m .rcma, Iion lhc Contado6 Lic€N Law lor llE following r@n (5(.703 I 5 <br />Blsins rd Pruaeio. Cod.): Any City or Cornly which !.qut6 a p<mit lo onnrud. ahd. ieplov., dsolish or qun y <br />sLactur., Fior ro its isumcc. also r.qut6 rh. applicdl for such !.nnir ro nE a rig..d slar@ol lhrt hc or lhc is lics.d puNet <br />to rhc prorisions ofthc Contracror's Licens.d L.p (Chapta 9, Conntui.s with S*rio. 7000 oaDilision I ofthe ltsinBs dd <br />Prefesions Codc) or rh he or sh. is exnpt o@lioe dd Oc b6.b ao. thc allcS.rl qmption. Any viololion of Se.lion 701I 5 by a.y <br />applicanl lor a pcnnir subjElsth€ applicanl to acivilpqahyofnol dor.lhtu 6r. hun&.d dollas($500). <br />L a orrr oarh. prcFny, or fty mplo,6 \,irh $a86 a tbcir sl€ comp€salion. will .lo th€ Eo* ad thc srud@ n mr <br />inldd.d or or6cd for salc {Sa.7lH4. Bcins ed Prcf6ioB Conc Thc Codrrclois Licee L.w do6 not apply lo d oMd of <br />fi. pmFiy who hilds or iDFov6lhmn. ed who do6 $.h *!* hms.lt or h6.laor rhmtrgh his or hd oM .mploy6. <br />prclid.d that such imFtrvoMls e ml inldxlo.l or ofi6€d aor slc. lt hoso-6. !h€ buildi.s or idpllllffir is eld eiihin on. ,d <br />ofcooplemo, rhc OM6 Buildg wiU h.v. th. h{do of pmvog 0d lrc or stE did rol hild or inprcvc thc p'opqly fo. lh. purpos ot <br />L s o*nr ofrhc popsly, ane{clsivelyconrraclin8 wirh lic€ns.d coitadoE to coishd rh.pmjel (se.7044. ash6 <br />aod Eolsb. Cod.r Th. Conlrad.r's l-iccn. l.a* do6 nol dpply ro b ownd ofproFny who builds o! implov6 lhqcon. <br />and who conr.cls for such rtroj{rs wirh . Co Ecro(s) licmsd pucudn to rhc Contdcror's Li.N tlv) <br />I m.r.mpt u.dd Serion .B.&P.C forlhis r.en <br />va8(EB!tro!lf!!$M! <br />DEClAtAlt9! <br />I hercb, afinn undd !.nahyofpgjuryonc oflhc followinE dclaations <br />_I har€ and{ill'@i ri. a Cdlirlalc olconsl lo s.lf-laurc aor trorte .onp.nsrlion, 6 Fovidcd for by S61ion 1700 of lhc <br />Lrbor Cod€, lor rnc pdfol:Mc. of rh. wort for *hich lh. pqnil is isu.d. <br />I haE and vill 'nlintain <br />porkd conp.Natior iNuranc.. 4 ftrt&.d b, S{tb. 1700 oarh€ tibor Cod€, lor the pslomec. ot <br />th€ *,o.k lor whi.h rhi. rErhn ie Nucd My work6 .onlp.@rion iBu.e.c .dis dd policy tumbn 6c: <br />yI cedify rhar i, thc psfoflmce of thc work aor which rtis p.mir <br />'s <br />irsud! I stEll nor @plor..y Fion in my Den.r <br />$ 6 to b€comc subj6r ro rh. *ort6' .onpqetnrn hs ofcalifomia, md agE thal il I should beomc subjal lo th€ <br />work6' ..n\poerio. prolisio8 of Saiion 1700 of $. ljt r Code I shEll. lonhwilh comply vilh lhoe provisioc.. <br />WARNINC faihrc to sur€ \ork6 compostion covsasc is lnlawrul. d sharl subjcd m mployd ro Ennnlal F.altls &d <br />civil fincs uD to on€ hundr.d lhous d dollaB ($100.000). in addilio. rc rh. cost oaco6lc6ttion, dena8s 6 p,ovidcd lor the <br />DECI,AAAIIO! <br />I h@by altm undd Fnalry of p6jrry rhar I m liffil Ndd Fovieion of Ch.pla 9 (comnqcins vilh Sdlion 7000) ol Diltsion l <br />of lh. BBine 6d PofsioN Cod., dnd my lic.M is in tull forc. ud .fi..1. <br />l/tr/fuot a .*".^* <br />coNsrBllcItoll.ElotlclgElc! <br />I h@by amm undq p€.ahy of pdjury lh.1 rh6. is a cocttu rio. kndin8 .gmcy ior th. p.rtommcc oath. woII for which this Fnil is <br />issu€d (Sa 1017. Civ. C.). <br />AITUTANI-DEEIABAIIAI <br />I nd.t'yallnn unds p.f,.ky of pdjur, onc of lh. follo*ins dal alions: <br />D.mohion Prmns- sbdlos Norificdion F.dral R.sularions (Tnk40. Pd6) <br />Rettuncd litr..f Nor,6carion <br />I c61ia, that rhc lcddal regul,lioN EgordinS 6b61os movd oe nol applicablc to fiis projct. <br />I l cd r ry r har I h,\. r.rd Lh! applicahon ed !rd. r hd rh. abov. inlonndion is cotrel I asc m onply qilh all Cil, and Counry <br />oinmanc d Sralc Lsq Eldi.s ro burlding con$tudio( ad hdcbyaulhoriz rcFMlalivB oflhis Cily ad Cou.tyto dl6 !F.dt <br />Ar2 o <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 />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER tt?z.b -bto> <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rouqh) <br />Ivleter Release /..22-2.d.n,/t, <br />Rough /-22-2p &lrd ,/t\ <br />Service Meter / - >2 -?,oFINAL/-22-",tb,,Jlt <br />Notes, Remarks, Etc <br />Rev.0B-07'2015 <br />Communications Cable <br />Sation 3076 olthcUbo.Code inlcr6l ddromcy\ 16. <br />",,", t/ I cf2o ) . <br />.n"*".*, I lO <br />Lm lft s Addr6' <br />abo!€ morion.d pmpdy <br />--------T------