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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCAi IION
<br />I hd.by amfln undd pdrally of perjury lhal I I crcmpt frcm lhe Conlrack'B Li.@ k* aor lhe follo*in3 r.Mn (5(.70115
<br />gusinBs ad lrolBsion Cod€): Any Cil) or Counl, Nhich r.qut6 a pdnt ro mnslruct. ah6. improve dmolBh or rqan any
<br />slrucrue, Inor ro irs i$ue.c. alio nlun6 rh. appli.er for such p.flnil ro filc a sisn.d slatodl lh h€ or sh. b licmcd !Um&t
<br />lo rh€ uovisioN oflhc Conrracroas l,icersej LaN (Ch!fln q, Conm.ncin8 $ilh S..lior ?000 ol Division I ollhe Bdin* dd
<br />Ptofcssions Cod.) or lhar h.or sh. is erdnfl lhefron i.d th. bsis for th. alles.d €xdplion Anyliolarionofselion 7011 5qany
<br />applicant for. pdmn subjdslfi€ a$'licantloacivilpc.ahyolnolnd,.rh&fi\ehundraldollds($JOo)
<br />l, d osn.r 6lrh. propcny, or my cmplorG wnh N.s6 s lh.ir slc co'npoMtion. Nill do th. lvotl &d thc strtclrc is nor
<br />inreo& or olT6.d fo! el. 1Se.7044. Busind and hoa6sio6 Code Tn. Contadofs LicN La$ do6 nol apply lo oud or
<br />rhc p!,Deny Nho bsil& or inpro!6 thdon. rnd who doe such sorl himsclf or hqFlf or lhrough hG or hd om mploycB,
<br />provid.d rhar soch imprc\mB {€ mr inrdd.d or ofr6.d tor slc I t how6s. rh. tDildins or iopsrmmt is sot wnhD one yw
<br />of€q)kiotr rhe o*nd BoiUc trlll hflrc fie hF-kn ofproins lh.l h€ o, shc did mr tuild or ihpror. rh. propdy lor rn !{.F.s of
<br />l. 6 otr n6 olthe propsl]- on exclusively contradi.s wirh licm.n .o iadoa
<br />'o
<br />conslrucl Ihc Eoj..l (S( 70{1. Buim6
<br />Md Bl)iiri,l Cod.: Th. C'ontacrois l-i.cnse Law do6 nor.nDly to an owncr ofpropenywho builds or inprcv6 rherNn.
<br />and *,ho cor mcrs aor slch Foj..rs s nh a Coflado(t li.tu.d pnNad ro
<br />'hc
<br />contr.clois Licsc Law).
<br />I orn.rerpllnder SNtin ,I] & PC l rhb rcavlr
<br />Derc O*ner:
<br />!}lq8tr&8S.(AUtElSArAr
<br />DCCIAAAIOI
<br />I hcrcby amm und6 poalty orpdju'ronc olrM ldbwnrs ddldrtions:
<br />I h.ve dnd *ill mainr.in . Ccnificir. oaconmr to S.lf-lBurc tor $o si compds{ion. I pbvid.d aor by sNrio. 1700 oflh€
<br />Labor Codc Lr rhc p6fomr.c. of rh. so.l for $ hi.h lhc pann b issu€d
<br />.ffil*t *r, ^"u,^r,\o,r{r conrr{nsalnn,nsu,iD,c. $
<br />'1,c. ..111{l.,.L,rlJ.rc'.r :'.' \1.r.}d,"il-tr.i
<br />"""' {-u11o^'l A"l
<br />r,,,ric, rurrL,er 76 u/eCAkb Urz.-
<br />Eluned 6t Sc.lion 1700 oflhe Labor Code. for Ihe tcn,n@n..ol
<br />ion insurd.c .rrid .rd policy numb.r trc:
<br />I..niflrhar i.rh.pdfaman..ofrne Nork lor Nhich rhispcnnn is issued. lsnallnor q.pky.nyp6son i.anymanna
<br />$ dlo t'.comc subjet lo lhc $orl(6J comlENlion lawsol(alifomia. Md +t . rhd ifI stould bdolnc suhjcl to lh€
<br />M*s J conpm.tion povisions of SEtion l?0! of the Labor Codc, I shall. fonh{irh comply Nith rhos provisiotrs..
<br />WARNINC: Failur. to sr. worl.u .ompeMrion .o!m$ n unh$ful. and shall subjd u @rloyd to dnnintl Fnalris 6d
<br />l. ond hundr.d rh.os.nd dollars ($100.000). h addilnn k,lhc cosl or ion- da6a!.s rs rrovid€d lor rhc
<br />sdridn .1076 dlthc bbor codc, inrdd and .lbrney s f6
<br />t)t.( t. \tt\ I t()\
<br />I hcrcby amfln trodo poalryoflururyl li..nselunddpn,visi.nof(hapt69(commcncinswilhS.ctionT000)orDivision.3
<br />.f rh. Rusinssand Prolssions Cod.. mdm! lic.ns. is in full forcc md .llitr
<br />.".*..,*, 3 Lic.ns.Numbq
<br />/aba .,/C-
<br />CONSTRUCTION LENDING A(;ENCY
<br />I h6cby amnn undd F.noltyolpdjuryrhal thseis a con*rudion lfldins asdcy aor rhctqfomanc. ofth. wo for which lhis !6iit is
<br />issu.d{se l097.ci! c.)
<br />AIII,ICAN[DECIAAAUq!
<br />I hl$, arni udd pmali, ofpdjory on. ofthc lollowing ddlaralions
<br />Dmolirion Pmirs-Asb*ros Norificarion Fed*al R.snlarions (Tnk 40. Pd6)
<br />Rcquted t-dra olMtifi caio.
<br />I c6tify rh.l rhc l€ddsl EsuhtbN rcssdins Gbelos rdnoval d. oor appli.rbl. to rhis pbjdl
<br />Zffi,u r t^.. ,*a rr'i. applicarion &d $ar. rhar d. .bo!. inronn.rion is con.d I asrd ro onply wnh au c,r, .nd counry
<br />o'dinan.6 dd Srer.l-a$s rcldin! lo building .oNlruc]io., ald hdcb),adiorize rctrMlo'iv6 oflhis City dd Couly ro dld lpon rh.
<br />abo\e nrdrioned prcpeny for
<br />Atpli.Nnl or Agml Signslur.
<br />t{4
<br />/zo
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<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)
<br />Rough
<br />Service lvleter
<br />FINAL )/ts,/tox F*fR/c,/
<br />Notes, Remarks, Etc
<br />Ivleter Release
<br />L/t</ 'z
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