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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hschy anm unds polny of pojury rhar I @ cr.ng 6on th. Contaclo6 Licdc Law lor lhe lollowing r.eo (5(.703 I J
<br />BusinBs ad Profsion Cod€): Ary Cily or Counly rvhich rcqun6 , Frn to coddd, .lrs, improve dsnolish or r.9an ey
<br />srtucruE rior to irs issnmc., also r.!uir6lh. appli.ml ior such p.rnil lo filc a sisocd slln@c ihd h. or slE is lic6cd PNuIn
<br />to thc FovisioN olth. Contrclor's t,icqscd LaB (Chaptd 9. Conn.ncing wnh s..lio. 7000 ot Divirion I of th€ IluinN d
<br />Pmfsions Codc) or Oar h. or sh. is q.nF fiq.fto,n ed lhc hsG aor rh. alks.d crcmplion. Any violdio. of Sdion 701 I 5 by e,
<br />applicmr ao, r Fmir slbj6b rhc applicanr lo a cilil pdalry of ior Eor. rhd 6!. hun&.d doll s($5&r).,./Ll,sownsolrheprop.ar.ormycmplo)6*rlhua!6athcn&kcompGaion,*ildorh.mrl&dLh.slMlEGml
<br />inlo(k or oftacd for sL (Sc.70{4, Itci,s md hol*ions Codc: Th. Conradoas Lic@ kw do6 nol rpply lo & oMs of
<br />lhc rmpsry who hil& or inprcv6 tt@l! and who do6 s(n so* hlro€lf ot hffil t or lhoush hb or hcr 6wn .mPloy.6.
<br />provid€d lhar such i,npmvocnls e! nol inhdcd or or6ql ror slc. ll howad, th. bxildinS or imP.ovoret t $B wilhin onc )@
<br />olcoopldion, $e Omcr Buildd will hav. lh. hrda of prcving lhd hc or nrc did iol hiB o. inltov. tn. F.Fty for lhc purpo$ of
<br />l. s osd otrhc prcpely. dn .xclGnely conradinS wnh [cmcd contmcros lo conslrucl the proj.ct (Se. ?044, a6'na
<br />dd E!ftssion Cod.: Thc Contracloc! Li..Bc Law do6 nol.pplylo e own6 olproFny {ho blilds or improv6 thdon,
<br />ed who conhcls for $€h proj4c vith a ConrrEclo(s) licctu d t6@r ro $. Conrdols Ltffi L€w).
<br />I dn ex.mpt undd Selion-
<br />D "., l-_. / { :a292.> (,,,,
<br />.[oatrEBl:coMflrsarl0!
<br />DEC! 8Au0!
<br />I hs.b! amm und6 psBlty of pdjury on. oflhc lollowins dalsalioN:
<br />I havc dd lill mainrain a Cfiifierc of Co6dl ro SclarNlrc lor work6 omposalion. 6 piovid.d for by Setion 1700 of tb.
<br />Labor code. for lhc pdomsce ofthc wo.k fo! Ehioh rhe pdnir is i:su.d.
<br />-l havc ,nd will mainrain {0&6 .ompcMiion irourmc., d r€quircd by Sclion 3700 ollhc t bor Cod., fot th. pdlol:Mr. oa
<br />lh. wo& ror $ hich fiL pmn is iaercd My wortd comp€.Mion iNure.. wjd ad poli.y nu,nbd &c:
<br />I ccniry thar in thc psto.encc otrh€ worL for wti.h rhir Fnn is issued. I shall nol mploy any F.on in ey m&no
<br />e s to bqos. subjet to t. sor{6 .onpas.lion l.{s ofc,litoEia. sd asE that ii I dEuld baom. subjat lo rh.
<br />vor{m'co,npdsstionpmvlrioNofScdion3T00ofth.kborCodclsh.ll.fonhsirt'comdyunhlhosprcvisioN.
<br />WARNINC Falur. ro sur. workd' compaMion covasc is unlastuL dd shall subjdt M mplols ro Eini,.l FEllis &d
<br />civil nn6 up ro on. hu.drdl rhousd doll6 (S100 .000). in addi'Fn ro
<br />fd,-
<br />rh. con of.omp.Mrion. doraBd 6 previdcd tor thc
<br />scrio :1076oarh.LaborCodc. int66l a attomcy s
<br />5q,/or 6
<br />I,ICEISEDI;ONIXACIAA
<br />DECI,Af,A!(}!
<br />I hseby amm undd p.nalry ol pdjury that I @ !ce..d uodd prcvGior ot Chapls 9 (.onDdcing vnh Sdtion 7000) oa Division l
<br />ol rhc Bsine ed Prcf<ioG Cod.. and ny li.re i! in full forcc od .lt{t.
<br />CONSIRUCTION LENDINC ACtrNCY
<br />I hd.ny arm undB paaty of prjury fial lhac is a @n 1tudb. kndi,8 dgocy lor th. FfoEwcc ofthc *ort for {'l'ah th! Fmil b
<br />is!.d lsd.3097, Civ. c.).
<br />ATIIICANLDI,CIABAIIQ!
<br />I nod,y rftm u.d6 paalty of psjury onc otlh. iollowitrg delmtioB:
<br />Demohio. Poois-Asbelos Noi6.arion F.doal R.gularioB (Tille 40. PM6)
<br />R.quirEd rit6 of Nolilicdion
<br />I cdify lhat ihc Gdoal rc8ulatioN rcBsdins sh.slos r€moval dc .or applic,bl. to lhis projat
<br />!.a{cditthzt t la\. Gantlt,npluhon udstrr.rhd $c.bov. infomarion B coodl I agrc b conply wnh dl Cily d County
<br />ordinarcB od Srar€ Lls Elarirr !o buildins @Blodior dd h6.by sulhoriz. r€pr6dlaliv6 ol$is Cny d Cou.ty io drq upon fi.
<br />above roolionc<l prolIny ror
<br />S'\pllicrnl or .lgcnr Siqmrurr 6.
<br />PcflnilN none (prinD:
<br />dJ
<br />Qa,
<br />",," /- (r-zo2o
<br />Site-Work
<br />Underqround
<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 / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equrpment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL z1 rt l't tt Dkfi,/w+ 97
<br />Notes, Remarks, Etc.L
<br />Rev.08'07-2015
<br />It
<br />Cari6l
<br />Policy Nuhbs:-
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<br />I i.ctr\c Numhe
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