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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O\vNER BUILDER DALCARATION
<br />I h6eby amnn u.dn p.nrlry ofpdtury lh,l I m erempl 6om th. ContEcloB Licmc Lrw for rh. aollowing r.etr (S.c.7oll 5
<br />Busi.* and Profsion Codc) Afly City oi Couoly which r.qun6 a pdi,n ro co6rdcl. rhd. improve d.molth or re.n uy
<br />srtocl@, pnor lo ns isuec€, also r.quns lhc @plic l lor such poen lo [L a sig.al iatdd thal tE or si. G lic.ns.d puea
<br />to the povtions ot the Conrmcrois Licoscd Lar' (Chaptc 9, Conm..cing enh S€crion 701$ of Divisioo 3 oflh€ Dusin6s md
<br />Pbtcsiofls Code) o! thar hc or shc is cx€h/ $qc6oh dd $. bsk for rh. alL8.d dmption Any violalion olselion 703 I 5 by any
<br />applicdl aor a pmnil subjels thc appliol lo . civil pdahy o I not oor. lhd 6v. hundr.d dollds (1500).
<br />l. ai ownd oarhc propc,1y, o ny onploy€B wnh was* a thcn sob compesation, ll do lh. Norl ad lhc slru.l@ G mt
<br />inradcd or oiIded aor elc (Sa.7044. DGin6s ud Pror*ioB Codq The Com.actoas Lic6. L.w doe nol opply to 4 omq oi
<br />rhcFDrqly Nho hil& or inpro!6 rhdotr .flj who &6 suct wolk hinsclt or h.Rlf or rhm$h his or hs own cmployc,
<br />provid.d thar such improv@b e
<br />"ol
<br />orod.d oi otrad for sL. Ii hovd6, th. hildin3 or inp.olcMl i! $ld *ithin oe ,@
<br />of conpldion lne Own.r Butls will luvc thc bNkn ofpmving thd he or shc did rcl build or in{rcvc $e popdy for d. purloe of
<br />l. 6 osrs oarhc pmrdy, e .xclBively contadins wirh licm.d conlradoE lo corclrud lh. projctl (Sd ?044, a6rB
<br />ud Eol*ion Cod.: Th. Conrra.iofs Li.c.sc Law do6 nor apply lo an own6 orpropeny rvh. brilds o. imProv.s thdon,
<br />and who co;racrs lor such pmj.cls wirh a Co rscto(d liceGol ru sur l lo ihc Contraclois Lic€e L,*).
<br />I m.rmpr unds Sdion-. B. & P.C. for rhi. rae..
<br />uoaBlB,t-coMtDrl rox
<br />!ECl. aAUAr
<br />I hdcby amm uod6 paaly olpsjury onc olthc fouowing ddlaotio$:
<br />I h.E a.d will @intai! a C.nificstc ofco6dr lo S€lf-lBurc for workds .onpdMio.. 6 plovided tor by Sdion 3700 oflh.
<br />ribo. Code am tbc palolrmc. o ath. K* for which thc p6ftil b N!cd,
<br />X n*. ,,0 *u, .",r,",n *olk.6 .onpcGorion iEuranc., s r€quircd by ser ion 37oo of rh. kbor cod., ro' thc Fro,r@c. oa
<br />compdslion insurarcc ffid dd poli.y nunlbcr ac:
<br />CD
<br />P"li.yN".l,", q3O qL.B}r at.9L,3D
<br />I ccdify rhal in rh. p.iforman c ollh. *ork lor which lhis p.rnn is is$.d. I shallnot mploy a.y p6on in any h&nr
<br />e s lo b*one subjdr to rhc w6rk6 @npcBatio. lass ofcalifomia. ed asc thal if I tlould b..omc aubjal lo th.
<br />*0r!6' .oinp€Ntion pmvisioN of Salion 1700 ollhc L€hor C.de, I slull. aonhwnh cosply wnh lhos provitions..
<br />\YARNINGT F.ihr.lo Kuc wort6 co,npqelion covdagc ir nnlawinl, Md $all subj*l u oplors lo dihi.al Fullis dd
<br />civi, n.B up ro oDc hun&.d thoMd dolld ($100,000). i. addniod ro thc cosl otcomFEalion. d@scs e provid.d lor rhc
<br />Sdion 1076olrhe Labor C.de inrcr6l and artomcy s 16.
<br />l)t,( r,,\R.\ r x)\
<br />I h6eby amm und.. p6akyoapdjuryrhar I dn lice$.d undcr provitio. olChaplr 9 (corm.ncing vin Sdion 7000) ofDilition l
<br />oa thc a*ind ed PmfsioB Cod., a.d my lic€e b in lull lorc. &tJ .Itdr
<br />c\o (tr$s. NumLT
<br />q
<br />,"",1.Jr.f,oQ)
<br />cqlsr8lJcro!-LElDllcacrNlI
<br />I h@by ailrm und6 Fehy ol psjury rhal thac ir r @ii(fudioo h.drn8 agdcy for th. Ffomo.. ohhc uo.t 6. whkh lhi. Fmil b
<br />isu.d(se. 3097. Civ. c.).
<br />ATTLICANLDECI.AEAIIO!
<br />I heq 6ftn uodd paaly ofpdj.iy 6n of ttr followirg d(laaliom:
<br />D.solition Pmils-&b6ros Norificdion Fldd.l R.gtrlarnrf,s (Tiil. 40, Pd6)
<br />Rcquir.d l-.lld of Notifi&lion6;d Ihc i.d6al resulnlioB rcsddins 6b6los rflovalac nor ,rpltlbl. to rhis pmjrl
<br />I havc r.ad lhis rmlic.rion md srar€ that thc.bov. infomation is coder I aBr€ ro.orpl, wi$ allCny.nd Cou.ly
<br />&d hdcby aulhorize reprMnariv6 ollhis Ciry dd Cou.ryto dr6 upon th.
<br />trbor€ mfltione! prcp€ny
<br />l.e.(
<br />) .,I.,DJD
<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 />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER tlzrl"r D+lfloL _+ts"4,
<br />Transformers rl
<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 Roush)
<br />Meter Release tp?l2a Pfr{fl6,-4&a
<br />Rough
<br />Service Meter ll14l'k)PWa z# Ej - 'frlvtO Po"t.r-
<br />FINAL t l "-b'114 Dnroc LJLET
<br />Notes, Remarks, Etc
<br />e*
<br />Rev.0B-07-2015
<br />,",",l.JI.eDgp
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