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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTS OWNER BUtLDEtr D&ITANATION <br />I hdcby amrn unde ldalry oa pdj"ry that I dr excmpt liorn th€ Contmclo6 Lic.@ Lrw aorlh. aollowiog r.eo (Sd 7031.t <br />ausir6s md Profsion Cod.) Any City or Counly which r.qut6 a ponil lo .odirucl, .hd, imFov., &rDolieh or r.Fir e, <br />smcI@, rior ro ns isgudcq abo r.qliB lh. ao! such pcmil lo 6lc a sisncd llaoc that n or sh. i! lic@.d p@rn <br />lo tn. prcvisions oarhc Contmcioas Licmsed t.v (Chapld 9,"s vith S.clion 7000 ol Divirion 3 oflic BGiIH Md <br />IhoGsions Cod.) or rhar h. o. shc t cxopt rhocFod dd th. for rfi. all+.d.rdrlion Aoy violal,on ofselion 7011.5 by aoy <br />ffiffi ;il;ffi ffiffi ;;ffi ;i*,:#:riffi ff "H.,rh. Fdrdl sno hril& or impmr6 *E6n. tud sho dc sucn w& or hNl f or rimu3h his or hE own mplo,€6, <br />prcvided thar such imp,ovo€nls @ nor hrdd.d or ofiod ao. sh. If. hovd6. tic biiiBi.s or nnp.or@l is eld within onc ,@ <br />olcoopldiorl rh. (,*dd Buildc sil ha!. rhe bud6 ofproving tfid h. or sh. d'd nor build or improle tlE pmpaly lor d. purpos ol <br />.1. soM6oirh. Fop6ry. ancxclGn.lyconkdcri.s with licm.d conlractoslo coNtrucl projxt (S( 7044, BBi6s <br />buil& or inpmlcs rhdon.dd P,oi6sin Codc: Thc Contacrort Li.eN. Law do6 nor oppl, to own6 oapropaly <br />.nd who conn ls lor sudr wirh a Conllscto(O liccBd pursuer b nE Co <br />OECI.ABAIIOT <br />I h(.by afiim !.d6, of pojury on. oarh. follo{i.g dsleatioE <br />Ih.!crdwill'ui.inaCdific&t.ofcoNntroS€lUnswcforvork6codFsrion.6FovidcdforbySdtion3?00ofltc <br />hbor Code. aor th. pcfonnmc of the *o* for ut'ich thc p@n 6 Nudl <br />_ I havc ,.d vill nai.rain vor!6 conpcBalion iBurece, 6 r.qut.d by SEtion 3?00 of lh. Labor Cod.. for ln. poao,ijjm. of <br />rh. worl for which rhis pdmir i. irsu.d My workd comp€ffilioo ireuroc€ ceid dd policy nunbd d.l <br />Dic) Numb.r l\pr6:/ln- <br />'!f I ccn 'f, r har m r hc Ffomrncc of lhc worl lor which this p6,nn is i$u.d. I shall ool mploy &, p.rsn in &y mmd <br />$ d ro bdom. subjer lo rhc w*d' omFtsaion laws olc.lifom4. ed r8B tnd ia l stould b€omc subJdl to llE <br />work6 cohpecarion pIorisiom oa sdrion l?00 of thc Labor Code, I siall. fon hwilh.omply u <br />to su. *orkdt coopssation co dploycr <br />'o <br />di,nir.l p6Ell <br />hun&cd rnousdd dollm ($100 sddirion ro rhe.o$ of.o <br />Cod., inrdcsl md atonErt <br />!lcLL!tL(!.N,!]B !1!)-B <br />DECLAA{I]O! <br />I t.r€by amm undo p6ahy of pdjury lhar I &n licc$dl lndd prolision oach.pl6 9 (comocins *ilh S€.lio. 7000) of Divilio. 3 <br />of th. Busin6s ud Prol*ioB Codc. dd ny lictuc is in fuu forc. md .fidl. <br />CONSTRUCTION Lf, NDINC ACENCY <br />I heby alImr undcr poahy of p..jury thar ttqc is a.on$tucrion lcndrnS .g6cy fo.lhc pafo,tmc. of the wo tur vhich lhb pamit b <br />isucd(Sd. 3097, Civ.c.) <br />APPLICANT DECT-ARATION <br />I ho&yafmund.r p.naly olpcrjury on ofrh. aollowinS ddlmtions: <br />D.mlition Pmils-Asb6los Notific.rion F.d.ral Rcsuhriohs (Till. 40, P.n6) <br />_._.Rcqurcd L.(d of Norin€lion <br />c icsedinB 6b6tos rdnoval arc <br />I asrd ro.onplr*th.llCnyand Coum, <br />iv€s.frhis Ciry ud Cou.rylo orr upo. rh€ <br />above nrcntion€d pop€ny tor <br /> t or Ag€nt Signhtrre:o a. <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 />Communrcations Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Torqueinq <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 Rough) <br />Meter Release I <br />I <) <br />Rough 5 4il1),Dttulufi !6) <br />I 1lN,, W <br />FINAL :A '.)t lL'.r\1\ulf ta-v" <br />Iletes, Remarks, Etc <br />\JI I <br />-) <br />Rev.0B'07-2015 <br />APPROVALS DATE <br />Transformers <br />Service lvleter <br />)4\y1-V^5 . fu)q-Yt+'Al a.( <br />hkLYtillveS 'Mtr/ N <br />2pu2 <br />2H\/A <br />I <br />--------T------ <br />I