|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.OWNERBUILDERDOLCARA'TION
<br />I h..eb.v afitu unds Fnalryof Fjury lh.r Idcrmpr liom rhc Co r.cro6 Licds. tin lor rh. folloNing r@n(sd701It
<br />Busincss and Proa6sion codc)r n, city or coum, which mqon6 a pnnir to consrtucl, .ltr, inprov.. ddolish or leair any
<br />struclure prior 10 its isumc.. also r€!un6 the @plic r lor surh F it to file a sirfl.d slatmflr lhal h. or shc ; licftcd pud r
<br />ro rhe provisio.s ollh. Conlr.clors Lic.nsed t w (Ch.fl.r 9, Comm.ncinS silh Sdion 7000 ofDivision I ofthc gusincss ud
<br />Professioos Codc) orlhat he or shc Ls cxcmpl thqcliom.nd thebsis lor Ihc alle8.d crmplion. Anyviol.lionofSe.lion 70ll I 5 hy any
<br />aptli.aor ror a pdn subj<ls rh. ap,li.ant ro ! ciril peoalry or ool !nor. rh& nve hundred dold 6j00)
<br />l. a osn( of lhe FoFiy, or m, employd $ ilh ra*6 N rh€ir sL cohp6Mrio,. *ill do lh. q(rt dIhenruclrcisnol
<br />inrerded or ollcrcd for sle (S€.7Or4, Busins od Prol6sions Codq 'l he ConrBclois Li.msc Li$ do6 n.r aF ly ro .n o$nd of
<br />rhc pmpsly sho hilds or iqrovBlh6on- ad * ho do6 such NrrL hins€lf or hffi.lfor rhrouEh htu or hs o\n.nploy6,
<br />,rovid.d rnal such imprcvanors e rct inrcrd.dorors.n 6rsl. I[ how6,6.lhc toildiru or imprevmc is snd silhin on. y6
<br />.fcomddion, rhc ()*rd Bnildd sill Mrc th. hnlar oarrovi'U ${ hc or sh. did nor btrild oi nnrov. fi. ,,!F1y for th. Nrroe of
<br />l. 6 orvnq ofrlrc propeny..m crchNivcly contmdinB \vnn licmsd connadorslo connrud lfic pqel (S(. 70.14, BBIN
<br />and I\r,r*ion Codc: Thc Contaclr's Lic.tuc Las do6 nor apply lo a..rn6 or propdlJ-' $ ho btrilds or imlrovB th6.on.
<br />.nd \no cona.cts tr .h prcjds with a Conhcrorls) licdB€d puGuaar Io the Conrraclois Lico$ I aw)
<br />larercn, undcrScuxotr .B & PC lorlhis.ea{a.
<br />Orner
<br />1!Oa[88{!:O!IEEI&!M!
<br />Dtcl,]lxauQ!
<br />I tcreby atirm und6 ruahyolp6juworu oflhc lollowin8 d6ltralio6:
<br />I hav. ad uill mainrain a c€nia,cdl. olcoMl ro sclf-lNur€ tor soirs compots{io.. 6 pmvid.d aor by s.{rion 1700 o f th.
<br />L.bor Codc. for lh. psfomflnc. oflfic woII lor wh ich lh. ,mil is isu.d.
<br />Z!i+u,. una * ,rr *"'n,
<br />"in
<br />* nrl6' cfmpssar
<br />'on
<br />iNuranc.. 6 i.qurcd b, s..tion lToo or rh. L.bor ( ode, lbr lhc p6rdmmc. ol
<br />rh. work aor shi.h rhis p.mrn is isual M,r!6 .ontdrarbn iBurmc ceid md policy.umbd dc:a-
<br /><)
<br />I clni! rhal in the pdlo' 'nanc. ofrhc sork ror \hich this psmil is irsuc!, I shalln.r mtloyant
<br />e 6
<br />'o
<br />l$om subjer ro rh. workm' comp.ff.rio. lass ofcaliLmia, and a8re that ifl shoold t comc subjcr lo thc
<br />Nork6' co,npaetion ,mvhioN of Sdion l70O olrh. tjbor (hd.. I shall. fonh\rith comply wilh lhs proisions .
<br />W RNINC: Failurc ro kur. $0116 <onlp.nslion covdaec ir unla$lul. dd shall subjdr m anployd ro fnninal p<trti.s af,d
<br />.ivil nn6 up to onc hundrn rhousand dollm (Sl0o.0o0). i. lddniod ro rh..o$ ot comp.ffilion. d ra86 6 proridcd for thc
<br />inrcrd and atom6y','s fLs
<br />l.t( ENsaD ('()NltL\( I()R
<br />DICLIA{ISI
<br />I ho€by sftu m undd Fn.liyoipdjurylhd I m licas.d undd tlorision olChapt6 9 (conm6ci.s wnh S.dion 7000) olDirision:]
<br />oa rhe ausi.as and PolaioB codc, md my licms. is in full lor.r md .aa.cl.
<br />,.,,-,.Cb* C7?
<br />".," /./a,/z-o riceNeNumE /o///73
<br />C9I|SIAICI!!'I-LEIDUCAEIIC]
<br />I hdeb, amirn undd pcn.lry.ipdj!rytld
<br />'h6!
<br />h a $*'ndtJ. kndins astr., aor rh. F fonnmce oanE qort lor shich lhis !6mil is
<br />isnEd (sd. 11097. cn. C.)
<br />APPI-ICANT DECLARATION
<br />I h!*ry afift ondd pd.hy olperiury on. olrh. aollowins d(ldarioft:
<br />Ddnolirion tqmirs'Asb€ros Norificarion rcdml Rqnhlions ll irl.40, Pano)
<br />R.{uteJ Ldrd ol Nolifrcalion
<br />I cerlify lhar lhc lqi6al re8ulal ioos r.xaniry.stsros rcmo\0la,e nol ipplicnble to lhk p,oj€cl.
<br />I cnlilr rhd I naE rcad $t appli(arion md sr.rc rnd d. ablc infomiti.n is..n&l I.sr*'ocorhplywilhillCiryandCounry
<br />&d h€r.t y aurhorte rqrBmrarirs oflhis anysnd (
<br />t"s,
<br />Site-Work
<br />Underground
<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 / Groundinq / 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 Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />N/eter Release
<br />Rough
<br />FINAL /-r"- ?4 D-..f ,'.!
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />Pole Bases
<br />Service lvleter
|