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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' 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 and PolaioB codc, md my licms. is in full lor.r md <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*'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