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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I herebr afiird undr pqalty ol pdjury lhal I m crdnpl ftofl rh. ConlmcloN Lic6s lrw tor lh. aolloNins rasn (Se.7oll s B8in$s md Proasnr. Cod.): Any Cily or Counly shich r€qun6 a p6mi ro codlrucl. all6. inpro\ ddolish or rqqr any srrudure prior io irs issuMce. .ls. r.qun6 Oe applicdl lor such pcnnn lo ile 6 .isn.d iatcod thal h. o. sh. i1 li.aacd puMmt ro rh. rovisions ol lh. Cont,ador's Lic€ns.d La{ (Chapler 9. Cornncncins silh S6lion 7000 of Division ll of lhc Bosin.s md Ploacssions Cod.)orrhar hcorsh. G.rcmfl rhg.aronr and rh. bais aor rhc all.r.d cr.mpion Any violationofselion 70ll t lrany applhad lor ap@n sbjclsrh. applicaorro acivilp€naltyofnor !no!ethar fivc hundr€d dollac {!500) l. a o$ ncr ol the prepeny. or my cmpto,€e rvnh $.86 a rh.i rn€ .onlrhsdio.. trill do rh. \voA ed tfic ifl.18 b nol inldded orofttrcd for ek (5€.704,1. Busins d Ltofdios Code 1lle Conracrors Lic€N L.s do6 not rpply1o oNnsof lnc t !p6ry sho hil.h or i,nrror6 th66n. rnd Nho do6 such Mr* hinsclf or hds.lf or rlrouEh hir or ha oM .nploy*, pRrviddl rhar such ihtfrlddts ac rcr imddcd or ofiard for sak. lf. hos6d, thc hlildin! or imprevendr is sld wirhi. o!. )E orco'nplclion.lt. O*,nc. Buildq will have the burdq oaprcvin* E he or str did nor boild or i,npo!.lhe p,lpely aor $e prrpoe ol !. as owns oflfie prop€ny. .m crclusiv.l, contmctin8 vnh licmsed contradou to conshrcl rhe pFj.cl lss. 7044. B6in6 and hrlGion Cod. IhcCo.kd.r.r's t-icosel-a$ do6 nor aptrly k, do{nq ofpopcnyrvho buildsor nhpo\esrhoeon. and rvho conrr..ts lor such pror.ds with a Cont0do(r licd*d pusuanr ro tncConrracro.s Lico* La() I mer.nrpl undr Sshon .woBEE&r:r:ourErsAfx}! 0Ect48dr.!o! I h&cl,t anim und( p€nalry ot p6jur) on€ oflhc iollorins delmlions I havc dd rvill (ai.min a Ccnifi.arc ofconsdr ro Self-lnsurc for rorkqs comrm$rio.. prcvid.d for by S(tion 1700ofrhc t bor ( bdc, 6r lhc pdtumdc€ o llhc wo* for s,fiicn lhc pe'rit is issued. lhalcand$ill m.inrain Norl6 .ohr.Bati6n in.uran €, a Equi'dl b)- S(1i.. 1700 or lhc l rh)r Cnde. lor rhe Faomancc ot tn€ \rc for \ii.n nris p.mit is isd.n M, worl6 .onldlrdion iNUro.c carid and poli.y numb( d.: F T lLq hJ(li 'trJjDtat 3 zJo V/rlzozo I cenilylhat in thc pslonnancc oilhc \rork lor shi.[ rhis pdrnil h issued. I shall.or mplor a., p€6on in 0ny man.d$ a to b.o,ne subj*t t, 'he \ntk6 &np.nsar nr. hws of C(liromis. and arc rhat if I should b*om. subj{r ro thc ryortm' compLmlion prolisioB ol sdion :1700 .arhe Lator Codc I shall. lonhvirh compl, \!nh tho€ provbn ns lvARNlN(;: Failurc r., suc rvork$ conp.Balion cors.sc is utrl.\(tu|. and shall subj(t M onplor€r lo sinrinal p..ati6 ond cnil nn6 up lo on. nundr€d rhoBed dolld ($100.000), i.0ddnion ro thc cost ofconrp€nsaiion. dmas6 as prorid.d for rhc s.Lfoi :r07601 rl'rl.rlxtr(irdc. tr c'sraDd3rrn.!'s D",". r i"?-zo * LI(:ENSED CONTRACTOR DECIAAAIIOT I hseby aflinn undn p.nalry o t prjury rhar I m licasl rorlct pmrcion of chapra 9 lcomncidg wilh setion 7oO0) oflilision :l ol lhc Busins ed Prolsions Cod., and my li.d* i! in tull Lr.c dd .It$r n**cr"* . 0ltj D.t" . \Zfs\/Lazl 7qLlu7 <.u,,r,,.r. !t- R.5 ie*u €E s ir.,a carflaucrorL[lDlNclti[rcr I hcrcby artrm undd p.n.lry o t p6jut fial rhd. i3 , s.srrudion lcndins aEdcy ror rh. Ff.mdcc ollbc Nnrk for shich this rEnil is issu.d (s.. 1097. Civ. C.) ATIIICANfDICIAAAIIOX I ha&yamm undd p.n.hy ofpdjury oncoath. follo*ing d<le.riansi Ddtrolirion Pml!-Asbdos Norifi..lio. Fcdo.l R.rudions (TnE 40. Pan6) R.qun€d liiooaNoi6cal6n I cglily that rh. f.d.ml r.anl.tios Egading ah.sros @o!al e nor ap!,licab[ ro tnis proj..r 5+l cdr&rhd I h.\. Gd rh! apphcar'on and 3ra!.rhd rhc atFvc inaomarion G cor€d.l asre ro cooplywnh ollCnyand Counry_dtdinrn.6 and Sr4. ti$s Elatine io bdildinS consrru.li.n. ed h6.ty aurhonzc rcpr6dtlliv6 ofthis Cny&dCountylo €nr6 upon th. ,bovc oorioned peldly for itupetion pu.ros6 nnn,,."n, o. ,*.n,,.i*n",u." [ f, po -r,N mo. {prin, r:)( -i-y BvPlero s-r l-7-zo Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Bu ilding Bonding / Grounding / UFER Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release Rough Service lvleter il FINAL 2///za ,81 7// Notes, Remarks Etc lcl /u 7L/ 4 Under Slab / Floor Transformers