|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DELCARATION
<br />I hdcby srmr undq poally of prjury thar I d .r.mpr turt th. CoDtra.lou Lic.e l.rv lorlhc follo*ing r@. (Sd70ll,5
<br />Alsin6s ed Profeio. Cod.): Ary Cny or County vhich r.quncs a Fonit lo co.sltucl, at6, improv., dmolish or r.psir My
<br />srruc1uc. Fior ro irs i$ue.c, .bo rcqliG lhc opllicd for such Fnil to liL a signcd srdmd rhal h. or sh. b licscd PBUa
<br />ro rh. pmvilios of tlE Conr,Nlor's Licos€d Larv (Chlplq 9. Conrnmcing wnh Sdion 7000 ot Division I ot th. Bsins ud
<br />Pmlsions Codc) orlhat h€ orshe G.xmo lhc.froned rn bsis iorlh.allcs.d cxdPlion. Any viol ionofs.nion7011.5by&y
<br />aptlicad for ap6mi subjEtsrt opplicr to a civilpcnrhyotnol oor.Oo,iv. hundtd dolla6 ($500).
<br />I. a{ oM* 6athc proprty, or my emplorG wilh sar6 6 lh.ir elc conD6elio,. wiu do lhe work ad thc nrudrc is nol
<br />i drdcd or oroed for sal. (Se 7044, BusinN od ProfsioB Code 'ftc Conlradors Lic$c l,w do6 not apply to e ownq of
<br />rhe cmn€ny who toilds or inprovslhqoMd who do* $ch $it hins.lf orndclaor tttroush his or hE oM cmplor6,
<br />prolidcd rhdr soch iBpovdndcmmri dd.dorofigd for el. lL howds.lhc buildugorinprov@l bsldvihinon. ys
<br />ofconplclion. thc OMd aukt6 will hlvc lhc htrdm oaporins lhd h. or $. dij rct boilii or im!.ort lh. pDpdy aor lh prrtosof
<br />I. s ownd oalh. Fop<1y, m cxclusivcly contraclins wnh I.6E d c.fustou lo on{rucl lh. Foj.d (Sd. 7044. 8B66
<br />and Etrftsrior Cod. Th. Conretoi s Licc6e Las do6 nor ,pply lo M orvnd ol prop{ry uho builds or inpDv6 ddm6.
<br />and who co 4cts for sucn proj.cls wilh a ConiEclo(t li.m.d pu^lel t thc Conttclor's Licdsc L5w).
<br />I tun cr.'nfl $dd Sdion , B. & P C. lorlnG r6on.
<br />D.te: O*ne.
<br />ua[5[&s]qol4EENr4llar
<br />DIC].ABAIIOX
<br />I h(€by ar,,n und6 p€,altyolpqjuryoncoarhe follo{ine d(lealioN:
<br />- -I harc and will ,nainrai. d C.nificsr. of Conmt lo S.ll-l6w for erk6 .ooFMion. 6 FDrid€d lor by Sdlion 3 700 of lh€
<br />Llboi Codq lor th. pdfollMc. o f thc worl for which Ihc psfti a sucd.
<br />A har.mdwill mainrah wori6 conp.Natio. iBudcc. s ..qui'.d by Setion 3?00 of lh. kbor C!dc, lor rh. pdo,ll@. of
<br />csir ad policy .unb6 &.:My workds .onlplrulion iG,rdc.-l
<br />PrtatN $s JI A2EGA\b €e-z--
<br />Sdion 10?6 oithc lih,r Co.lq inlerd ud atromy s f.6
<br />Z 7
<br />I lkchy arm ondd pmilty ol pdjury ln.l I m und6 r.ovirion of ChaEE S (omnmci.s wnh S.clon 7000) olDivision l
<br />Li..B.Nu,nbd to <8 37/
<br />""", 2/?/ zo c^,*",1
<br />I hftby aflirm unds p..ahy of l.iury rha tnd. is ion kndinr as€ncy for lhc p6lbrlm.c of th. $orh tor which this pcnnil i5
<br />issoed (Se.10s7, Civ C.)
<br />APPLICANT I)FCI ATTATION
<br />I hdlby rfm und6 Fnahy of pslury oE oflh. followins d..ldalioB:
<br />D.molirbn PmiteAsbdos Notif!.alioo F.d6al R.gulrliod Onh 40, Pet6)
<br />_R.quirld Lald of Noli6cdion
<br />I cdiry thrr rh. fcd6.l r.gularioN E8srdins abdG mo!€l @ not rpplicabl. lo lhis ptuj..l.r,z-\l cqrl' rha I havc ,ad th! rpDlrarion 6rd !tar. lh& lh. stovc intom.rion i. cor..l. t alrc lo cosply with dl cily ed couty
<br />ordinancs3ndSrarclisrelarinstoburldinrconsh.rion. d n6cby sulhonzc rcpr6o aliv6orlhisCnyedCouryro@tdup.n$.
<br />abov€ molioned propoly for NFnrotr pu,Irss
<br />ADplicrnr or Bcnr Signirre
<br />1f
<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 />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER I @ Pll,v1w{I
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment 2t 'tKlza PF,n*6n
<br />Factory Wired Unit I fr
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouqh)tl
<br />Meter Release 4_fi+'ZA ##tr /
<br />t
<br />Rough L/({ lzt oav$ 8-7
<br />Service Meter I I I
<br />FINAL a1,/,.r*1ltt Dt+v1-+ k-/
<br />Notes, Remarks, Etc I [,
<br />Rev. 08'07-2015
<br />,,on* A/r</z ct
<br />I .diry rai ir lh. pdtonnancc ofllE work ior which lhis p.mit is i$ucd, ! shall nol frploy any p6on in any hmnd
<br />e 6 ro t€om. subjar ro thr worL6' @rposalion laws of Calitomia. ed age thal il I should h<ooc aubjel to tlE
<br />vo*6'conFstionpronilioNofSdionl?00oalhcLlborCodelshall.lonhwilhconPlywnhthospovieioN..
<br />WARNINGT Failur. ro sEu. wrlcu comp.Nalion covgasc s unlawful, md shau subid m oployd lo simioal paalt6 &d
<br />civil find up lo on hundrcd rhoMd doud ($100.000). i. lddnio. ro th. cosl of comps&lion, d@g6 a p,ovidcd for ih.
<br />of rhc Businds dd PllfsioB Codc, od my licdse ir in tull lor.c dd .llal.
<br />o
<br />t6ddt Ad&e:
<br />-
<br />PcrmilE nrnc {t,rlnl ):
<br />7
<br />fit
|