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ELECTRICAL-INSPECTOR HECORD
<br />APPROVALS DATE ID/SIG.COMMENTS O1INER AUILDER DELCARATION
<br />I hcrcby sfirm lnder pcnllry ol0crr!ry lhsl I r sxempl ,iom lhe ConlracloN Ltene Llt ror lhc louosins rcrvr (Sec70315
<br />Busirrs and Prolcssion Codc): Any Cily or Coun.y which rcqunca , Jrnnir u onirucr. rlr$, nnptuvc, dcmolkh or rcpair any
<br />srtuclurc. Frbr lo ns issuancc. lho rcluircs thc ellicant lor such Frmil to filc a iisncd slalcm th hc or slrc h lienscd l)u.sanrt' rhc trcvGio.s ol lhc Conracrols Li.c.sd lie (chaprcr 9. Comcn.inS wnh sc.lion 7000 ol Division 3 olth. Busincss ond
<br />Pmlcsrions Codc) or rh.t hc or stc is eieq,t lhcrcfrom snd lhc b.sh for Ihc lllcscd crcmnlbn AnyliolarionolSdionT0:ll.Sbyany
<br />aptli.rnrrorari.dirslbJccrsrhcaprlicanrloacivilp€nallyofnolmrclhrnfilchlndrcddolles($5m)
<br />\!.* "**, " ,* ppny..r nN.mprnrrc\ * hwas.!a\lhrtrr,h,$,nFnsJr,on.$,rrJ.rh.s,rks,*rrrr{Mmrmr
<br />inrcndct oroflcr.t ior qk (S( ?Oarl, Busims 0nd troicslions Codc: Thc C.nkrcrois LiccnB tjw des not !fl y r. an owmr oa
<br />rh. pn,Fdy who tnilds or irlmws rlr6n. ard *ho dB sKh s* hiis.lfor hcr*llor rhmlgh hi or hcrown.ntLy..s.
<br />flovidcd rh,r s!.n impmEtunh m fln inr.nd.n q oFcr{d f.r et l( horcrc.. tlE building or nr{,rorcmnr is sld wirhin om Fr
<br />ofcon{,lc'ion. r,r Ovrcr Buildcr will haw lnc hrdcn ofpmi.C du h. or shc dt d build or inq,mrc thc lmFny fo! r [u4ssof
<br />_1. o\owncrolrhc l)lo,Eny. ancxclusivclycotrrr.crin8 wirh liccnsldco.rdcrosroc.trrruct rhc proFcr (Scc ?(}14. lunncss
<br />rrd h,rf,ss Cod.:ThConr..rofsLi.cn\.tjwdoesnorapplyb.nowncrofllof.dyqh()brild\orinrphv.rrhcrcon,
<br />lnd who c.nlmcls tu such prcjcch wirh r Co mcto( o licetrscd lu^unnr ro rhc Conlmcu s Liccnsc liw ).
<br />I r cicn,l undrr S$(i,nr _-B A,t$",'",4-&lg .,",,". D(
<br />P.&CLI.BAIION
<br />I hcrcbyrllirtrrun trpcnrlryoll.rjuryon.olrh.r('llowin8dularrrnris:
<br />-lhlvcundwillmaintuinrCcrriiicatcolConscnrroSclf-lNurclorworkcncor|Engln'n.0sF,vidcdforh,Sccri(,n:17(x)olrhctihor cod.. for ihc p.rl'ormncc ol lhc wo for whkh rh. l.rdn i! i$ucd
<br />_lh0vcnnJ s,illnrinrnh sorkcff coflrpctrsolion iNtrratuc, ds rcquircd byS.cliu 3?00 ol ric L{borCodc. rbr rhc pcrti,flnlne ol
<br />rhcwortrorNnichrhnpcn.iri\isucd.MywortcF.onurnsurioninsura.cccxri.rundpolicynunrbcrK:
<br />-Lt c.nit rhl ir rhc !.rlormn.c orrhc sork ror Rhich rhh p.rnir is Nsu.d.l shnll mr cmFk,y rtry Fcrco h..t mr,rcr
<br />e s lo lErom suhrcd kr rl'. *orkeG' conrNnsai ion hws of Colifomia- a.d ue lhal if I slnukl h(rom subicr ro rhc
<br />*o*e^ conDcnsartu. prolhiotrrolS(lion 3700otrhc L{tnr Codc.I sh!11. fodnsiri conply *irh rlms t'n,vni{,os
<br />WARjIIN(;] F,ilurc ro surc mrlcB mfrp.nsrkd cov.Bgc h xhla*tul, rd sh.ll suhicr an .nDlorrr to rinrinol lEmlti\ and
<br />.ivil fincs ut b om hlndrcd thousrnd doll&s l$10O.000), nr addniotr ro rhc cos ol.ompcnsarion. drro8cs 0s irrovidcn for lhc
<br />Sccriotr 1076 of lhc Ltrbor Cirdc. inrcrcsl and alro.my i f*s
<br />*'- 7/?- /g
<br />^pp,ron,,e( 9-.( -&Ctd=.+../, LICENSED C('NTIIACTOT
<br />DEI;I,AIAII!]!
<br />I hcrehylnnm undcr ,)cnrllyoiptrjurylhll I an liensd undcr rovkion oIChrfls9 (on're inswirhSccrionTlxx))6fDiviln,il
<br />oi rhc Ausincss nnd Pbfcsions Codc, drxt ny li.cnr is in tull for.. md clTNi
<br />CoNSTRUCTIoN LENDIN(; A(iT:NCY
<br />I hcrcny offirnrundcr [rnollyoitclurylhd rhcrc t a snslocthn tndin8 a8cncy for rh€ I,crformn!_c orlh. work f.r whkh rhh Frmir ir
<br />issucd 1S...1097. Civ. C.)
<br />l.idca\ Nr r:
<br />dr.tucalfDEcldxduQN
<br />I h.rEt y atim ufrlcr penally of rErju., orc olrhe followine d(laralionr
<br />Dcnrlirion Pcfl nir+Ash.nos Nolifi cdion Fcd.Dl Rcgnldions (Tirl. 41. Pani)
<br />-+cqui'.d btro or Mri.,orion
<br />-l
<br />ccn ify rhar rhc tncd rcgulorhns rcEudins aslrsros Emval N ml !0 i.abh ro rhis pelkt
<br />-!9 ccnrfy rhd I hovc rcad rhrc ryplf,rrFn arn srrc rhd rhc alsk inloimrion iscoml. I s8e lo conply*nh rll Cny and Colnry
<br />odinane( ard shr. LiM rlnrDg ro buildi.8..nstrudion. ard lErcby Ntho.i2c Epr.*nllliws oflhis Cilyrnd Cotirylo cnt.r upotr thc
<br />trh)vc nrtrrioEd I'r,rny for ioslsli,'n purpscs
<br />?/? tgAppltlnt o. As€trt siEnllure K
<br />P€mire n"me (pnnr):9(,
<br />)'tt "+,K<a l"'Fa&'t--t
<br />Site-Work
<br />Underground
<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 / Groundinq / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Ivleter Release
<br />Rouqh ldLbl8T,v nwalz ,)
<br />Service ltrleter I UI
<br />FINAL Ilrtlt/t1 vrruq.d("9./No1es, Remarks, Etc.UI
<br />-r)
<br />Transformers
<br />L.ndcas Addrc$:
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