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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE OWNER BUILDER DDITARATION <br />I hcreby amm undo ,.nrry of p.rt!ry rhar I @ .r.npr f$n rh. Controclom Lrc.nsc Lav fo! th.followi.s r.en (Se.7011.5 <br />Busines md Proasion Codc): Any Cily o! Counly shicfi r€qrir6 a Dcmit to co6rrud. alla. inprolq d.oolish or r@an uy <br />slruclue. Fior ro ils sud.c, abo rcqunG rh. applicMr ror su.h Fmi b nl. r si8n.d slddnml rhal h. or sh. ir lictucd pmuaJn <br />lo lh€ I,orisioB of rh. Contrcroas Liccnsd liw (Chapre t, Commocins sith Sdtiotr 7000 ol Division I oflte A6in6 ed <br />Preldsions Codc) or tha! hc or shc n cx.nfl rh6.non dd rh. bsis foi Oc alllt.d donplion. Any violfllionotSdlion 7011.5 by oy <br />appticd foi a !.mn subjdts ihc rpplicet to a civil pemhy o t bor nor. rhm fiv€ hundrcd d!ll6 ($500) <br />I. .s ownd ollhe p,op€ny. or my cnDloyes with was6 s th€r sl. conposation, will do rhe work and lh€ s:lrucl@ is Nr <br />inrord or oilq.t for elc {S8.7O1,1. Busind tud Prclsions Cod.: 'tl1c ConlEclois Licdc Low d.6 not arply lo d ost6 of <br />nr pmpart sho hril.tror nnpm!6thsan. ad wno do6such m himselt o. h*lf or rhmush hi5 or h6 o*r @plor6. <br />providcd rhd such e!.ovflors e ht inlad.d o ors.d tur s.lc lf, how66. rh. tuildins or iftrrovffir L sold rvithin on. yw <br />of$dpl.rbn. lbc Ons BuiBq rill hN. th. hrd6 .t proving thd tE or 3h. did mr hrild or nnForc ih. Fopaly ft,r tlE purDos of <br />-1, <br />c oN.d olrh. Flpdrn m cxclusircly conlmdina wnh licdE d cotu{crou h odrrucl rk poJcl (Sc. 7044, BGiIK <br />ad PNtusion Codc The Conr4doa3 Licd. L.N do6 nol 6pply lo d oMr o apropd, who buil& or imprclB lhq@.. <br />ed *ho conrrds for such pr.j6ls wilh r ConrBcro(s) licNd p6@r lo rilc Contrctors l-i<t4 t w) <br />I tun.(hpr u.dd sc.rion , B & f.C. lorrhis rc6on <br />voarcas:coMfEtsalroN <br />DESdAAIIAN <br />I hd.by aflm un ld pdulry olFjory oo. ofrh. follosiiS dsLrarioBr <br />I havc od rill nai ri. a Cdificat. ofCoMI lo S.lf'16u. lor Mrtd6 6nrp.nsalion, s pmvidol for by Saioo 1700 oalh. <br />Labor Cod., lor lh. Faolr@cc oath. vo* lor wnich th. patrn ie isucd. <br />-l havc ard will 6aint.in vorkds corFsaion ituur.n c, 6 r.quncd by Sdrion :1700 of th. l,bor Codc. for lh. Ffo,@c. of <br />lh. work for wnich lhh pmit is i!$.i. My workEt @hp$arion iBuu.. wid ed poiicy numb6 el <br />,*., ,tlll^r<l &tt -*Aa <br />9t< r-l rncot>ql?o <br />_l ccniry thar in rhc psfornran cof the *or! aor which rhis prmn is tsu.d, I sh.ll nor dnploy any rtMn in dy med <br />$ N ro b..ofl. sotjdt h th. wortsJ com!.nel ion laws of Califomi., md asre lhal ir I should b..os. subjd ro lhc <br />work6' conpmarion prolisions oas€clion 1700 of lh. I-abor Code. I s\all. fonhsnh .or!1, *ilh tho* pmvisbN.. <br />wARltlN(;: Failrr. to su. vork6 comp.Eation covms€ is unlawful. and lhall subjdt e antlord to aininal poah6 d <br />civil fin6 up ro on. n6drcd Gousd dolls {t100.000). h sddilion lo lh€ cosl ol compcMrion. {tlnaa6 6 p.olidcd aor rht <br />:,:- lt'oii <br />he lihY a,xl. innY.{ <br />^n(lI 5 20ts <br />I hcrcby aflir m undq poalty o I pdjury rh.l I tub licds.d u.de piovi5ion ofChagq 9 (comnHcins with S*tion 7000) ofDivision l <br />of rie ausi.s sd Proasions Cod.. ud my licoF is in tull forcc a.d ctrers loo"noa <br />d.,. <br />codtrBtlcuaxrf.NDllc-acllcr <br />I h€rcby amrn unds [gulty ol pojury rhd thd. i5 . oisltuclion Lnding agmcy for lh. pqfomamc of lhc uork for $hi.h lhi3 Frmil i! <br />i$u.d (Sa. 309?. Civ C ). <br />AfXIICAtrLDICI,AIAIII}B <br />I hotnyofrmun.l6 Fnaltyofpsju.y otr of lnc foUovins d€lralions: <br />Dcholilior Pnnits-Asberos Nolificarion !-cdtral n€suhlioos ( l ille 40. Prn6) <br />-Requn.d <br />L.1rd olNolifi cdrioo <br />-l <br />c6rit lh.t lhc f€d.r, r.sulanoB Ee&ding 6bdo. rdnoral @ nor aptli.abL lo lht pnjd <br />Wdn) hd I h^ e,an lnlappltr rcn ed nar€ rh.r rh. aL{v€ inaomarion is cor41. l ssrc ro omply rvhh tll (:iry and Counly <br />oin6c6 M,l srd. ti{ s rcl,r hs ro boildins coBrudrn, .rd h(.by aurho.izc r.F6dr.i ir6 oarnt Cny dd Coomy lo 6t6 upon lh€ <br />ab\c m.,rioncd pftrNn, ror tutect ilot/| 5 20t8 <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 />Building <br />Under Slab / Floor <br />Bonding / Grounding / 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 RouOh) <br />Ivleler Release <br />Rough <br />Service Meter <br />FINAL wutt q\g$ <br />Notes, Remarks, Etc <br />rD/stG.COMMENTS <br />Communications Cable <br />t.ndd'r Ad&a <br />Appll.ol or gd( Signrlor' <br />Pmlre n.ne(prhi):