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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DI'LCARATION <br />I hd.by.mrm und6 pd.lty ol pdjury rhar I &n .rcmpt liom rh€ Conhcror' Li.ens. ta* tor rhe lollowinu r.Mn (Se 7trll.5 <br />B6in6s ..d Pmfaqion Cod.): A.), cny or cou.ry whi.h equn6 a tEmn to .onirud. dh6. imp.ov.. dd,oli'h or r.p{t y <br />struclure pior lo il3 i$uanc.. als rcquiG lhc applica lor strch p€mit ro filc a signcd srarotral rhat hc o! sh. ii licaEcd pcudr <br />ro thc pmvisioB oa rh. Conlrlcrors Lic.ns.d Latr (Chapn 9- Com.hci.! sio Serion 7000 oa Dnision I old. Busincs d <br />Prof.sions Cod.) or $ar he or sh. is .xmpr fi@tos dd rn bara lor lhc rlleSed .mnplion. An, violation ol S€clion 701 Lt by any <br />applicanl for a pcnnit srbjrclslh€ appliconl lo acivilp€Mtyoanor lnoretho fivchundrcddollss($500) <br />_1. as owrcrolrhe pmpeny, or my.,nplorG sirh wagcs6lhet $le compmatbn. willdo th. wo,k md tlE struclE is nol <br />i oded oroifd.d aor el. (Sd.7014, DBinN d Pr.asirns Codd Thc (o.'lroclois Licos,js doc nol applylo d o$,s of <br />th. pmlh) who boilds or nryrov* $@., dd $hd do6 su.h *o* hnns.lfor h6.lior rhrcugh his orfir o*n oploy6, <br />provided that such imlrov@rs ft nor inlod.d or ottold lor eL ll ho\ard. rh. buildins oi nntiovmmr i $B wnhin ',ne )w <br />of conDldion, th. Osr( Builda "ill havc the hIds ofprovins thd h. or sl'. dii nol tnild or impre\ c 6. I'spsry aor lh. purpos ol <br />-1.6o{nrof <br />th. Iropsly, d dclusiv.lyconlrftring virh lics.d conlra.roBlo cda'tud tbc Fljd (s(. 7044. aueins <br />md Plol66.code: Th. Cotrtraclois Liccns. Law do6 nor apply to eownr ol prop€ny rvho builds o. nnprov6 $d&n, <br />and *ho contmcrs lor such pojdrs wilh a Con!6clo(, ltc6.d puGudr ro rh. ('onlra.lols Li..N tr{) <br />lamerempl u qs.{rion ,Lt &PC lorthisrcGon <br />.!roaxEr!r:co!!tErs6!!9! <br />D&CIANAIIO! <br />I h6€t'y afiirm und6 p€n.hyotpsiuryoncoilhc lbllowin,r dNlaralioN: <br />I hflv€ ed rvill roinl.i. a Ccnificare ol Coredr ro ScllJ6urc tor workBa @nD.nsri(,r, 6 p.ovid.d ior by Selion 1700 of th€ <br />tibor Codc for rne pdaoflnMc. o f thc \nt for whicn d. Fni b bx€d. <br />_l havcandwrlllnaintain *orkers conpcBarion iBurdoce. $ reqlned hy s&rion 1700 oarh. tibor (td.. for the pgiomecc ol <br />a! iieucd. My worltd!- conpq&lio. i*l@.c .&nd ad poli., numb6 ee <br />lat 4 <br />L////./71/ <br />I cenilylhat io Ihe pcrloflnanceollhework for s[ich lhis pdm]t h issu.d. I shall nol cnrploy any p.6on in any 6e.d <br />s s to b..on. subjsr ro rhc mrts comF.elion l.ss ofcalilomia d arr rh,l if I shnuld h.r6n. subj.{i t) th. <br />woIkm comp.nsalio.povisionsofSeclionl?00oflh.tibo!Cod..lshall.lonhsirhco'nply$irhlho*psvisioru <br />wARIINC: r{ilme ro suc workm' comp.nsarion covGase is unl.waul. dd shall nrbjccl an mplors lo Fninil <br />'j.nahie <br />and <br />civil fm6 up Io onc hun&.d lhousd doll6 (t100.000), in addirion lo rhe con or&np.Nlioo.d,ruE stJ,rolid.d ro! th. <br />Sdion 1076 olnrc bbor Codc, intresl and lrtorE) s rs <br />,",+l0y f5l0l8- <br />DI]CIJsATIAN <br />I h@by am,n u.d6 F.alty of Fjury rhd I m licds.d und6 Folisio. ofchrpl€ 9 (.om,Mcin8 with Selion 7000) ol Dilision 3 <br />ol lhe B6in6 sd PrclsioB Cod.. ud my lic.N is in tull forcc ad c,Id. <br />D /e"2??0.o? <br />*"ll0vjj20tg c.n(r'.,.r ^<- <br />(olutrllcrloNtllDllc-acENcr <br />I hd.6, rlIri u.d6 Fnahy of rrjury 'h, thd. ie r co.nodion Lnding r*dcy aor $. Ffomde ofrh. $o.k for snich lhn pdnir b <br />i$ucd (Sd.3097. Civ. C.) <br />AIIIICAILDECIASAIIQN <br />I b.dy amm uidd poalry oaFjlry on. of th. followins d6l@rio6: <br />D€moliion Pgmils'Asb6tos Nolilic ion Fcdoal Rcsulalions (lirl.40, Pan6) <br />R€ut€d Inrs of Notifrcalion <br />-l <br />cdifythd rhe fcdsal r.gulariom rcBddins Nhcros rdovaluc nor applicablc ro rhis prcjEr <br />k*t-"x:tI h.verdd rh6 rrplicrrion ed.rar.$.r lhcdbovc iniodatn,n ir.o l I aBrc ro .omply wnh all Cny snd Couory <br />rro I a\s rrLxri,i! ro bu'1dtr,3 consru(otr. and aurhonz. rolrMrativ6 oarhk ciry md Cou.tylo ql6 upon lhc <br />abve menttrn€d prop€ny lor inspalion <br />,{pDlic!nl or ,\lcnl Signtrlure <br />Pem'il€e ninre (prnrl): <br />,ll0V 1 ! 2P1g <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 / Grounding / UFER <br />Transformers <br />To rq ue rng <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roug h) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />Rough //-lc 1e,.4e..2: <br />Service Meter <br />FINAL llt tr/l't >u6t <br />:ZA : t.l; <br />It4eter Release <br />Notes, Remarks, Etc.