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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS OWNER AUI LDI:R I}I]LCARAIION <br />I h.rc6y amm lodr p€flahy ol psjury that I m cxmg 6.m thc Contr.dou Lic.ns. L.w aor thc hllowins Ee. (Sd.701 1 .5 <br />Busin6s 6nd Profsion Codc): Any City or Counly which r.qut6 3 Fmil to conslod. rh6, ihprovi ddolish or'rcpair tuy <br />slru.'u... prior lo irs audce, als requn6 rhc arplicafl aor suct pemil <br />'o <br />nl. . si8n n st.rmot thar hc or she is licds.d pwer <br />lo lh€ Fo\isions ofrh€ Coona.tois l.ic.nsad IAv (Chaprd 9. Condd(.s wirh Sction 70OO ot Division I ofrhe BBins od <br />Phf*ions Code) or lhat hc or sh€ is .rcmpl thEefrom od rhc b.si5 foi lh. rlLgql q@plio( A.y viobr n,n otsc.tion 701 I 5 by atri <br />appli(d for atmil $ubjds th. atDlicantloacivilp.n.lryofnor,norcth fiv. hundr.d dollss ($s00). <br />- <br />l, 6 ownq of the Inorcny. or my employE with sa!6 a rh.n er. .onpoetion. *ill do lhe $orl ard lh. snl.l@ i nol <br />intod.d or olTddl f.r ek (Se 7044, BNins ud rrofsioB Codc 111. (ontroclors LiccG k* do6 nor arpt, ro m o{n* ot <br />rh.Impqi, vho tuil& o, i,n,lov6 fi@n. dd *no &E such \ri( himsclfor hGcltor rhrcugt his or h6 own mployce <br />prclid.d lhar such imprclmdrs mnor inkdql ofi,.d for el€. rt hoscE. lh€ hlildins or imprcvonor bsEwnhino..y@ <br />olcompldiotr, th. osn.r Blildd vill Mv. thc budo or proviq thal hc or shc di:i nol build or improv€ fi€ popdy aor th€ purpos of <br />I. d own6 ot rh. Foldy, m .rclBiecly conmd ins wnh licffi.d conradoB lo conslrucl rh. prcjEl (Sc. 7044. Bsms.ri hnfsrid Codc:'thc Conracrois Lic.os. Law do6.ot apply to eo*nd oa prop.ny { ho build! or idprov6lhd6i.and who co.bids lor such prcjc<ls wirh a Connldo(s) licd.d puButul ro in Contr.crois Licd. La{) <br />I tun e\.nrfl ${l.r serion_. ti. & P.C for this rqso. <br />DrIe: Orns: <br />]r9BtrE8S:gOr!88!SAIIA! <br />D!rcr4!{r!o! <br />I hcrcby amrm unds rc@xyolp6lu'yoncolthe lolloNirs decl&ations: <br />I halc dd will mainrain a cdin.al€ olcoI6r ro Sclf-lnsure aor work.ri @mp.nsorion, s provid.d for by S4rion I700 oarh. <br />Ldor Cod., fo. fic pdfofre.. ollhe wo* aor vhich lt€ p6nn is isu.d <br />I hnvcrndNil mai air work.6 co . inuhncc. 6 r(lutd by Strl ion 1700 of the Labor Code, lor lhc pdomanc€ ol <br />rhe (or( for shichlnis!.nnil <o,nposation usulocc cmis adlFlicynumbs {c: <br />U <br />-l <br />ccnify lhal in lhc pdlomanc€ oflhc worl for whi.h $is pdnil is iisucd, I shau nor dploy aoy p6on in any odn6 <br />s a to h..omc slbjd b lh. $oir6 ompsN.Iior lavs of ('.lifohia, &d a{r rhd ia ! should h.con. 3ubjcl lo rh. <br />\rctk6' conpecalio. pavtions oaSEI ion 3 700 of <br />'hc <br />tibor Coda I shnll, fontwhh onply wnh rho* pmvisioB <br />WARNINC Failur€ lo Kue \ork€rs' compen$rion colcror. is unla$ful. and shall an cnpk,r.r t) aii ral lrna tils and <br />€ hunded lhousd dolla$ ($100.000), in io., drh.g6 d prolidcd lor rhe <br />v- <br />I hercby arm undr rEMlly olr,gjury llEl I m liens.d undo piolision oachaprd 9 (.o,n,nocing wnh Serio. 7000) of Dlvision l <br />ol the BusiK md PmlsioB Cod., md mr li.@ it i. tull torcc d.frd <br />l()7{AK,I <br />( o\slRl ( r(r\ r r \r)r\r; v:r\( \l <br />I h.Eby arm mda poulry of r.rjury thar lt* is s cotr(dclion knding l3ocy aor ln. p6fom@. oa$. erl for whi.h rhi! lnoit b <br />is$.d (Sd 309?, Civ. C.). <br />L.hd.ri A{krN _ <br />afrluaNfD[ct a8aua! <br />I hddry aJtm undcr poaly oi pdjury on. of the followin! ddldarion!: <br />D€nrolirion Pdmits^sb.ros Nolificalion Fcdoal Resulalions Onk 40. Pd6) <br />_-R.qut.d lf,ltooaNorifiqlio. <br />d. .o' rypli.able ro rhis projdr. <br />abo\( rcnri()nrd pmlxnv f(n rnsrrrion <br />lpplicn l or.\senr SiBral <br />rLS <br />mDly *i'h alLCil ana Counr' <br />c v Md cohN ro *rauFnrh. <br />," ;tl"lrr <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />9igns (monument) <br />!!!e Safety /Low Voltage <br />Fire Alarm / Dam pers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER)a.1, //j Et.^rul--z--tl <br />Transformers -5 >-/./ /K--C/>'--'\- ' /./ <br />Air Conditioners <br />Roof Top Equipment <br />Facto Wired Unit <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Meter Release <br />Rough <br />Service lvleter 2 o - zl^ trt Dtt /a:-\ <br />FINAL ,t 2- /'/ 'f,L /9)ar{O? c ) / <br />Notes Remarks, Etc. <br />: <br />DATE <br />Pole Bases <br />Torqueino <br />Sub-Panels <br />Walls (Conduit) <br />Ceilinqs (T-Bar Rouqh) <br />c*"*..E <br />c6lily lh.r I hav. read rhis applicarion dd sr,l. rhal'h. atFre <br />d Star€ Lawsrclarineto