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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.OWNER BUILDER DELCARATION <br />I h6.by affm urdcr pc.ahy of pejury thal I @ .r@fl fiom Oe Conlradou Liccni. LjB aor the following lten (5&.701 L5 <br />Busines dd Prolsion Codc): Any Cily or Couniy whi.h r.quir6 a p6nn lo coNlrucl. sho. inprorc, d.inol6h o. r.pat &y <br />strucru€. pior to irs isudcc, also !.!uir6 lh. @plic r for slch p.flnit ro fil€ a sisn.d srarmor rh,l hc or shc t licaB.d lusua, <br />ro rfi. provisioB oafi. Co"lrlcloas Li@trsed L,w (Chapid 9. Com,n.ming wnh Scliotr 7OO0 of Division I ollhc Busin* dd <br />Pmfesions Cod.) or thol hc or shc is cxflpl ltacnom Ed lte b.si! aor lhe .llcs.d cxmpl ion. Any violaliot olsdio. 701 I t t y e, <br />applica for a pmir subjds lhc applicdl lo a civil prtuh y o f nor norc rh& filc hu.dr.d dollas (S500) <br />ff3t.*o"n*oi't'.p.p."t,orm).,nplo)6trirhtra!6srh.irslecomp€Nrbn.wrll&ih.tr'oA&nrh.nMU.snorinroidj or^fe.lj r.r slle (s( 7044, Bulin6 hd hori.sions Co&: The conrsclo.. Li.a* bw doenot.pplylo anowncrof <br />rh€ pmpdi! who b(ilds or inprov6lhsen. od who do6 sRh wol{ hnns€lf or h6ello. thmu3fi his or hd oM dDloy6, <br />prcrid.d lhal such inplovmmts ee,ol hlsl(kd o!otrEld aor ek l[ ho\q6, ih. hildins or in{mvmot n$ld wnhin 06. }@ <br />ofNnpl.lion. th. Ownd Boitl€r willM\c Lh. htrdar ofFov$g thar hcorshc dil nol boild or impi$r. $. FDpdy lor tt porpo*of <br />-1. <br />N otrns of thc plo!€ny. s exclusively conrBdinr rvirh lic€ns.d contadoB ro .oBttucl lh. prcj*l (S€c 7044. B6'nRs <br />ed Pbft$ion Code: Thc CDntra.lols Lic..sc Law do6 nor Applyro d osnd ofpropdly who builds or improvcs lhdcon. <br />and who ontmcrs lor such prejstsNith a Conimcro(, licmrcd pusuml torh. Contocror's t.icos t{w). <br />Imc.Dludo SdFL,B &PC talt6r.e0. / <br />,.,", r.[a[tB ""*,--A.td]o*-!woRrdI[s' cbntPF,tsaTlON <br />DESAAAIIO! <br />I h6ely .fim u.dd Fnally ol pajury on. ollnc lollowing delmliorc: <br />_l havc a j will naind. a Cdincrrc oacoiMl lo S.lf-l$urc lor sortnl mnlp.nstion, s Frvid.d lor by Sdlion l?00 o llhc <br />lrbor Cod€. lor thc psfonn c€otthcworlfor$hichlhcpq it b i$u!n. <br />I ha!€ and will,naintain volll.r3 conp.Ntion insunnc.. 6 .equn€d by Setion 1700 oflhc Labor Codc. for lh. pdLtlM.. ol <br />thc wo,k lor which this p.nnil is is.d. My workEa mmpmrlion insur .c cdiq d.d policy nuobd @: <br />NARNINC: Failur. io ecure wo,k6' onD€.srion covdaB. is unlavful. d shall subj(t u dplo)t ro di'ninal Fnahi3 ..d <br />ndr.d rhoMd dolltrs ($100.00{). in 6ddnior b the cosr ol codD.cain'n. d@as.s d provided for rh. <br />(td.. i6rdd drd !tumcy s le6 <br />lc <br />ot("^!Jlrof <br />I hGby aflim undo poalty of psjury $ar I a, li.as.d udd provnion of Chaprd 9 (conmdcing siLt' S..lbn ?000) of Division 3 <br />of ln€ Busins dd hofsio( C.d., &d my lic€ns is i. tull aorce od cner. <br />COIIIAJJCIIANJiIIDING.AGET(I <br />I lmby .mm und.r Fn.lty of p6ju.y ihar rh@ is a otr(dcrion knding astry for rh. p6fomdc. of rh. $ork aor *htn rhis p@In b <br />i$!.d (Se.1097, Civ. C ). <br />AIIII(AILDICLIaAIIOT <br />I My afnn undd paahy olpsju.y ore of lh€ lollorinS dc.learionsl <br />D6oliion Pdmils Asb.sros Nori6.dio. F.ddal Rcrularions {Tirl. 40. Pad6) <br />Rcquired knd olNorin.dbn <br />-l <br />ccnirythat lhc ftdsal re8ulatioN re3udin8 dhclos rdrov0l arc not applicablc ro lhis pmj.d <br />I cdia! $ot I hav. rdd rhir applicarion 6d s0r. ihar rh.ab.vc inlomalion is coEd. I aBre ro comply wnh aU Cny and Cou.ty <br />odin.ma md Srare La{srclatinxto buildio(ddbn.-e turcby.utho,izc rcpr6dlativ6 o ilhG Ciry <br />alxNc mmrioncd pmp.nt lor <br />\pfri$nr o, \!rtrl si[trrrurr ,7 ffi:_ <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 />Bonding / Groundinq / UFER <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof To p Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />lVeter Release <br />Rough Vt Ti/xu{ <br />Service [\,4eter <br />FINAL 2-of. ro 04< tou <br />Notes, Remarks, Etc <br />COMMENTS <br />Under Slab / Floor <br />Transformers <br />ryen e-dz.b) <br />44 caiiyrtrar m rtc patormnc. orrhc lvorl ror rhich ttis pmir is issu.d. I shall nor dployany pdsn in d, n,mnd <br />$ a ro beomc rubjd ro rh. *0l{6 @q)derion la"i or Califomia, rnd .d@ thd if I sho(ld b€.om. sbj6l to the <br />w.ih6'.ompdelionprolisioBols.crionlT00officLab.rCode,lshalt.fonhsithcomply$irtrhosprovisions <br />I onJ.r ( <br />^dJu{