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APPROVALS DATE ID/SIG.OWNER BUILDER DELCANATION
<br />I h6.by .ilinn undd po,ny of p6ju.y rh.l I dn d.'np am,n rh. Controclors' l-ic.nse Laq lor th. tollowin8 ra$n (Sa 7pll.5
<br />BBin6s d Proa6sion Cod.): Any Cily or Courty Nhich r.qrn6 a lqrnn to mtrrrucl, alt6. inp,ov€, &oolbh or rclEt dy
<br />st!cr@, rior ro irs irsudc€. also requirB rh. appUcanr for such Fmi ro 61. a sisncd $ddor rha h. or d!. b li..nsd p6uan
<br />lo lhc Fovisio6 of tlE Contn.tois Lic.ned Law (Cnaprd 9, Comcncin! wilh Sclion ?000 of Division 3 oflh. BBin* 4d
<br />Ptuacsions Cod.) or rh.t h. or shc is .rchpl thqcFom ed the bsis for rhc alLscd €xonplion. Any violrtion oaselion 7011.5 by ony
<br />applicam ior a p.fti $bjet rh. appli.anr to a civil pc.alry of nol mor. rhd nvc hundr.d dollds (5500).
<br />_I, 6 oNnn of rhc Fopcriy, or 6y mplorc with was6 s lh.i $lc conp€@rion, * ill do lhe work ed $. nMm is not
<br />n ode{ or ottdcd tor sl€ (Se.r044, BNinN dd Pmf*iotu Code Tle Contrcclois Lic$e llv doe nol apply lo an owd ol
<br />lh.I'opqly pho buil& or inplov6lh@n. ard vh. .106 such qon hiftsell or h€elao. throu8h htu or hr os onploy.6,
<br />ptovid.d rh.r suth i' p,!r@drs @ nol inlqd€d or o,Idrd for ele ll howd6. lh€ hrildins or inprov€mnt is $lj wirh'n on. ra
<br />oaco,nplsion. lhc oMq Buildg eill hrw rhc hud6 ofprcving fid h. or shc dii nor hrild o! imprc!. fi. Fopdy aor lh. pu.ros ol
<br />l. a oMd oathe pmtdy, m dclusiv.ly conr4cring s,io lic6a.i codrr.lou lo .oNttucr riE Fojd (Se. 70.14, B6ine
<br />dd Eoftsion Codc: Thc Conlra.lor's Lic.ns. Law do6 nor apply ro M own6 ofprop.ny who buil& or inprcv6li6an,and who coitads tix s.h rej.clr *nh 6 Co Bclo(s) licncd pmwr ro th. contacl(tr s Licos L!w)
<br />I anerempt unds Saliotr . B & Pc rrnrhis,cMn
<br />traB6EBll:olltEllarI9!
<br />DESAAAITOT
<br />I h6eby amfln u.d6 p6ahy of psjury one oilhc lolbwnrt ddltrario.sl
<br />-l
<br />hav. ei will ndnlain . Cdrifiot. of CoNmr ro s.la lNlrc loi lorkgl onrpdririon. d prolid.d aor by Setion 1700 of th.
<br />l,.b.r Cod., aor tb.p6lommc. ofrh. e forshich thc pqsn is i.su.d
<br />(I ha!. a.d will naiiaii work.rs coepcBarion i*urdcc, s r.qutcd by S6rio. 37OO ollh. Labo. Cod., lor th. Faor:m.. ol
<br />rlr. ("rl lor (hi.hlhn Dftn
<br />9tult
<br />n is isscd My uor lers tompos(bn iNursce c&no ed poliq nu'nbd e.:
<br />Iaq trun Jn)'20 16: //-//-20/7
<br />trl cdrify thd in 0E pdromdc. ofrhc sork for vhich rhis psnir is issucd. I shaU.or @ploy any !.66n in any mmnd
<br />$ a to bdomc srbjdt to th. \ olt6 oDpderion lass oacalif6mi.. ed agre rh.i ia l sholld lEon. subjct lo th.
<br />vork6' conpeBalion pDvisions oasetion 3?00 of th. bbor cod., I sh,ll. fonhB ilh conplr s itn thos pBvisions..
<br />\\ RNINC Failur€ to wuc srrk6' comp.sarion co\m8e is unl.*fin. ad shall subjd a onpk}lr ro dnin.l p6?hi6 md
<br />.Nll l]'ics up b onc hundred rhousrnd dollds ($100 in addnion lo $c cosl orconpc@tio( drnas6 I prolidcd lo.lhc
<br />sdhon 11076 of(he l_at rcod. inrerBl md
<br />,,,...1/-/4-z0p
<br />t2tcl,!!3A1tol
<br />I hdeby afrtrm und6 p6aly ol pdjury rhd I m lic.B.l undd !mvi!io. ofch,pi6 9 (comna.inB snh Sdion 7000) of Divisioo l
<br />ol dc Bci.* dd ProaeioB Cod.. ad ny lictuc d in lull lorcc and cif(r
<br />F.-1 c))./,777 )57
<br />t20 s
<br />CAISIaUCIIANIIdDINGACE!(]
<br />I hd.!, arm udd p..alry oa pdjlry rhti $d. is a coierudion lddins letuy for fie pdfoijfu.e of rh. work lor whicn this ponn n
<br />su.d(Se 1097. Ci!. C.)
<br />AIILICANLDECIAAAIIO!
<br />I h.arry 0ilmn undd pcnalty of pdjury o.c ol rhc follo* iry dcldarions
<br />D.moliioo PdireAsb.srG Nolifi.arion Fcddal R.sularions Gnk {0, Pan6)
<br />Rqtnn.d krlooaNoti6diro
<br />-l
<br />cstry th,l lhe t d6.l EAulalioN rcBeding ahdos moval tr. no' a9pliclblc to lhis pmje.l.
<br />EI cdrit rhar I h!'. rcad rhis applicarion &d srar€ rhar rhc abovc inromarion is cotrar. I agE lo snply wnh aI cny ed co@ry
<br />hdeby oullu E reprscnlahvB otlrhis Cny od Counryro drd,ponrhc
<br />^; l'-ft24[qaF qq
<br />ordindnc6md Skr. L.q s
<br />'cbl
<br />in! to,b!'ld,m coNlrucr'or ad
<br />ab.!. mnhon.J p,oD.nr ro, i6;r(- p6,-/ ./, ,/
<br />apetcn t eeensieno*rylf - 4'''7-
<br />Pmr,en.he,prinn, f Aaf
<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 / Dam pers
<br />Communications Cabte
<br />Building
<br />Under SIab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />To rqueing
<br />Sub-Panels
<br />Air Conditioners
<br />B99f Top Equipment
<br />factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)t(tt4d fi,'1.D)
<br />Ceilings (Hard & Soffit Rouoh L/I /\
<br />Ce ilings (T-Bar Rough)lz-lo.*.u//.tt\
<br />[\4eter Release v
<br />Ro ugh
<br />Service Meter
<br />FINAL )1 ,/ v4,ar'f))ul
<br />ELECTRICAL-INSPECTOR RECORD
<br />COMMENTS
<br />ry--'V/14'lr,
<br />Notes, Remarks, Etc.
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