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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS tDistG.COMMENTS OWNER BUII,DER DELCARATION
<br />I ha.by amrD und6 p..aly ol pcrjury that I m .xemB from th. Conlra.toE Licen* Lirv for th. followins I6)n (Sft.703 L5
<br />Businss and Prolsion Codc): Any Cily or County \vhich r.qui,6 a Fmil lo coNlrucl. slt6, idprovc. d.,@lLh or etBir o,
<br />stuc'uiq pdor
<br />'o
<br />irs tssue.., also raluirG lhc applicdt lor su.h Fnnn r nlc a signcd srat@dr thar h. or sh. is lic.ns.d puuu6l
<br />ro rhc provtioE olrhc Conti.{oas Lic.ns.d l,a* {Chaptq 9. Commocms $i!! Sdrion 7000 oaDilision I oarh. Busm6 d
<br />PoasioG cod.) or lh h. or sh. is .r.,npt $sclio 6 dd $. b6.i! ao r r he allcg.d .rdprion. Anyviolalionofs.dion 701I5 byey
<br />.pplicantaorspfltritsubjectslh.appticanlto.civilpctr.hyofnolDorelhanfilchundr.ddollos(S500)
<br />_1. {s ovndoarhc pop.dr. oi nry.npkrt6 {ih was6 6 rhen Fk compoE lion. willdo th. wo,k rnd ttc slnclG is mr
<br />inidicd or olTd.d for elc (Sa.r044, Buin<i ed Pmf6sio.s Cod.: flr Conrractol s Lice$ L.w do6 nol aoply to e o@d of
<br />lh€ |x.pdy who buildror i.rFo!6Ihs@n. a.d *ho &6such Bo himcll or hcll or 0lough his or hd oM .mplort6.
<br />provid.d rfiat such improvmls d€ nor intddcd ororcdl roreL.l[ hoq66. rh. h]ildin8 or inprov.m.6r is$ldwithinonc y@
<br />ofenrgldirn. lh. (rnd lloills snl navc lhc trkn ol pmling thal h. or sh. dll nol buiH or imFo\ c thc rlrEry for th. pupoF of
<br />-1.
<br />6 oNns of th€ lropsly. m cxclusiv.ly conlE€lins Nith licens.d conlracloE
<br />'o
<br />coBlru.t th. Fjc.1 (sd 7044, aci.s
<br />and l\ua6i.. cod.i Tn. conkiciols Li..nse Law do6 ool arply ro aoNn6 oapoldy who brilds or improv.s thq6.,
<br />and wno conl,acls loi such Fojds Nirh a ContEclo(, liccns€d pu6@r rorhcCo.raddrs l-icc@ L,*).
<br />-l
<br />m€xcnpt und6 SElion , A. & P.C. for this r6on
<br />D.t€: Ormr:
<br />!{t85lSg.qqst!EN4-lor
<br />DECIAf,AIIO!
<br />I h.reby amrm undd pcnallyofpqru,yon.ofth. aollowing dale.tioas:
<br />I h!!c ud vill maimain a CdifEal€ ofconst ro sclf-lNur.lor \orkm @dpcnsaiion, 6 p.ovid€d for bySelio.l?00 oa$c
<br />tjbor Cod.. lbr rh. p6foll1mc. olln work aor wnich th. p6,nn is isued.
<br />! have and \vill m.iMin Do*.rt comrEBar ion iGurance 6 r cquneJ by SNlion l?00 oi rh€ ltbor C.de, aor rhe pdfomdc. of
<br />lhc \ork aor which lfiis pmil is isu€d. My work6s' comp.rcation iNurecc c i€r ard Dalicy nudbd r.l
<br />Kcenirylhal in the pdiorm0nceoirhc$ork lorNhichrhisp€nnil is isstr.d. lshallnol o$loyanypq$n ind|ndne
<br />ro b.LonE subjat ro Ih. work6 competrrar
<br />'on
<br />la*r ol Caliromia. &d asrr rhar il I should bcro,n. strbld to lhc
<br />sori6' compaetion prcvsioN of S..lion 1700 ollh€ l-abor Codc. I dEU. lonh*ilh codply *irh rnos lrcvbioN
<br />WARNINCT F:ailur.lo suc *ork6 onptration ovdge is unlarful, Md stall subjN! u @plorq ro oninal Fstslri. d
<br />civil fines up ro onc huffred thousd dou6 (1100.000), in addiriotr to rhc con oa conp.elion. danlgd 6 providcd tor ln.
<br />Serio. 1076 ofrh. Lntor Codq intdel md aftomey s tB
<br />\*>1- $il]N G \-f,
<br />ITCETISIILC()NII,^(IIAur:(I^&ll&!
<br />I h€reby a,Irn undcr p.nally o I pdjury that I m licosd undd provision of Ch.pt6 9 (colnnocios wnh S.dion 7000) oa Divtion .l
<br />of rhe BusiB dd PmfsioB Cod., ed fty licw is in aull forc. od .ftar.
<br />e th -s oa\
<br />t-
<br />colllaucro!,llDac-ac&lcr
<br />I h6.by amm uidd Fnalty of l,6jury $!1 lt@ is r co.sto.rioi h.dj,!g agdcy aor lh. pdfollMc. otd. mrl fo. whkh this Fflil ir
<br />issu.d (se. 3097, civ. c).
<br />AfIIICANLDECLAAAIIO!
<br />I h6ay atrm und6 Fnaly ol psjury on€ oalfi. follosinS ddle.l ions:
<br />D.moltion PmiB Asbelos Noti6c{io. Fcddal R.gu,alior. (TnL 40. Pd6)
<br />-R.qut
<br />d lritd oaNorifu,lion
<br />_l cqlify thot thc f€iLral resulatioG Es6dinB stGros rmoL al &€ nol applicabl. lo this prjccr.
<br />S,,6*,, ,n, , ** .-O ,n" applicatiob md siatc rhar thc abov. i.romahon is coffit. I asrc to comply virh all (lry snd county
<br />ordindc6 dd srar. t ws El,ling ro b! ildiog .o reElcl io.. and h@by aulhoriz. r.prMralivG oflhis City dd Countylo dld upon lh.
<br />dr^c trrmincd pn,p.nv ln' insrarnn,
<br />ipplicrnr or ,{gdr Si*nilurr:
<br />$\/f'!G-
<br />\9.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />s, 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 t ,t t
<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 Rough)
<br />l.gtq Tdq a1\r4e/J p >)
<br />t
<br />Rough ilfl14 1i 't^^*,
<br />^ E
<br />Service lvleler 9lrlt4 Id /. LLerA
<br />FINAL
<br />Noles Remarks, Etc.\'ar
<br />+
<br />DATE
<br />Meter Release
<br />,)
<br />olilh irnl,A,l'4 b)
<br />L.nd.r3 Ad&6s:
<br />-
<br />Ittrq I
<br />I
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