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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE COMMENTS Or..rBuild6 Deldrion <br />I he..by llfirn und.r p.ully oi p.rjury th.r I am .xehfl fom lh. ContrldoB L@8. hs lor fi. followinB rasoo G*.701 1 .5 Busir6t <br />ed P.ofesion Cod.): Ary Cny or CoDry {hich rcquirB a p.mil b otulruct, .hd. improv., d.molirh o .9ri. dy stru.ruc. prior ro id <br />issua.c.. d$ eqund rh. lppli@nt lorlrchD.rmilto ffL r sis..d !t!1.@ that h. or sh. ii liccBcd p@uil lo lh. povi3ioor of $. ,Contlctois l,ic.N.i Llw (Chaois e. Comm.ncins wnh S6rEr 7000 ofDivEon I oftlE Bsin6s rnd ProlBnoB cod.) or lhil h. or <br />sh. i! crcopl rh(cfros and llr h6k aor th. rll.s.d .x.sprion Any viohtion of Srlion 701 L5 by &y lppliclnt aor I p.mir subj.d! rhc <br />.ppliclnt ro. cilil p...lry oftrol mor. the iivc tddr.d dolllB(t500). <br />_. L .s own.r of !h. pop€rry, or ny cnploym qilh saa6 B tb.ir sol. cohr.6rio.. will do rh. worl lnd lh. srrudur. is nol ini.nd.d <br />or of.red for sl. ( S.c 7014, Busin6s.nd Prof-mns Cod. TheConlractoir L'e6e tju do6 nor apply ro.n own r oarh. propcn, <br />who builds or impro!6 rh.mn. ddwho docs sutwo nims.lror h.^.ltor rhrouEh hi! orhd own.mploycB, pro\id.d rhofiu.h <br />inprc\rncnt rr. nor im..d.d o.on rcd rorel. l a howcv6, tn. buildiq or nnprov.mmr is s6ld wirhin oe yc oacomplclion. lh. <br />O{...Buildd sill hlvc th. burd.n ofpDvirB rhll h. or sh. nor bxild or impro!. aor lh. purpos. ofsal.). <br />l- 6 own6ofrh. prop.dy. rn.xcluriv.ly.onkrclins sith lic.Ncd conr!.ron to oBttucl rb. piojccr ( S.c ?044, asiodr and <br />Pof.$ion Cod.:Tn. Cont..lor's LE..s. Lrw do6 nol.pply lo !n ownd ofpropdy who huild! or improvB rher.on . and who <br />conr.dforluch p.oret wnhrcont.clo(t) hc.n!.d pucla,lto th. Conr.dor'! Lrc..!.kw ) <br />_l m .rnnF wd6 S..ion B &PC f..rhh r.xr.n <br />WORKERS COMPENSATION DECLAIIATION <br />I hGby amm urd.r pcdhy ofp.iury on. oflh.lolloqin8 d(l..irioa: <br />I havc and will m.inr.in. C.nifical. ofcoB.nt r. s.lrlnsur. ror wor!.6 @nlp.Mron. B provid.d aor bysd'.. r70oorrh. <br />L.bor Codc. aor lhc p.rfomanccoath.work ao. whi.h rh. p.mit ie isu.d <br />requred bySecton ST0Oofrh. t bor Codq torrh.D.rforronc.ofrhc <br />'nsudnc. @r's lnd poicy numbqar. <br />/,Porqrrubd N <\n273oo/ ,\pi6: <br />(Ttir sdbn n .d mr b. onpl.rcd init pm{ B ao' oIE hun&d doll$ itl00l or l.s)7 <br />I ccniay lhnl in lh. p.rfonm.c.orrhc sork for qhi{h this p.mit is issEd. I shall nor.mploy cny D.6on in.oy Eanne. so a ro <br />b..an.subjecrroIhe workas .ompensal$n lowsof C.lfomii,.ndis.€erhit ral <br />c"mp.ner otr pro\ y/ns or s(r,f ! 7oo or r h. <br />",,, lL /(o //4 <br />llbor Cod.. I shrll, aonhwih c{xniily s irh r <br />nn n no,Lr*. /,"*.r.ufitr6 up lo on. hurdEd ltou.nd dolL^ <br />onpeaarion or.hae <br />'s <br />unl.*tu|. ed sh.ll subi<r m.me <br />(1100.000),in lddnion lo rh..o3t orcodocoslrion. da p.ovid.d forlhc S.ction 1016 of <br />rh. Lsbor Cod.. inr.r6t i.d rtom.y t re6 <br />LICf, NSED CONTR,ACIORS DECI-AR]iTION <br />I h(cby lllm uDdcr D.n.lly ofp.rjury rnrt I o licN.d 6d6 pDlisionoachaprd 9 (comctui.s wilh Ssdon 701)0) o,Division I of <br />iotrrCodc. udnry lic.ns. is in folltt,c.0nd ellal <br />( o\stRl ( lt()N l.ti\DI\(i \Ct:\( \ <br />l hscby affm uod.r p.nalry of pqjuly rhar rh.r. is r coBrtu rio. Lndins a!.ncy lorrh.p.rro@nc.orrhcuork <br />i.su.d (Se. lo97, Civ. C. ) <br />488!rq4NIS-!!g!4B4MN <br />D.nolirion P.mits-Arb.slos Notifi.ation Fcdtr.l R.sulatio6 (Til1.40, Pan 6) <br />_ Rcqut dt lrd of Norifi.arion <br />l..tiryth,irh.fcd.ralclulirio.sreSardinsasbcaosr.movoltrenorapplicrbl.rolhiiprojcl <br />.l c.dit thar I h.!. r.ad lhis appli.riion is concct. l .!rc. rocomDly wilhtrllCiryaod County <br />ordidn csand Siare Ij$ r.l0lins to lufioritr.pr.* ativcsol$isCiryand Count) <br />lbo \ c m.nl ioncd prop.ny lor <br />Applicstrl or ag6l sis.:E-+ <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 />Communicatrons Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Rough <br />Service Meter <br />FINAL s/ta-/ts->s{.s ^^^,Gn ) <br />Notes, Remarks, Etc vv <br />I lnspeclion Forms\E eclr callnspecl o. Record doc 03 31 06 <br />ID/SIG. <br />Meter Release <br />("*-o *,, <br />f ----T------ <br />-------r----- <br />=