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ELECTRICAL.INSPECTOR RECORD DATE ID/SIG.COMMENTS I h6eby amrm nnd( Fahy ofpgjury lhal I m.x.mu frcrn lh. Conl!.clos Ltens. Liw for lh. following r.Nn (Ss.7011.5 Bsio6s ad Prof$ion Cod€): Any Cily or Counly which rcqutB s pnnil lo conslruct. ahs, improve do.olist or r@an tuy sttuduq rior |o n, isumcc, a]lo rquic rh. arplicdl lor such Fmil Io fiL a s's!.d sralct6r lhal h. o. sh. ir li.ds.d p6trMr to the provisioG ollhe Con[lcroa3 Lice 3.d Law (Chapr6 9. Comncn ins wirh S*lion ?000 of Division ] otrhc BBinN dd Pofdsions Code) or rhal h. o, rhc b crcnpr lhscEoD ud lhc b€sis lor th..llcBed crnplion Any violarion of sdion ?01LJ by ey aprlicant for a Fmit subjets lh. applicanlro acivilpenanyofnor mor€rhM fivchun&.ddolldsl$500) _1, s o\84 ofrhc Drcp.ny. or ny .nploy6 {nh was6 d rhcir slc coop.nsltion. {ill do dE {ort @d 0E sln(le i! m{ ini6d.d oroftd.d for $1.{Sc.7044, B[inc ed PlDfsioB Codc Tn Conlrlclol ! LiccN taw do6 nol $ply lo e omo of fi. pr.Fry who buil&or iEpor6doe( and who do6suct w hirE€la.r fi*lf or through his or id oM cnployc, provid.d thal suct imprcvmnls m nol ht6d.d or ofida1 ror eL ll h.va6, th. hrildinS o, idFsmr ie $ld wnhin oE rar ofcompl.tiotr E o\md auiu6 vi[ lEv.lh. tn&n oaprovins lha nc or sh. dil ml b'iLt or in'polc rh. F.pgty for ln. FrFs ol -1. s ownq ofln€ propqly. m €xclsivcly contmdin8 {nh lic*.d conlmdos lo @"slru€l tL proj6,l (56. ?044. Banne ed Pmtsion Cod.. Th.Conlridols Liccn* kw do6 nor arply to e ownd ofplopqlysho buil& or ihrrov.s thdon. ed Bho .o'{,ads for such Fojccls Nirh a ConrBcro(, liccns.d puu@'l to rhc conrhcrors Lic@ Larv). I tun cro.tt u.d$ s..rion_, B. & P C ror rhis ru$n Drre OFner: \!)4[!Bjilor!tE!r itg! D!C!^-!{rQl I hc'.hy.llt utrdc' pltrallr-!fpsJLLDoncorlheloll$\inEdeclarallons: l havc d *illmainrain aC6rilicar€ ofconEnr to Self-lnsu.e lor Nork.B conrpensarnn. d pmvid.dforhySeriorlT00ol$e Labo. Cod., forrhc pgfomancc oflhc ro.k lorrvhich ihc r€nrit is isucd. _l hav. a.d *,ill rarlain worke6' .odpeNll io. insurdc€. 6 r.quiled hy Sdrion 1700 of rh. L.bor Codc, aor rh. psfomanc€ of thc qorl for $hi.h rhB p.mn is isuql. M, wotkdr conpdallon rsur&...mis aid rolicy.ombd d.: Policy Nunb€:_Eipir*: I cslit th.t in lh. pEfomanc. oirhc wo for which rnis lwn is irsucd. l snall nol mploy any p6so in sny n nr $ a ro b<ohe 3ubjel to th. so*a conpdrlltun la*s or Califodia. ed lsd rhd if I ihould lEom. sxb.iei lo lhc worts co,nFGarion provisioG of Sdio. 1700 of thc ribor Codc, I lhall. fonhwnh .omply wnh tho$ provisioN \IARNINC Failurc lo sur. sorkqs clmpaslion covmsc is unlasful, d shall subjd d oplors lo diminal FFlrs and civil fincs up to one hundrcd thousand doll6 ($100.000). in addnion to lhe cost ol comrEnstion. dd.sd d ,rovid.n for dE Seiiotr 1076 olthc Lah.r Code, inldd md onormy s ac6 I.ICEIIEDIQNIBAqIAf, DESTIA]IO! I h@by amm undq poalty of psjury lhat I m licos€d und( Fovision of Chaplg 9 (comddcins vih Seion 70lS) oa Division l of th. Buins d PrcldioN Cod€. ud my licm. is in full forc. od cr€t. CON AI]CIIONIIIDINCAGEX(I I hftby amrn undn p.nalry o I pojuy Ihar rhs. is a stutruclioo kndins agdcy aor rh. t6aome.. of $c $or* lor shich this Fnril is issued (S(.1097. Civ. c ). AIILICANLDECI"6MIIA! I My ofrm undd pdrhy of !.rjury on€ of lh.lollowinS dalmrions Ddnolilion Pmns-Asb6ros Nodncation Fcd*rl R.sulario.s (Tnlc 40, Pan6) -R.qun.d klld of Ndifi cati.D I coliay lhar rhc r.dqal r4ularions esadiry db€sros rmolal arc nor ipplicabl{ ro rhis I,mjd I.dify lhd I nare @d rhis application el $are rh,l lh. rl,!e i.aomdion iscor.d.I agre lo comply sith al!Cityand Counq ordi.anc6 ad Stare Larvs i.lating ro building coNlocrio.. an{ hmbyaulhodc rqrM.rdiv6 olrhis Cilyand County lo dl6 upon lh. abovc mcntioncd propsly fo. inspalion purlos Applicml or Aeml Signrlure: P$nrit€c n.me (prn ): Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER A44h ) Transformers lt-(t/,/.u.{n) To rquerng Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit lValls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rouoh Ceilings (T-Bar Rough) Meter Release Rou gh t (6,(j-/111/ Service Meter rl FINAL ,,.),ilflfic Notes, Remarks, Etc.I '-v APPROVALS t?.l (,tg I