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APPROVALS DATE tD/stG.COMMENTS OWNER BUTLI'ER DELCARATION
<br />I h.Bby atlird nnder ,'.Mlry of pcrjury th l am cxcmtr fmm rhe Coiracbs Liccnsc tjw for rlrc tollosinE rcr$n (s.c 70ll 5
<br />Busincss dnd Profc$htr Codc): Any Cn, or Connry whth ,rqun s s Frn t lo connruct. slrcr. intmvq dcmlnh or rc,)at any
<br />strucr!,c- prior lo ns isrudd, ulr, requims rhc oppltmr for such termil lo filc a sis.cd ntre'm.! ihd hc or stc is licened nrN!.r
<br />lo lh. pn,vnions ofrhc ContBcrols Liensed liw (Chanr$ 9. CommminS wilh Secrion 7000 ol Divhion I ol lhc Businc$ rnd
<br />Polc$ions Codc) or rhsr lror\hc hcrcnqr lhcr.from Md th.btrsh lhr rhc albsed ckdpr ioo anyviolalionolscdion 70:ll 5 bydny
<br />rrpli.trnr r(tr d p.mn sub.Jdls rhc rpnlicunl ro s civil l)emlry of nor mr. rhan tlvc hnndrd dollds (3500)
<br />-1,
<br />as osicr olrnc pmpcny. r, hy.mpbres wirh srScs as rhct $lc omFnv'li.n. silldo rh. wolk ond lhc snEtr h nrr
<br />i .ndcd or olr.r.d n, sb ( SN.]o4,1, Businc$ Md Professioas C{nlc 1 h. Conk,.t -{ Li.cn* Liw des ret arnly rd M owftr or
<br />lhc loFny who toild!or innoEs rh.@., s''d wtx) ddr skh w.ik hims.lfor h.r*lfo! rhmush hh or hd.wD cmployccs.
<br />pmrilcd rhri slch iml,.vcnrnh dc nor inr.Mcrl or oflcrtd for sh. ll howNcr, lh. tuiUinS or i,rprok.rnr ii $ld w hin orc )ur
<br />olconplction- rhc Owncr Buihcr will hlw Dc htrdcn of pmving rhnr lu or shc did mr tnrild ot i.npmE Jrc I,Dpcny t tE luryv of
<br />-1.
<br />rownc,olrhc pmpcny, an.x.lusivclyc.nhdinB wiih hcc.scd connackns ro coniru.r rh pmjcd (S€. 7014. Busincs
<br />rnd Pr,assirn codc Thc conhdols Licensc Law dcs not lpply i(' r. o*n$ or ProPcn, who builds or inpovc\ rh.r.on.
<br />and who onrnch f.r srch pmF.G qirh a Co m.ro,{r) )tchscd pusuont ro rhc Cotrlrncior's Li.cn* tiw)
<br />Dole ()wn..
<br />W(IRXER\' CT)NiPENS^ fl .N
<br />DECL/$AIIaN
<br />I hcrchy alirdnnddi p.tulry ol lErju.y om ol lhc lollowinB dclarrtiotrsl
<br />-lh!!catrdwillroinruinrCcnirrdrcorconrc.ltos.lrltrsurcl'or*ortcF.omncn\ario..arlrcvid.dforbyScclion3?OOoflhcLlhr adc. io. rhe pcrr,'mErcc of rk w. for whi.h rh. Frnn i! ilsuci.
<br />I havc ,M Nill nritruin wo crl conucnsalion inslrlncc. as requncd $y sdrn'n 37ur ol I hc Lahor Cdc. ror rh. Frforrorcc ol
<br />rhc work r(tr *hi.h rhis lE.nril is is$cn. My woltqr .onllcnsar ion in{uanc. .aricr ui Flicy numhcr &:
<br />l.cnityrh,r inrh. pcrlonnnncco, rhc qork for uhich this p.ir.ir k is\ucd.l shill nor c floy0nrr.nnn in,nyn'nnnci
<br />h N ro lrconE sunid lo rtc wolkcfi o,mt .\arion la*s orcaliforni{ old,8rcc rhll ifI should bccnft subj.ct ro thc
<br />qortcr{ comnctrsl ion provnio,s or S(tion l?00 or rh. ljhtr C(xL. I xhrll. lon hwirh comply wirh rho{ l6visiotr\..
<br />WARNINCT Frilurc to wurc workcis' com!.nsdion oemsc i\ u*!rul. nnd \hdll suhFcr !nfmrlnltr ln 6mntl Fmlras lnd
<br />civil fi.cs u, lo onc hu.drcd lhousand dollos ($lOO.mO). in add'ftn iu rhc c.n or coFctrlion. daNScr ar lmvidd fo. ih.
<br />SNr'.n l(rr6.rrh.lilsrcodc inr.E{ r.d dromt \ fe\ \ I /. t t ,.1 Ur* 7t>/t_,"". -29-12t/lt no,,-*, (/ ' r rcE{*p coNTRAc,lt)R
<br />DECI.ABAIION
<br />I hcrchy aftrn unifi p.nally ol p.rjury lh.l I an tia.*d ulld.r povhion of Chrtid 9 (onmrcin8 wilh Scclhn 7m0) ofDivirion l
<br />of rhc Busine$ and Pmfesioos Cod.. atul ny lic..se is in tull forc {n cfist.
<br />,\ '-*
<br />)(
<br />IONSIIUCUONIINDIICICEIICI
<br />I h.abylnirm undcr rEnalryofF,ju,yrhar rhcrc is a.o.(fl.Ib. hnding agcncr lq rhc Frfornhncc oflhc mrk for whth rhn Fmjr n
<br />isiu.dlsft 109?. civ c.).
<br />ABBI.ICAIIJ'ECLIAAUA!
<br />I tlnhy.rm undcr Fn.lly ol Frjury onc ofrhc followins dcclsari,ns
<br />Dcm,lirion Pcrmn\ Arb.nd Nori,l.ariotr Fcdcr.lRc8ulati.ns ( lirb,r0. Pan6)
<br />Rcqutcd h rd of Norificalion
<br />-l
<br />ccrriiyrhurrhc tcdcrdrcsrhrn,n\ rc8n tlin8 .{b.(os r.nr)u!l c Nlnpplicobb r, rhi\ tojc.r
<br />o omply wirh rll Cily and Counry
<br />rhic Cnya Counryro cnrcr ul,n rhc
<br />*,", or/zr /rg
<br />-l.fiiiy
<br />rhur lhdv. rcsd rhF hrtlkrhnn t {Jrcrhd rhc rb.). inlomrinn r.nncd Ir8rsr
<br />ndmomc\,nd Srrre br\ (l,r'ns ro hdrld'nF .nn{ru.rh.. drllcrrhyrurhori/c,cIYcrnlrrivr. nr
<br />lborc nrnrnmd Impcnyl.r ir\ngclio[tuq{{- I I
<br />{pprion, or^ss,s,s*ru* N{e! r 4711-
<br />p.mi,mnon?(pr,D,): ifiw *olSz'r&cL/
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilinqs (T-Bar Rouoh)
<br />[/eter Release
<br />Rouqh .,.:\
<br />Service Meter 4,4t,tg I .f/iWrAe W\
<br />FINAL qSta l/,,iAl 'rQD )
<br />Notes, Remarks, Etc.lt \
<br />ELECTRICAL.INSPECTOH RECORD
<br />! r rrrnror un'xr Sccrtr'n . t! & PC for lhn'.x{n
<br />ocfzr L
<br />kndcac AddEis'-
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