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ELECTRICAL.INSPECTOR BECORD
<br />OWNEX BUILDER DOLCARATION
<br />I h.r.by,fifln rndcr pcnll'y,,r p.rjory rhrr I !n eicnlpr riom thc (tnr,acron Liccnsc Las lor rhc lollowi.g mnn' (se70]15
<br />Busincss ad Profc$nrtr c(ic) Any City or Coutrry which rcquid l.mil io ..nstdd. nlltr. imlrovc. dcnnlhh .r rcpan rny
<br />dtu.r!.c. prior ro ns nsuona- aho rcquncsrhc appliconr tu ruch pcm r h filc r si8ncd \llrcmnr rhor hcor sh€ h lic.n{al pu$uair
<br />ro rhe trovGions oflh. conlracro. s Li.cnscd Ltrw (Chnprcr 9. ConndcinC wirh s.cri('n 7o0o or Divni.n I ofrhc Busnrss,trd
<br />Prefessions Conc) or lhrl hcorshc iscxcnu lh.rcfon 0nd rh.basis ror rhc rllcScd cxcmpt n. Anyvioh'ionofSalionT0:11.5byany
<br />,ptlicatrla{tr! pcmrir suhjccrslhc arplicanr h !cililpenulryotlot mnc lho" rivc hundrcddoua6($500)
<br />L ,s owrcr ol rhc pml(ny. or nry enFl{,res wilh uagcr .\ rh.ir hlc compcns ion. silldo 6c{ollel rhc (ddur is ior
<br />inrcniL{ urolTLrcdLislr(SN704J.Bxsi.c\sedProfcs\ion\C{.:ThcG,na.d'rLi.cnsdLwdocsnor0mly1o.tr.$wof
<br />rhc pRrpcnt shl hilds or impn,ks rhm'L nid wlD d(E such *ork hin,{llor hcsclror rhtuuBh hh or hcr osn.nDldyccs.
<br />rovidcd rh8l \uch impmEnEnh m mr idc.dcd oftrn lor suh lt: hovctrr. lhc noihins or impmR'Etrr is sld *ithin ',nc Fr
<br />ol coDlplclir4 d. osncr Buildcr will hovc ih. burdcnolpft,virs rld h.or\tu did nor buitl or ni!,(nc fi.ImFny for thc j,u!r)Eol
<br />-1.
<br />!so*ncr ol rhc pn,|Eny.0 crclusivcly.onlircrintqirhlic.nscdc.nr.clonroconslrucrlhclojccr(S(.7Or4-Bn.i"cs\
<br />nM P$fts\ir Codc: 'I hc Conks.ror'! l-i.cnsc t-a* doc\ noi nprlyt, rn.wn.r ofptup.ny who builds or nNrovcs lhqcon.
<br />and who conlmcts lo! srch lojccls qirhrContn ror(s) lians.d puisulnr Iorh.Conrmcnn\ Li.cnr tnq)
<br />-1.flcx.nr
<br />undcr se_rio B & PC Lrthn rrlotr.
<br />]TI}BtrE8S]:AUIDN$Irj)N
<br />DE(:I4RAToN
<br />I hcrcby rllnn utu]$ Finalryofp.9uryonc ofrhc fouowina dmlmrnrd\l
<br />I hnrc il will nEnnain rCcnificrr.ofCon\cnr b Sclf l,NUrc fi, *orltdr conlnci\rtoi. as lnrridcd nr hy Sc.rid:17(rO !fthc
<br />lii'or Codc. ntr rhc pcrtonnon.cotrhc wok l'or wnichrhc rrnnir h hnrcd
<br />_l havc rnd will marnr0nr workcB- con{Bnsrr mn insuirr.c. r\ oquiNd bt S(r io. 1700 oi rhc tjhor Odc- for th. pcn'orrorcc ol
<br />y woikcs' comFnerion in\ur.R. cdicr n tx'lky nun$cr uc
<br />'t -(q
<br />I ccnirrhlr in rhcll.rlonmk-'cof rhc *ort br $hth
<br />'hn
<br />pcrmil is tsucd.l lhrllnor cnrploy ony ,)crson in anynrnnrr
<br />n, shh..orsrhr.crt,rhxsolkcr.omp.nsrn,nlassofciifornia,xndaEtu.rh ifl \h.uhl b...nf, subjccl rothc
<br />sokds cornpcnsir6n proviri,'ns ofS..rion l700.frhc l-ahr Gxlc,l shnll. fDnhwilh.onDly with rlx\c pmvtiotrs..
<br />\YARNIN(i FJilurc h {ctrro *orkcr\' mn,|x.n\ari,r co\.tu8c i\ unlNtuL. rnd \h ll {'hicr rn cnlllloJ.r
<br />r,' rlr md or.omlcnsrion, &@
<br />-,F,--
<br />!llll.!B:!-IL()J
<br />I hcrcby.litor undcr pcnarty oI p.rlu,y thol I am liccnsd un&r pmvasion olChnFq 9(c.nnrcnciflB wirh Sstion 7OO() orDilnion:l
<br />ol rhc ausircs Md Ptur.ssbnsCodc.u hylic.n{ i* in rullrohc rl9..r
<br />C-r2 A**o fcovl6c t
<br />"Tlultt,..,""x
<br />CONSIBIJIIIONIDNDINC-ACENII
<br />I hcrcl,y aflirm dnder FnshyorFriuryrhar rhcrc h a sndtucrion knding saocy ror rhc pdrortuncc orrh. work rd whi.h rhis p$mit is
<br />jssucd (S.c.1097. Civ C.)
<br />APPI.IC,{NT DECLART{N(TN
<br />I hct'bydnnnnndcr pcnrlly of pcrjuyotrc.llhe followinS d.cldariotrs:
<br />Dcmlirion P.nnns-Asb.sos Norin alion r.dcrul Rcsnl ions Onk 40, Prn6)
<br />-Rcquicd
<br />t lrc.of NdifrNlbn
<br />I ced ify rhrr the f.dcral rcgxlalioni 6gudn's ashcsros rcmhl !E nor qJpli.abl. r.
<br />-l
<br />en ify rhal I halc rcad lhis aPDltation lid (alc lhd rhc otnvc informrhn n conrr
<br />oRli,hkrsrxl Srrrr tiNs rcEri',I r cotrnfl .iioL rn,l h.rchy xtrrhf rt. r.!r.\rnr
<br />t
<br />I asr ro mtryl, *nh atl cn, lnd coxnry
<br />arivei ofrhh Cn, Md Con.'yio cni6 utr.
<br />'lEa$o!c nEnrioncd lropcny fo. ins
<br />Appli..nt or Aaent Siantr
<br />APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Bondi ng/Grounding/UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Condilioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Ivleler Release
<br />Rou gh
<br />Service Ir/eter l-
<br />FINAL q/d/tx "'rfu4l )
<br />Notes, Remarks,Ec \./
<br />f/o lt6
<br />Under Slab / Floor
<br />txnd... AJ,lrs
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