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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARA'IION <br />I hd.by amnn onds p.nalty o t pe4uly rfid I m .xdnpr fiom rh. Conrr.croB Lr.ne Law for thc iollowing rmn (S.c 70l l 5 <br />Busin6s ad Pr.l6sion Code): Any Ciry o. Cou y which Equir6 a pdnn to consrod, .1i6. ihpro\q d.molsh or rcran dy <br />srructu€. pnor ro its issudc., .lso rcqun6 rhe applicer for sucn pn6n b Iilc a si8ned sd6.6l thal h. or $c it licdtscd pwel <br />tu rhc Fovisio8 olrh. Conrrrloi! Liccnsd L.w (Chrpl6 9. Cormocinr Nith S*rioo 7000 of Dilision I oflh€ BusiBs Md <br />Itof.sions Codc) or lh.r hc or she ir .iefrfl rh6dro'n sd rhe bdis for rhc rlL!.d .rmpiion Any violdionofseclion 70.! 1.5 bymyr ' <br />dpplicdt for a Fmir subjdrs thc atplica.ltoacililp."anrofnolnor.thofivchun&€ddollds{5500). <br />-1. <br />6 osner of rhc Dropeny. o. fty.6rlolEs s irh \"s6 d rh.t $1. c.np$nion, $ill do tt wort ud l,l€ srudE a rcl <br />inrod.d oroffd.d tu sa].(S< 7044, aosind ed ProaBio6 Cod.: Tn ConlE.lois Lic€e L3w do6 .ol appl, ro m oMe oa <br />lhc Fop€1y sho hrlds or Lnprov6 lh@n. ed who do6 such wrt hins.lf or h@lr or lhough his oi hd om .mploycB, <br />rovid.d rhar such inporandrs ft nor iddd.d or offdid for el. If, howd6. rh. trildin-! or inl.tovorcnr is sld wilr,in on. ]r <br />ofcompldioa th. Osr6 Buikld $nl bNt tlE hmr6 olFoving rhd h. or she did mt tdld or inqrov. fic pmrsly for lhc purlD* of <br />l,6o\vnc ollhc Fop61y. r cxcluircly conlraclins wilh li..Nrd .ontaclo6 <br />'o <br />codo.l lh. ptojccl (Sc 7L!U. A6ins <br />dd Pofssbn Cod.: The Conlractols Li..ns. Lz{ do6 nor apply ro d ownd ofprop.ny who builds or improvdlhad.. <br />and who conhcrs fo! such proj..rs with a Conlraclo(s) licNd pu6@t r{' thc contrcrois LicNe bw) <br />I m erempt under Ssl ion . R. & P.C. ro! lhls ,ason. <br />r(l8[EBS_lArlEErlAIa! <br />DICIdAAIIAB <br />I hqeby amn. unds pqaltyofpsjuryoueorlhe fdlowinlr declealtuns: <br />I ha!. a sill maimain s C.nilicar. ofconsr to Sclf-lBu!.lorworler! conr!.nr.'ion.6 providrd lorbrSdionlT00oillE <br />Lrbor Codc, lor lh. pqfonne.. ofrh. work aor which rh. pdnir i. iso.d. <br />' <br />h.v. afld $ill mainlain wort.rr comr€ns.rion insumncc.6 r.qutcd tySdo.lT00ofth. Lnborcode. aor lhc psfomanc. of <br />rhc rork aor vhici lhis p€lmil ie isrcd. My workds comp€tral ion imurance cdid dd policy nunbr e. <br />I cdilyrhd i6th.pdrormanccotlh. work for qhich lhis p6mil is isu.d,I shall nol @ploy any pcen in m! menE <br />s d lo bsome subj{r to fie wo*6' cooD.nsarion &wr olcalilomia. dd agre ihat it I should b<.oE subjd !o rhc <br />Nod6' m rposrion povisioN of Sc.lion 1700 of th. Lrbo. Code. I sh!,|. fodh*ih mmply Nilh lhok pmvisioN.. <br />WARNING: Failrc ro suc *0116 conpeGalion colrarc is unla{ lul. &d shall subjsl an onployr l. dniml p68hi6 dd <br />cilil nn.s up b one iundi.n rhousmd dolls l$100,000), in addnion ro rh€ coi ofcomp.Nation. dahas6 a provid.d aor rh. <br />sdridn 1076oarh€ L.bor cod. i d6r dtrtlre!'s a6 <br />trcExsED_cotrrtAclaB <br />DICI48AIION <br />I h6eb, afm uidd p.n lty oa pdjuy rhsl I m licds€d undd Fovision otchaplq 9 (.oinacing *ilh S.dio, ?000) of Division l <br />ol lhc Busioe 4d Prcf6ioB Codc, axl my licc. is in irll for.. a.d .fldi. <br />Contr..lo.: <br />(QlnralqraN.LItDlNcAclNcr <br />I hqeby aflinn und6 p€.ahyofpsjury rhat Ihq. a a.oinrudion kndinB 0gocy forrfi. p<folr@cc oflhc*o for \rti.h rhis pdftil ie <br />issucd (Sc.l0i)?, Civ. C ) <br />AIII.JIjANLDIiCLABAJIO! <br />I hcltry aflim undq roah y olFjury onc orlhc followo8 ddldalioB: <br />Ddnolnion Pdnits-Ash.slos Notifi cation !-.d6al R.lulations (Tnb 40. Pan6) <br />Requtcd t-dr$ olNorlfi cdion <br />-l <br />co1iry rhal thc ledqal rcsularions regddnrs dbdros ron{lal a. nor applicabl€ ro rhis prcjal <br />-l <br />.diry rhar I harc r@d rhis arplic.iion as1 $al. $ai th. above inaom0liof, is .ord. I agr6 lo cooply *ilh aU Cny and Counlt <br />oidi.anc6 ed Sl!r. Lrws r.laiing ro buildine conntud iorl rnd hdcby adfioriz. r.![6otaln6 o t rhis Cny &d Coonly ro 616 upon thc <br />alEv. Mrioncd Itropgly for inrp€lioo purpo36. <br />Appli.unl or Agsl SiEnutrre <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safe ty /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />To rquerng <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 Rouqh) <br />Meter Release <br />Rough <br />Service [\4eter /^ <br />FINAL il-7"t(hlur6l <br />Notes Remarks, Etc <br />Site-Work <br />L.nd.i'Ad&s'- <br />tl <br />f-------T------ <br />--------r------