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ELECTBICAL.INSPECTOR BECOBD
<br />APPROVALS IDiSIG.COMMENTS OWNEN BUILDIjR DELCARATION
<br />I hc,eby amrn lndcr p.nalty .f lcrflry nEr I an cxcmpr fmn rhc Conrrack c Lkcn* r!{ tor rhc rollowing B.$n (sc.?o.ll.5
<br />Busi..$ and Ptur.asion Codc): ny Cn! or County vhkh rquncl , pcrmt lo conslrud. olrcr. improvc. d.mlnh o, Eprn any
<br />srocruc. prior to ni isuaRc. aho rcquncs lhc appli. r Lr such Fnnit ro fik ! signcd srarcmnr rhlr hc or sh. is li.cnrd l]uisuair
<br />t, rh. pmvisnrni olrhc Conr'acrois Liccn*d lis (Chaprcr 9- Commceins wirh Scdion 7000 oa Division 3 oflhc Busincs enf
<br />Pmf.ssbns cod.) or rhar rE ., rhc is crcq)l rhd.tu,n and rhc hf,rn for
<br />'he
<br />dl.g.d cx.mprio.. Any riolalhn of Strlbn 701 I 5 b, rny
<br />alllic.nt for a pennil subjelrrhc apllicsflrto6civilpcn0lryornornbethlnfilthuodrcrldollos($50o)
<br />lLG*
<br />"**,r,n" r.*nr. or mrcnplo)ccs wirh *oEcs as rhct stc crn0cosario.. uitrd() rrr wo,k,.d trE srM@ n nor
<br />inlcft*n or oficrcd ror e . ( SN.7044. Busirc$ rnd Prolcssions Codc: Thc ConlBdols Ltcns tiw des not atdy ro o.*ncr or
<br />rh. pmFrly *ho b!il& o' in{mrB rh.@( rld who des ffih wort hims.l( or h$elf or lhnuh hk 6r h.r own cmpbrccs.
<br />providcd $ar such imnmwmnk m mr inlcnt { oi ofi€ed for slc la, h,w.hr, rlr huilding or inlpmwmnt is sld wilhin om ]Ed
<br />ofonpLrirn. ilx Ownf Builitcr will haw rhe hrdctr of Dmving lhat h. or sh€ dil mr truild o. impoE tlE IrDIEty for rhc ,rurxM of
<br />l. {s o*mrofthc tmF.ny. amcx.lusivclyco ra.ring wnh li.cnscd coniDcktrs ro .on(rucr rhc lmjccr rS(.70,14. B!\ii.s
<br />a.d PDicsnn Codc I hc Co.rrucrois !-iccnse liw des nor npFly ro r. os'rcr oi popcny eho build\ or nnpii,vcs rhcr.on.
<br />rnd wh. $nthcB rd srh ptuh.a wilh a Conkacrdlt li..n\.d lU nair ro rh. cdntu ttr s Li..n* tr*)
<br />-l
<br />amcrcmrl utr{icr $dnnr-. a &PC forihisrco$n.
<br />"","bllbl1b "#-Z-.L*41-' ]r!)a6E&ttalltEAliarl!
<br />DSCL$ r()!
<br />I h.ir.$y rlnnnrndc' |{drlr! ofNrjury oft nl rhc,nln'qi'U dr.l r rn,I
<br />-l
<br />haw .rxl will nuinrrin 0 Ccniilc.t. of Consnl b Sclf lnsurc for w.lktrs comprNdion. as pmvided fo! by S(xon 3 l(Xl of lhc
<br />blr, Gd.. for rhc p.rtormun.. ofrhr wort for whicli lhe psmir i\ i\ikd
<br />_lhalcrnd willman oinwoltcn compcns ioninM.ncc.i\.cquncdhySdion3T()0.trhcL,horCodc-{orrncpcrformuccof
<br />rhc work lotwhichlhk pc nir is hsucd Myworkcrs c,npcnsdtioa insuruncccatricr rd F,licy nuni,cr uc:
<br />PolicY Numbcr:-ErDircs:
<br />-
<br />lakrrr,r, ,,,*
<br />^,r.ntuncc
<br />orrhc *or( ror {hich rhis pcrn,ir i\ is\urd. I strtt tror.n,pk,r rny p.son n, nn, nr{nnc,
<br />$ ds t h..om \trbicr k, rh. *ltrk.r\ Lunpci\dn hs\ ot Crlifonria. lnd +n. thlr iI l dNuld bLronr b,.d l() lhc
<br />$dkc^ comr.nun,n pn,vnn,n\ olSc.rn'n lT0Oofrhc tjhn Codc.l shall. fonhwirh comply $irh rno* provnion(
<br />WARNINC Failurc h scu.c sorkc( compcnstn)n corcagc i\ unla*tu| rnd \lull {rhtc.r Jr L'ipl.ycr k, sinrirl l.nhics rnd
<br />.i!il finc\ up k, oro hridrcd rhou\dnd dolla^ ($lm.m0)- in nJdni,)n t' rhc ro$ ofcn.rlatr\rrtun. d{trB8cs rr provnicn tu r[c
<br />,:-t"E/tr''""'ffi|i". r-,--A + G
<br />LX;EN:IELCONINAIIAA
<br />IECLAAAIION
<br />U-a-,--
<br />I h.rcb, lffirm !.dcr pcmltyofFrjur} lhal I afl liccnst undcrymlisiofl ofChaptcr 9 (otnr.ci.s oirh Scrbo 7tn0) urDivisiod:1
<br />of rhc Busincscund Pn,f.ssi..s Cbdc,0nd my lac.s. k nr full fom &d cffccr.
<br />SONIiIf,UCIONIEND]XIiICENS
<br />I h.eby arlirn und( Fnalry of Frju,y lhar rhcE h r .onsm.rion lcodine ngcnc, ror rhc IslollMcc or th. work t r *htt rhir pcrhir i\
<br />hsued lscc 1097. Ci! C.).
<br />AIILICAII.DICLASAII{T!
<br />I rtEb, ,rim undcr ,$any oa rErjury ot ol rk aolk,wins dah.!!ions:
<br />Dcnrlirion Pcrmils-Asbcsros Norificsrion F.nsal Rc$bli,trs (Tirlc 40, Pan6)
<br />-Rcquncd
<br />Ldrcr ol NolifEarion
<br />-l
<br />cdifyrhlr lhc Ldcral EBUhl ions rcSmdi.8 trsiEs.s rcnmv.l rrc mlorplicahlc to ltG pmrccl
<br />Yal en'ry rhar I hs'crcad rhhapnlrrri.nsJd {irerh,rrhcrtDlc iniorturion (.dr.c' I agrft ro omply wirh all Cily lnd Counly
<br />ordituecc od Surc lrws el"ring b hlilding.onrrd.rion, rnd h..cby auihrnc rcpescNrtivcs oflhis City.nd Coutrrylo cnlc, uF)n lhc
<br />lhorc nxntnnrd porcny lor
<br />\<-,\--L <--
<br />\crr.l,l2-Dr 1.1 6ii\rur "l-
<br />^,,,Clultb
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltage
<br />Fire Alarm / Dam pers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rough)
<br />l\4eter Release
<br />R ough
<br />Service lVleter tt
<br />FINAL 4lbllq',|(\vr/l\.,\O t/ ?,
<br />Notes, Remarks , Etc.-I I \
<br />DATE
<br />Communications Cable
<br />L.ndc\ AddF*
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