|
APPROVALS DATE ID/SIG.COMMENTS O*od-Buildo Dcclsdti@
<br />I hftby amm undcr p.nalt, of p.rjury thar I h dnpl fom rtc Con!-&t6' Licdsc L!* lo $. lollo*in8 Bon G*.r03 I 5 Bqif,B
<br />d Prcf*ioi Cod.): Any Ciry d Co@9 *hich Equi6 a p.rnn to cotuEucq dla. improvc, dmolish or rcpd, uy slsctu., Fior ro it
<br />i$udcc, abo rcquirG tc applicmr for su.h p.mt ro filc a signcd slardol dai h. o sh. t licms.d puRudr ro $c Foyisioro of thc
<br />C@ta.lo\ Li.m$d Law (ChopLr 9, Cmmoci.S with S@ o.7000 ofDivision 3 offi.B6in6 ud Prcfsids Cod.) o Iiar hcd
<br />lhc is cxdpt th.Efro6 dd lhc bais ld $. rllcScd cxmpdd Any violario oa S.cUo 703 I s b, d, .ppli6l lor a pchn s$jeB th.
<br />appli@r lo a civil p.nalty ol nor noc thd ,jec hun&.d doll6 (t50o)
<br />I, a own.r of itc prcp.rty, or my .mDloy.cs with wa86 a th.ir rcl. compcnsation, will do rh. wsk od thc srucrB. is not intcndcd
<br />or ord.d ad salc ( Scc 70,14. B6ines &d ProlBi@s Cod. Thc Contr&1or's Licd* Law dG nd arply !o u ownd ofrh. prop.ny
<br />whobuilds or improv6 ttfto, ddwhod6 such wdk hiroclf or hdclf or throqh his or hd M ddoy6. provi&d th.r iu.h
<br />improem.nr. m nor inhd.d or ofir.d for sal. Il ho*cvcr. $. buildrn8 or imFov.mdr t sold witnin m. y.e of conploon, lnc
<br />OMd'Build., *ill l.v. th. blrdo ol prcving tlut hc d sh. nor build or inprcvc for $. purpoa of sal.)
<br />_1, a ownd of $. pror..ry, M cxclciv.ly o.tuting *idi li..ns.d condct c ro corhcr rh. prcjcd ( Se 7044, Bsin6! d
<br />Proasion Cod. Th. Cortr&tors Licas. Llw do6 nol rlply b & owhd of prcpaty who builds r inrrov6 i[o@n , ed who
<br />connrc$ for such prcjds with a conEero(, limscd DuEuut to lh. conretors Liccnsc kw )
<br />I d cx.hpt undE S.cr'on ,B &PC for rhis r.don
<br />IABtrD8ICAI4IENIAIIAN.DECIAEdI&N
<br />I h.rby amm mdd p.nalty ofpdjury orc olftc follo*ing dccleatiod:
<br />_l h!v. ad will rujnt iI a Califi.d. oi Cmot to S.ltuM@ for *qi6 cmpoialiM, a previ.Ld for by Seioo 3700 of th.
<br />rabo Cod.. aq rh. p6{mde of $. worl fd which rh. Fmil ir isucd
<br />_l hsvc &d will hsinlain sql6 mmpqsalion iNure@, c r.qutcd by S.clion 3?00 of th. kbor Codc, ail thc p6fmec. ofltc
<br />wtrt fo. vhich lhis p.rnil is issucd My wsk6' compcnsarion insuro€c ffid d Dolicy numb.r dc
<br />Policy Nunbd Expi6
<br />(Tht scclion n.ed nor bc compl.t d iflhc lafln is for O.c hun&cd doll6 11r00) or lc$)
<br />_I cdiry th* in th. p6fmdc. ol lnc vork f6 *hic$ dis tmir is isucd, I shdl nor cflploy dy rEsd in ey lMnd so 6 to
<br />bccd. subj.d lo thc *{rc6 ' compcnldlion laas of Caliami4 ud agE thar if I should beom. subj.ct ro th. so*c6'
<br />.omp.ns.tio. provisionsof S.c on 1700oflh.tdorCod., I shall adrh*nn .6ply with rhcc Fovisids
<br />.S -za,/a /
<br />WARNING: Failurclo !.curc workcR @np.nsarion €ov6aa. is unlawlul, od shallsubjcci a mploy.r to aiminal porlti6ed civil
<br />6n6 up to ooc huidrcd $oBud dollc (t loO,OoO),in rddilim ro lhc 6r ot compdlalid, dd!s6 6 prcvid.d ad th. S.cim 30?6 ol
<br />Ih. hbor Codc, int.cr -d art@.y\ 4.6.
<br />ucEdiED-coNrB croaiDpcldBAuox
<br />I hftby ailm und.r parlty of pcdury $al I n li.d.d unda p.ovisi@ of Ch.piE 9 (cormcncing wi$ S@tion 7000) ol Dvision I ol
<br />dr BBinar dd Prcreioni Cod.. dd ny lico5. is in full lmc Md crcr
<br />caNsrBuclo!!ll@0ctcIlcv
<br />I h@by .mm udd pa.lly of pqjury dtal th6. b t @nsEucrid lcndirg lg.ncy fd $c p.rfma.c oa rh. w*t f6 ,hich this D.mt ii
<br />issucd (Sa 1097. Civ. C)
<br />AITLICAII]iDECIJAAIION
<br />Dcmohion Pmn$Asb.s4 No ncrioi Fcd.ral R.guladons (Titl. 40, Pan 6)
<br />Rcquicd Lctcr of Notifi qtio
<br />_l c.niiy ihar th. f.dcral rc8olatoN rcgading dbstos r.hovol dc rol applieblc lo this p,oj.cr.
<br />_ I cdnry thar I h8vc rcad this appliEtim od sllr rhar l,l..bov. i.lodation h c6.ct I as@ |o Mply {ith rllCit, dd Counry
<br />ordindc6 dd Sralc Laws r€lalinS to building cmsuudion, dd h@by au$ori2c rcprBalarive of thk City dd Counry ro .ild upon th.
<br />aboyc hmti@cd ptoFrty for insD.crio plrDc6
<br />o
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />=YrrlH EN
<br />Rough
<br />FFRNI
<br />Notes, Remarks, Etc.gflmCti{:Eu$Dr, {u.
<br />ELECTRICAL-INSPECTOR RECORD
<br />Licos. Cl6s:_ Lic6s Numb.r
<br />-,/.trzt./,// -',e,
<br />Service Meter rn::l
<br />FINAL
|