|
ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUILDER DELCAI'ATION
<br />I lF€by arun und6 pLnalr, of perjnry ih.l I m cx.nrpl lio'n lhc conractoB' Li..nse titr fo! thc fouowins i.en (Sc.7011.5
<br />Busin6s md Prufcsiotr Codc): Any Cny or Counly *hich rqute . pd'nit ro co6trucl, 6116, inprolc, ddolish or rcp.n uy
<br />slrucrurc. prior to ils issuecc, als. r.qun6 rh. alplic@t for surh !.flnil to fil€ 3 sisn.d $6rdbd rhal hc or st. b licascd p6udl
<br />ro rhc provtioN ofthe Conlrlclois Liccnt€d ,jrv (Chaol6 9. Co'n,ncn in8 wilh S{lion 7000 olDivision I oathe Bosins ed
<br />Prctsions Codc) or Fr h€orshe 6.x.frpr ihd.fiom md th. bsis Lr th. all.g.d cx@prion An,violarionofs.clion70115by.ny
<br />applic.nt lor ap.mn subjalsrh€ applicant ro.cnilp.naltyofool mor.rhd nv.hun&eddollss(5t00).
<br />l. N omcr of rhc p,opsly, or n, @plot€ vnh Nas6 6 lh.n $i. cohpos.lion vill do thc work sxl $. n,ud@ b nol
<br />inrodcd or orcr.d fDi saL (Se.7044. 86i.6 Md Poa6ioc Codq Tb. co.trcclols Licffi Larv do6 ooI eply ro d olhd of
<br />rh. !mp.n) u,ho build! or iiwov6 than, ad s ho &6 $ch "!ft hnNclf or hmlf or lhbugh his or hd om e,nplor.B,
<br />pro!'ded rhar such i,nFormars e mt inlod.d o. oF6.d fo. slc ll ho\r6<. r,ts boildinS o! qrc!.'6l i. $ld wilhit onc yw
<br />ofco'n ldion. rfic Oin6 Buil&r q'iu iarc lh€ bddo ofFovins that he or shc did ml tuild or inpmr. fic popqty aor lh. FrIo* of
<br />l. 6 orvn6 ollhc Fopcly. an cx.lusilcly co,tradins with li.eaed coit{tou to o.sl cl th€ rojd (SE. 7M4. B8ins
<br />aftl Plofsbr Cod.i Tfi. Conlracr.r's L'cosc Law do6 nor itply ro m ownd o I propcny vho builds or inprcvBlhdNo.
<br />and trho co.tacts loi $ch p.jds wilh a Contmclo(s) licosd plsual ro lheConltecloas Licc6c lrw)
<br />I d.rcn6r undd sdrio. . B & PC forrhb rcson
<br />Own..:
<br />woRl(xns. coMrF{sATroN
<br />DECIdEAIJ9N
<br />I h6.by altm uod.r ,..rlt, ofpdjury on. oath. lollowins ddla.liore:
<br />-l
<br />hav. d eill minlsin a Ccrrifical. of Colgl lo SdfiBc. for wo.l6 @m9..!aiion. s prcvi.lcd for by Sdrio. 3?0o oalh.
<br />Libor Cod.. for rn. pdaommc. of th. wor* for whict th. Fdil ir i!sr.d.
<br />yl h*. and wrll mainroin * 6rk.B conpccarirn iNdmcc, s requi.d by Sdtion 1700 oalh. Labor Codc. lbr th. Ffom c.of
<br />rhd $or k lor \vhich lhis pemit is isued My *orlss
<br />Zt)'^nw Ayw/Y\
<br />\N(t)/tthl 4l(K tq
<br />t cedi& lhal in lhc prfomanc. ofthc work for Bhich this p6mn is issu€d, I shall .ot mploy any !.6on in dy 6Ma
<br />so dlo be.omc rubjd ro rheso d'o,rp6s.lion losofcalifonia &d,!rd lhol ia| should beoe sobjdt toth€
<br />*o 6' srp.@rion prottios oa Sd ion l?00 oflh. kbo, Codq I shall. fonhwilh conply virh rhoe PovGioN..
<br />\\ARNIN(: triluc h s.ctrre ro.kri..mpcnq(nn, (\.rrgr is nlawful. and shall sulidl & mployd lo oiminal Il6ahk! tud
<br />civ,l n.es up ro on. hundrcd thousdd doll6 ($100,000), n ion. dmaa6 6 provid.d ,!r rh.
<br />I hftby amrm uod€r p@1ry oaFjury ihal I m lic.&n und( Fovrsion ot Chaprs 9 (conmdcias $'irh S..rion 70001 oi Division l
<br />ol rhcBsinN d Prcf€ssiore Cod.. aij m,|i.tu. i. in aullaorc.udc0i.l.
<br />t?1v??+za,.,. rtlr lt7 ."",,","., Utu) tErt\Aa,vz-r\wc.
<br />coll[8]/cuolLlElDjxc-acDlcl
<br />I h6.by orm undr Dd8.lly of pojliy rhn d,c is a coNocrior kodins tedc, fot th. Pdfomdcc olfi. erk tu vhich lhi! Fnn is
<br />i$u.d(36. 1097, Civ. C.).
<br />trnds s Addrs
<br />AITI.ICANLDECIAAAIIAd
<br />I lsrby.trm urds Dqah y ot prjury on€ of lh. followinB ddl{alions:
<br />Dmolhion PamiteAsb6ros Norificrtio. F.d6.l R.g arions (Tillc 40. P6l6)
<br />R€quted kl( of Nolificaion
<br />-l
<br />cdily rhar rh. acddal rc8ulalio6 resedms db€ros r€doval e nor applicable to tha prej..t
<br />I .6iify lhd I halc rod this applEarion &d infomdion is cor€.l. I lsrd ro .onply wi$ all Cily a.d Co, y
<br />ordindn.s dnd s(.rc li\rs rclaring ro build,n!rcpr6orarir6 ollhis Cit, md Counly lu drd uPon rh€
<br />abovc morio!.d popdly aor
<br />ADoli.ant or Aqcnt Sisn!n,rc
<br />W*z.vt,'n"*n* *." ron*r' .J A-l)/'l U
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (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 />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />It4eter Release
<br />Rough
<br />Service lvleter ruilt,)z ///,rle
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />se.rrcn 1076 ofrhc l..hr(odc inidd andanorney's
<br />r,.,.: rll rlt4t
<br />-_T-r-
<br />^.. rlt l@
<br />FINAL
|