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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS OWNTiR BUILDER DEI-CARATION
<br />I hd.ty amrnr undcr p€.ally ot pgjury rh.t I d crnfl 6on lh. Conlr.clos Liccns.li* forOc aollowing r@n (Sn 7011,5
<br />B*in6s a.d Prof*'on Cod.): Ary Ciry or Cou y which r.quir6 a pqm't lo conntu.l, ahd, ihprovc &molih or Epait dy
<br />lhduq Fid ro ns isumc., also r€qun6lhc applicdl tor such pnnn lo nL a si8..d slalmdt lhal hc or sh. is licas.d plmer
<br />lo rhc p.ovisioc of rh. Conlraclois Lic.n$d rltr (Ch.pl6 9, Commcncins rvith S€liot 7000 of Division I oflh. B6inds dd
<br />Pofcsiois Codc) o, thal l1.or sh. is.r.mpl th6.tom md lh. bsis for lhc allcr.d.rnFion. Anr viol.tion ofsclion 70ll 5 by any
<br />appli.trl ao. a ponil sobjdsln. opplicanilo acivilp.nallyofnor h.,. rha 6!. hun&€d dollss (1500)
<br />-1.
<br />s otrnd oflh. pmpcdr. or ny cmplo)G wilh wass 6 thcn sb comp.nstrion. will do lh. rvo,k ad rh. srtudm is mt
<br />in6.Ld or o rs.d lor sl€ (Se 7C',u. Businei ad PiolsioB Cod. Ti€ Contictoa s Li.ds. Ijw do6 not .pply Io a os hd ol
<br />rh. lrDpdy who toilds or i!'povE thsbq a.d $h. do6 s.h st( hitrelaor hrylr or rhrcuth his or hd ow @ploy.d.
<br />p.ovided rhll s!.h i.ryrolare s m mt irndd.d or orold lor sb. It ho*a'd. rhe hiktB or imFovd.l i! eld *ittin on. ,d
<br />of co'npleriotr rh€ ()sra Buil:!6 will havc lhc hndo of F.ving thlt h. or sh. did nol build or idprcvc O. pr.Fty for thc puPor of
<br />-1.
<br />a o\hd oarhc tmtdy, m .rclusiv.ly contacl ins with licos.d co.lh.lo6
<br />'o
<br />coNrud rhc projdl {Se 7ol4. a6ins
<br />a.d lioGssion Codc:'rhc contacroas Lic6s.llwdo6.ol applr ro an oNn6 olprop.ny *ho bxildso. imprc\arhson,
<br />and sho .onrads for such projtrls Bilh a ConlEcro(r licdcd pu6ua to rh. (trrradoa s l.ic6e t!s)
<br />_l d.rnrpr undo sdrion_. U. & t C nrfis r.aJn
<br />.!qa5E8$:g(2E.tErSAnO.N
<br />DECIAIAIIO!
<br />Ihercbyaiinnu dei pdrlty ol Fjury on. olric rolhsint d(l alioN:
<br />-l
<br />harc ed siu nainrain r Cdificdc of CoM! ro Seli-lNurc lor Mlkes o"rP.nstion, 6 provid.d lo. by sdlion 1700 o f th.
<br />Labor Code lor rhc psfoddc. of d. \@rt for *hkh th. panit is i$u€d.
<br />-l
<br />have and {ill Minratu $o*.rs coBp.Mtion iBuranc€. 6 tcquncd b, Sct ion 1700 of lhc ljho. Cod.. for th. Pdfomoc. or
<br />rh. s^rl far $hn h rhir pm is rsrcd M) tro,t.6 rcf,pda'on GUd.c ffiE dd polr) numbq d.
<br />csr6 , €re-- tpt\J
<br />I cenirythol in lh. p.rlor@nc..irh. *or[ ior {hich rllis p.rmn is issucd,I shan n.l mploy tny pmn in.ny 'nen.riJ s ro b€omc subjdt lo ihc so*6' compcnsalion l.rvs ol Calilod& dd +re fial it I should b€(on subje' to lhc
<br />qrt6' co'np4d i.. pmlisions of Sdion 1700 oflne L.bor Cod€, I shall. lodhwilh co'nply Nith lto* provisio.s
<br />WARNINC: Failuc ro su. udld' co,npoMlion olcfts. t unlasful, ed sh.ll snbjal s cnplold to cininal paaliB d
<br />nrn ro Oc cosr oa conp.Mlion, daoase a prelided aor lh.
<br />inr€rst:nd tncy s fcL:
<br />.14
<br />I heby amnnrnd6 paalty of F.jury lhal I @ li..Gcn lndd provision ofchapld 9 (cohnd.ins wilh S.dion 7000) ofDirnion -r
<br />or rhc BBins dd ProisioN Codc. &d my licsc is in tuU forcc and.0irr
<br />f3"
<br />aot(,*,^,.,
<br />CONSTRUCTION I
<br />'NNIN(: AGFN('Y
<br />I h@by aflm undd p.nally ol pdju.y lhat lh@ is a cotr{oclion L.din! asa.y aot lh. Flomflnc. oflh€ wo.t tur $ hich rhis Pdmn b
<br />hsucd (56.1097. Civ. C.)
<br />AIIUCANLDECIASAIIO!
<br />I hs.by arftm undd pd.h y ol pdjury onc ol th. following dcldlion.:
<br />DmoInion Pcnnirs-Asb6ros Nolifi.arion F.dml R.gularioro (Tillc.40. P.n6)
<br />-R€q!iEd
<br />tdrd of Noincrdon
<br />-l
<br />c61i! lhsl rhc tcdml r+ulalio6 esadi.s sbcios r@oval re nol arplicablc lo rhis prcjdl
<br />[,.-'",n, ,**.ro,no appharion udsr'r. rhd rc.bov. inromtrion is cona1. I alrc ro onply wnh all cny dd coury
<br />/oiinancc ua Sralc t-a*s rctaq lo hu'ldj!€snfrdior irdhlrbyaurhonle (F.srarn*of rh:sCir' andCounD rodrc up..rh.
<br />rAt-r. ma,'.ndl nmd\ ror,..a-/*< / I /,/;;ffi;:TrV_y /,to,..h, _,". i@aoff
<br />rer.rrenr.crp,rno,.x. .DwD--. /tt{.* z- .--
<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 / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<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 />lvleter Release
<br />Rouqh :L/u/ls 6DtaD
<br />Service Meter
<br />FINAL t/ i1/t1 5lsi-l{
<br />Notes, Remarks, Etc
<br />_->
<br />Air Conditioners
<br />civil fin€s ut lo one hundr.d rhous&d doll6 ($100,000), in
<br />o"", ' /2-[L "(
<br />I rn,lr' ' 41.[6'
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