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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS OWNER AUILDER DELCARA loN <br />I hLreb amfln und6 p6ahy of pdjury thot I d,.rdnfl fmm lhc Conlracr6d' Licehs liN tor rh. follopinB r@n (Se.?o. 15 <br />llusins snd Profsion Cod€): Any Cny or Counry which r.quir6 a prnn ro .odtud. ahd. impro!., dmolish or rcrEt e)i <br />sroclue prjo, ro irs issu&cc. also r.qliB $. arpli.d for su.h Fr ro 6le a siSncd stahfll ltal h. or shc b lictud1 Nuud <br />to th. pm sio6 ol rne Conrlacrois l,(cnscd Law (Chaprs 9. Comncncins snh Ser@n 7000 ot Division I oa lhc Asin.ss dd <br />Eoa.snns Codc) or rhal h€ or sh. ie cionpl lhdcrioD dd rh€ b€st lor rh. ill.g.d .tmFio.. Any violalion ofsdlioo 70ll.t by a.y <br />applica.t fo. r p.mn sbjea the dpplicant to rcivilp.tr.hyofnol nBr€ lha! five hund,cd dollds ($500) <br />l. as o$fld oflh. prcFdy, or nry€lnploy6 rilh vas6 6 rheir sl€ conpdsariod. silldo rh. Nort ond th. slelue b .ol <br />inrdded or ofised lor sl€ (Sc.704,1. BBinB ed hof6si.B Cod.: The Conlroclo! s Licms taw do6 nol apply lo d ownq of <br />th. Fopedy sho boil& or iirrro!6 th.@n. ed who do6 such trol{ hnns€lfor nmcllor rhoush his or hn o$ndnploy6, <br />prcvid€d lhat such inrpro!@ls ac ml n ud.d o, otfsed tur el€. lf, howw6, lhe buruiu or iml,oBnd is eh wnhin on. )d <br />olconrrl€tion. rh. Own6 Iruikk sill lEvc rhc hrd6 otr,rcvina rhal hc or d'. dd nol build or imrm\! !h. F.pdy aor fi. Ftrpos or <br />-l.6oLws <br />oirhc pmp6ry. exctusnrlyconrractios wirh licF*d conra(onro (nshct thc prcjd (S(. 7044. BBmG <br />and Pllf6sbn cod€, Th. Conlractois Li.cos. Las do6 nor apply ro d osn6 orp(p.ny who builds or improv6 ihdmr <br />and Nho.o 6cls lor such p$jdrs*nna coma.ro(s) li.rs.d pusumr to lftc ('onlracror's ljco* tiw) <br />_l Mr.rc ll, mdd se'io I &PC tuihisreN,n <br />Onne.: <br />][aa6Ias'-ea!!88!!arlo!lECt BAr!!2! <br />I hcrcby afi]rm undd pdalryolpEjuryonc oflhc followin8 delmlioN <br />_I halc dd *illdaimain a CdificotcoacolBdr ro Sdtusurc aor erk6t coiip. rrion. a F$vid.d foi byS.crion lr00 ot!h. <br />lrbor Code, for lh. p6fome.c ol ihe worl foi $i.b rhc peml u issu.d <br />_l hav. and {illmrinrain work.B compcsarion insurnn .. s !.!uir€d by Salion lT00ofthc Labot Codc, for ln. lqfonnmcr of <br />lor {hich rhir p@il is isr.d My worksr conpmdioniBur cc cni( dd lolicy numtE e'wr. <br />Kpnri"y <br />-l <br />c.nilythal io Ih. psronnanc. orlhc $.rk lo' shi.h rhB!.nnir is I si.ll tror onploy any p.rvrn in any mdntr <br />$ 6lo bccom. sobjet to rh. \ 0116' compdsalion laws ofc.liaomk. ud asr* rhd ifI3hould bcon subjdl tolh. <br />Mrt6 comp.Nl ion prcvtioB of Salion 1700 ol dE L.bor Cod€. I shall. lonNnh comply *ith lhos pmvisioN.. <br />waRNlNC Failurc to *cue vorkcB cd,npd3aro. Nrdasc ir unlawful. dd sh.ll slbid an onployd lo dininal p6ahi6 d <br />. l lin.s ut ro onr h@dtd rnoded doll6 ($100,000), in adlhion 1o lhe cosl orco,np.Ntion, ddagd N prolided fo. th€ <br />Dta( 1.,\R \t ()i\ <br />I m lic.En uad6 p06ion oa((connndcinB wnh Selion 7000) or Divtion .l <br />ol rh. Businss dd ProasioN Cod., dd mylics. is in tull forcc ud elTal <br />v €ln ,..""W-r,*?/u/r/{A {,1 casfr'r-n <br />D I n@bt altrn uhdd p.naltyotpdju.ythrt lh6e is a connruclion lmdiis a!d.y lorrh. pdfommc. oaihc*! fo. which thls Dsnil is <br />issucd (ss 1097, ci! c ) <br />ATII,ICAtrI.DICLTBAI()I <br />I hq€try aflinn trndd D.nalty of p€r,ury oru of rh€ follo*iu dccl&.i io.3 <br />ocmohion PdmnsAsbBtos Nolificat ion Fcdd.l R.anL!io!!-('In b 40. Pano) <br />Requned Le doaNotificalion <br />regularioB r.8&ding dh5t8 rondeld. nor <br />-r.dify <br />lh,l I h,!.r[d rhe alxrve irlomlaln]n is <br />t. blildl.n co.sto.tion. md h6.by authoriz! <br />*t <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 / Groundinq / UFER <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar RouOh) <br />Meter Release )\er6 <br />Rouqh <br />Service Meter I <br />FINAL h l^[ (q ,(/lqu aUeU \ roakh hde akiv"t <br />Notes, Remarks Etc l/O4</8^n1 <br />DATE <br />Transformers <br />//A <br />' <br />W