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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE rD/stG.COMMENTS OWNER BUII,DER DELCARATION <br />I hdcb, ailnn u s poalry ot rdju.y rhd I &n.r.mpt from th. Conti.roB' Lic.ns. ttw for lh. foUovinB EMn lsc.70ll.5 <br />Buin6s aftt Proasion cod.)r A.y Cily or County *hich rcqu6 a pdnh ro codrud, an6. inprovc, &iDolish or r.pair ov <br />srtudr., Fior ro irs issuuc€, also r.qut6 th. applicdt fot such p.nnil ro fiL a signcd $n.,Mr thd h. or 3h. n l.a*d psuet <br />ro rhc FovGioos of $c Contrrttr s l,iccn*d Law (Chapl6 s, Com..cin8 siih Sdion 70n0 of Division I ollhc asrncs dd <br />Pmf*ion! Cod.) or rh.t h. or sh. is .rcnfl lh6.Fdm dd th. hsis for lhc allc-s.d .rdplion A.y violation ols..1ion 70:r I 5 by my <br />applicanl fo. a psnn subjcrs!h. rpplicdtlo acivilp.naltyofnot morclhd fiv. nundr.d dolles {!t00) <br />-1. <br />B ownd oathc proFdy. or my cmplo)6 wilh tr'as6 6 th.n $b cDmposslion, *ill do lrt *ott ad dE sl.r€lw t ml <br />imarLd or otId.d for el. lS(.?044. B6ioe ed Prca6sioc Cod.r Th€ Conrndol s Lic@ ks do6 nol apply lo d osnd oa <br />r h€ p.lrEty who hrilds or t prov6 rh@( .rd sho do6 Mh qo* him.lf or h.*lf or lhroush hir or hd om mplov.6. <br />provid.d thar such ihFovcffiss. mt iil6d.d or ofqd forsb.li ho*6'6. th. biildins or imp.or@r i! $ld*nhin onc <br />'rof complaion. lh. Omd &nud *ill hav. rh. hnd.n oaprovi.s thi hcor sh. did mr L iU or imPmrc L\c poFry for E purpoEof <br />-1. <br />6 osE oarh. proFny, m Gxcl6iv€ly conlracl'n! $lh licncd contracroc lo .oElruct thc projc.r (s( 704'1. B6in* <br />md Ptrrftsim Codc: t hc Contra.l6r's Licc6. Law dod nol applr lo e os'n6 ofproFiy sho builds or improvd (hdon. <br />and vho oii6ds lor !u.h F.j..ls *ilh a ConlE lo(s) licsed puBM ro in. aonrEdof! Li..M l,*). <br />I d.rmd u.da Sdtron , B & PC lorrhirrNn <br />Orm. <br />wolll(lrRs' contPENsal l(}N <br />DECI.AAAIIO! <br />I h$cby amn. undd p.n.lty ol pojurv onc olrh€ n,lh$ins ddldarioB <br />I halc ed *ill maimain r ( 61ifical€ ofcolMl ro Sclflnsuc aor \orkcrc' conrpd!,rion. s Fovid.d for by S6non l70o o f th. <br />tibor Code lor r h. pslolfuc. of lh. wod( ior "nth lh. patnil i5 Bucd <br />-l <br />h.v. dnd *ill m.inl0i. worke( comrE6alion iGura.ce. s rdtun.d by SEI ion l70o of rh. kbot Codc. tor lhc pdfomr.. of <br />rh. { ork for whi.h rlir pdnrit b (su.d My worldr coftpdsrio. iNutacc cans dd lDlicy nu,nbq sc <br />Poli., Numbsr-ErPn6: <br />I cenitlhar m lh€ tqfoman €ofthcworl for whichlhispsnr t i.sx.d,I sh.ll not mFloydyFrson in oavmund <br />y, 6 lo b.cod. subj(r ro rh. work6 s .onposalnrn hss .fc.lifomia. ed asc lha ra l $out bcom. subj6l lo rh. <br />wort6 compaerion tmvisioN of Scnion 3700 of rh. Lah.r (tlde.l shrll. fonh* ith .of,ply uith lhos povEitu <br />WARNTNC: r:ailurc ro 6d. so ds conp€Ntion covassc is unla{ful. Md shall subjd e dtlDF lo riminal tEuli. dd <br />ciril 6n€s up lo onc hundrcd rhoumd dollss (1100,000). in addnio. to ol comp€nelnrn, dmses 6 pro\ idcd for thc <br />srii.n 1076 ofrh€,f,t-r Code 'mdd &d atomet s fs <br />D"1", L/-30-/7 <br />I hftby afliirn undq tE h, of psjury lhal I dr licossl und( pror ision olchaplg I (co'nn6c ing wnh S61i,n ?000) olDirision l <br />ol rh. ltusinss od I'ror6si{,6 Code, md my lic4* is in full forc. and .lldr <br />zr-30J2 <br />I ha!b, afm un&r p.mlly ot pcrury $al lhe i! a conshrclion ladins asdcy fo. th. Ffm.. of lh. wor* tor stkh lhis Fftn b <br />issu.d (s*. 1097. cir c.) <br />AfIIICANLDECI,AEAIIO! <br />I ha!ry rrm u.dd pa.hy of pojury onc ol thc follo$ing delmrions: <br />t).molilion Pmils-Asb6ros Notilic.tio. Fcddal R.suhtioos (Titl. 40. P3n6) <br />-Rcquired <br />lnt6 olNcri6cdhn <br />l.dil} rhd $. f.ddalrqulatio6 r.sddin! dkros rmo\ il d. mt appl&bl. u rhi! poiEt <br />I..illy rhar I h.rc,.ad this lnnltilnn srrrc (hd 1hc rh\c ie cor€t I aec lo ompt Enh dl Cily and Counly <br />rcF6olniv6 of lhie Cily .nd Coury lo 6ta Llor lh. <br />-^,,4-<f:fr <br />ordin.n.6 dd srar. La$ Eldina Io truildrg coartudion. <br />atn\€ ficnrinrd pdpdl, aor <br />/\pDlic.nl or Ag.trl Sig ilnrt <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 / Groundino / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouoh) <br />Meter Release <br />Rough <br />Service Meter I <br />FINAL I lq11.t \g-&4 9 <br />Notes, Remarks, Etc l' I <br />Air Conditioners <br />lrndd ! Add,6: <br />- <br />t---+--- <br />t-- <br />I <br />I <br />=-