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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE tD/stG.OWNER BUIt,DER I}ELCARATION
<br />I hdeby arrD under pdalry of lsjury that I an crcnfl fmd rne contaclou Licmse LaN ao.lne follorins rffin (5(.7011.5
<br />Btrsi.ss and Prol€ssion (ode)r Anl Cn! or Counly shich requnB a Fnnil to connrucl. alttr. nnprove. ddolith or r.pan a.y
<br />struclure priorro ns nnranc€. also rcqun€s the applicant tor such !E nil to fil€ a signed $alm$l rhal hc.r sh. is li..ns.d puuuanl
<br />ro lhc ptuvi,ions of$e ( ontradois Lic.nsed Inw (Chaptd g. Com,nencins shn S(lion 7000 ol Division -1 ofthe ausiness aod
<br />ProfesionsCode)o.rharheorsheis€xemprthqcfrofl.ndthebasnlorrheall.sedexdption.AnyviolarionolS&lion70-rl5brany
<br />lpplicanl firaptun subje.rsrh. appli.ant lo a.ivilp..alr,olnd hore lh,.live hundrcd dollds ($500)
<br />l. d osnq oi dr Iroleny, or my mplols wirh $ ag6 d rhcir solc .omNnsarion. will do 6e wor k ond drc sltuclu! is nol
<br />inraded orof€r€dlorsale(Se.7044.BusinessmdPrel6sionsCodetheContracloisLic€NeLa\rdo6nolafl,ylo o$dof
<br />dte popd) *ho buikrr or iftprov6 rhd$n, e.t *ho do6 such *rrk hinslf or hsellor rhrouBh his or hE o\rn en,ploy6.
<br />provided thal socfi imlro\ onenls @ mt inloded or.fteE{ for sle lf, ho\rev6. rhc boilding or ifrp'nandt is sld wiihin onc )cu
<br />of con{ldion. lh. Ovncr Builde will have lh€ budd of proving lhat hc or she did not hild or in,pIove lhc pDpdy nr tu purFoe ol
<br />l.asoNndofthclIopdy.arnexclusilelyconn?dirBwilnlicensedco mcrorsto coroh'.1rh. lroj(r (S{ 7044. Busn6
<br />Md I'|n,llsri,n C.dc: The C.nlr.cttr s Licdsc Lalv doa not.pplyr..n o*nd ofpropdr! sho builds or nnproves threon.
<br />ard who contrmrs lor srch projeds Nnh a Connrcro(r liceNed pusunnr k, rheConiracr.is t-ic.nsc liN)
<br />l oncxenrg trndLy Seclion . Lr & f.C lor lhisreason
<br />Dnle own€r:
<br />OCCLAEAIION
<br />I hereby amfln u.ds pdahy oarejuryoneoflhe follo$in! delar.tions
<br />I halc ond will maintain a Cedificate ofConscnt io S€lainsurc for workm cotoptrddlion,4 prolid€d lor byScction 11700 oarhe
<br />Labor Conc aorrh. pdlom c€oflhewo fo, shich the pmil is isucd.
<br />y' ha e and r ill rnarnram s orkeE' co,npeNat tun iEurance. 6 requrcd by S(tion I700 ollhe Laboi Code, tor $. pafomm.c of
<br />Ih.uo'ltutrhi.hrhispmnrsbsucdV)(orldi(omp€nsaronrn\Lrd1!r(a,ieiandpol.c)nunb.,.
<br />Ntntirr4 c.,t t,?. 6 F Tlt.? o eal-
<br />]1n,* r'rn,,", ' |,JS4<.o? 3J?l E-pi."., t!2 /, lz"r.
<br />Iccni4lhalinrhcperlorDmnceoftheNorklorlrhichthhptr n is t$Ed.I shall not emplo) an) p€uoninanynr ner
<br />$ 6 ro beconE subjst ro lhe worksl o'npmsarion laNs ofcalironia. and arm rhd ia l s
<br />sorlolc.nlPsxarronpro\isonsolSecri.n:l700ofrhel.ihn(!de.lshall.Lnh\irh
<br />IVARNINC railflc ro secre *orktrl compcnsal[n coveragc is unla*tu|, and r .n cDr]ro).' h rin,iDal tmxlrn: rnd
<br />civil fins up to onc hundr€d thousand dollau 15100.000). in addition lo lh€ co mp€nsation. d.das6 d piorided lor rhe
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<br />I I rn1r.ax,\rxrli
<br />I he'lby affinn unds pe'ahyolpslurylhal I an licensed und.r lroris6n
<br />ot lhe h6in6s and ltofess(nsCode. d 'nylicosc 6 'n
<br />ltrllfi(aod
<br />r 9 (comndcidl whh secrion 7000)ttDi\ision]
<br />t
<br />.*-*.n*.' B.
<br />"'"' t lq(u
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<br />2.o colracror:{
<br />I hereby arm undr poall, of pcrtrry rhd th6e is a construcrion knding
<br />ssued (Ss 3097, Civ C.)
<br />lor lhe psfomance olrlrc trlrk for rvhich this psnn i
<br />4.E!ItANL!EC!AaAI!()!
<br />I hedry afllnn u ndo penalry olp€riury one olthe iolloqi0! d(laralions:
<br />Dcnolnion P.nnns- sb.stos N.lificalion Feiler.l ReBUlarions ( I nk 40. P.n6)
<br />Requircd tellerof Notificalion
<br />I cdiiy rhar rlE ladcrrl ic8ulalions regdding db.skJs rmo arc .or appli.atJle ro lhis prct{r
<br />4*;:*ll ar I have read lhis application dsrareriritlhe 've in ftnnrarnrn is cond I agrE ro cu,ply wirh all Ciry a.d Cou y
<br />Sialc La$srelatiry lo huildiDA co hereby aulhorne renresenhn6 orlhis Cily a.d Counr
<br />a6ov. nEn(ioncd popcny lor iBpdio.prpos6.
<br />/\pDlicatrl or.\g.nl SiAmlurc
<br />Pu iru nmrc lrr,inrt, (oltor %n 1aaL\t eZ-
<br />?olo
<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 />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<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 />Rough
<br />Service Meter
<br />FINAL
<br />//zo/zr; .,M
<br />)r t)!t z.:'_-tr94,4 )
<br />Notes, Rema Etc
<br />,D'
<br />-+
<br />COMMENTS
<br />Communications Cable
<br />Sub-Panels
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