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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNf, R AUILDER DELCARATION
<br />I fis.by amnn uodcr p.nalry o l Dcrjury tha! I d d.np n m lh. Coftacros Lictrc Law to. lhe folloviig rte; (S< ?O3 l .t
<br />Businds and ltoa*sion Cod.): An, Cn, or County $hi.h r.qun6 a p6,ril lo rcnslruci alro. inprov., dcnolisn o. ,.per dy'
<br />srructuc piorlo its nsudcc, a l$ r.qu ir€s t hE applicet lo r r! ch p.nnn to fi l. a siSn€d sl al.nral lhar he o r sn€ is lic.nscd pGudt
<br />ro lh€ pmviiions of$€ Contractois l.iccn*d Irw lchaprd 9. Com cncing wilh Salion 7000 olDivisio,I ofrh. Busin.s dor
<br />ProrNions Codc) or ihar h. or 3h. i5 .r.mpl lt6.fron 6d lh. b.sir lor lh. allcscd cxdFion. Any violarion of sdion ?011.5 by e!
<br />applican( for a psmir subjcts the spplican to a cilil p.Mhy oa noi mor. lhm fiv. hundr.d doll6 ($500)
<br />l. as own6 olrhe prcp€ny, olny cd!lo)6 $irh {a!6 s rfi.t $1. onDosrion, q'ill do rh. s!* ed lnc sru.rm n nor
<br />iibde{t or ollGcd aor elc (Se.7o&, ausins ed Pbl6io6 Codq Thc Contradois Li.@ ta* dod not aPPly ro m omE oa
<br />the prcp.rly *ho hoilds or inprer6 rha6( dd who doe tu.h mlk hins.lfor hosclfor lhough hi! or hd own.mploye6,
<br />piolid.d rhar such iDFovmrse mt idqd.d oroncdl ror Bla lf, how*d, rh. toilding or inpnvmol issldwnhuonc}!
<br />olcompkion, rh. Oado Buildc will h.!c lh. hrd6 olFovins thal he or slE did ml hild or inpror. 6. p@pct, for th. purpoE oa
<br />1.6 ow.sollhePlop€n}. on cxcluirclycontradi.g $irh licmcd.onk.clo6 to coNldd lhc Eojc.l (S( 704'1, 86,06
<br />md PltrfBirn Codc: 1 hc Co raclois t.rcense Lau' do6 n l atply to d owncr o aPropdly sho builds or inprolcs lh6on,
<br />and who @nr6.1s lor such prejcds snh a Coihc'o(s) li.sed prBumr to lheConldlor's Licm. llsJ
<br />I m cxmpl ud6 s(tion . a. & P.C. for lhis r.6on
<br />roatiE&t:coME!14]!ol
<br />D.Ectdaauar
<br />I hereby amnn unde pdnhyolpdjtryon.oithc lollowilu d(laralions
<br />I h,!. md will naintain a Cslificat. of CoMl ro Sclllccc for wort6 compc.s.lion. s providtd ror by S..lion 3700 oflh.
<br />Labor Code for rhc p6fomdc. otuhc wort for wtich thc pmir n isu.d.
<br />1l har. aid will mamrM sort6 compqsdrn rEurmc. * rcquir.d by Sdion l?00 olllE LaborC.d€.lort& Ffolfuc. of
<br />rh. !.r[ r.r *hi.fi rhiqmm,ir is iaq,.d Mv*ortd
<br />,*", /.'/{""J 4*L cornrEnsrio. idsurd.. .eid md policy au,nber ee
<br />z_
<br />I c.niry that in lhc psiomaocc ofrhc worl lor which $is p6mn is issr€d, , shall not mDloy aoy p@n in any m6no
<br />s d to be.oo. subjd lo thc wort6' conpd.tion laM oI califomia, ad ar@ thal if I should baome subjdl to thc
<br />wortN' ompmsalion prcviiions oI Sdion 3700 ol$c Labor Cclc. LEll. fonhwitn comply wilh tho* pov$ions .
<br />WARNINCT Fdlurc lo GUc m 6' omp€srion cov@sc 6 @lawtul. Md shall subjel oploys lo dtlin l FElris &d
<br />.ivil fine up lo orc hun&ed rhousd douffi (5100,000), i6 addnion lo th. con of comp.Nlion, datug6 6 provid<i for {h.
<br />S(tion 1076 ofth. ljbor Code inrd6lodarromey sfd.
<br /></7 bo
<br />I h6.by omm undd p..ah, oa psju' ," lhal I d uod( povision of chapta 9 (om6cins *ilh Selion 7000) oi Divlion l
<br />ol fi. Busins and Polsr6 Code. dd my li.eM $ io flll aorcc di .i[al
<br />q
<br />""", 2/5/2. .^,^"*
<br />I nftb) aftm undo Fna]lyofFjurythd tha. is a onslrucrion k in! agocy for th.pdfom ccoflhcwo.k aor *iich lhis p6mi is
<br />issued (Se 1097. Civ. C.).
<br />AELTCANT.AECIdBAIIO!
<br />t fi&Sry allEn und6 poalty of !.rju.y one of th. followins delmlioNl
<br />Danolirion Pdnrits-Asb6los Notilicat ion Fedtral Rcsuhtions (Til. 40, Pan6)
<br />Rcqut€d L.rlqof Nolifi carion
<br />I cdiry that lhc f.d6.l rgdatioB E!&di,8 sbdros rmolsl u€ ml applicabL lo rhb prcjd.
<br />]a,.*'o ,*, ,have r.ad lhis applralion a.d state thal th. ahove i.lomation is corcc,l. I ssr€ lo coBply *nh tll Cny and Counly
<br />ion. dd n.rcby .urhoriz. r.Eemtarive o I this Cilydd Counly ro c.td upon rhc
<br />a bov. rc.r io n.d prop€ny lor insF.l io n
<br />,\pDliclnl or Ag.nl Si*mture
<br />/h,
<br />Z6
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER Ll>8 -2O >fM a1*rz7
<br />Transformers \r
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment z '7*zb \*rtt iL.vy- /
<br />Factory Wired Unit lr
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release w -D(Frvtt y*7-7
<br />lr
<br />Rouqh
<br />Service lvleter I .t
<br />FINAL .o, ->rl \Ma,E 9'7
<br />Notes, Remarks, Etc.lr
<br />Rev. 08-07-2015
<br />Communications Cable
<br />.L 75
<br />1lLrce6etldj: l
<br />Permne nrmc (0rlnO:
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