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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DELCARATION
<br />I hd.b, altmn undr p.nalty of p€.jury 0la| I en cronpr frcm rh. Conraclo6 l,icm. llv lor lhc lollowirg i6on 1se.701 1 .5
<br />Ausin6s dd Prolsio, Cod.): any Cny or Counly Nhich rcqlt6 a p6nn to @n{ruc1, tlld, nnPlole d.oolisn or r.Porr drs
<br />sltuduq Fior io its issutrcc. als rcqund the appli.er fot strch pe.nil to fiI. s sisn.d slardol rhd h. or 3h. t liccns.d psu l
<br />ro rhc p.ovisioN of $c Co.tr&ro.\ Lic.B.d tjw (Ch,p16 9, Commercins wilh Sdlion 7000 of Division I ollhc Dusincs ed
<br />Ptuldioos Codc) or lh, n. or sh. ir .xdnpl thr€ftom d th€ bais fo, lhc allcgcd .rmFion. Any violation ofscclbo 703 L5 by dy
<br />applicaf,r lor a p6mil subjds th. appli.ad lo acililpc.ahyofnol mo,c lho fivc hundr.d dolld ($500)
<br />l, ai oM.r oarh. p0oFny, or my cmplorG wirh was6 d th€ir el. .o,rpdlion, will do thc wolt dd lhc ni{rue is nor
<br />i drtn or oIfd.d for s6l. (56.7044. Buio6 ed P\'or6ios Cod. Th. Conr.dois Lico* Llv do6 .or Apl, ro m ownd .a
<br />lh€ p@Fny *ho bnil& or improv6 tna$[ ond who do6 such s6& himsclt or h*lf ot ltrcugh ht or hd os dplor!6.
<br />providcd rhat such i.FovoM$ dc Nr i.roddl or olldld lor elc. lf, how46, th. hnding or inFov.rcnl ie sE wnhin onc
<br />'@ofconl9l(1io'! thc Osrd BuiHE wil! hnve lh. hndo oiForins lhd h. or shc dd @t hilll or trnFoE lhe pmpqly for lh. purpos of
<br />uaffiEEslcarlfElsalIox
<br />DECTABAIIOX
<br />I ho$y smm uodd psaly oaFjuiy one olthe lollowinS delaolioN:
<br />-l
<br />havc ad *ill roinrain. C61ificat. of CoNml ro S€IHG@ for so 6 .omp6s.tioi. a p[ovidd for by S*rion 1700 ofrn
<br />llbor Cod.. aor th. pdfomdc. of thc elt tor which the pmil i3 issued.
<br />ft hav. and will mainlain $orke6 corpe6axon ituuranc., s r.qrircd by S(tion 1700 oalh. Labor codc,lo! thc peaonn&ccolIis irsu.d. My work6- .onpats.rio, iGxrucc ffi6 ,nd policy nunLs d.
<br />€^ r)onq-l I I 'Ll
<br />I cenily lnxt in rh. ptrfonnan c oirh. work tor which lhis pmil is 6su.d, I shallnor €.ploy &y p€6on in ey mono
<br />$ drobco,n subiartoth.wo 6 compdsatiotr laws of Calitomia, ed as@ that if I should bc.om. sobjsl b lh.
<br />wor{sl comp€Ntion prolnn 6 ofS..1ion:1700 oalh.lnbor Codc.l stall,lonhwirh comprywnh rhos prcvisios
<br />S(lion 1076 olthc Llbor Cod. 'nrccr and anorncr's lc2-l ts lzo
<br />DECI,AEAIIQN
<br />I hqEby a,tm undd porty of pdjrry lhd I M limsd und6 Fnvision ofchaPrd I (onmacins uith Sdion 7000) ol Division l
<br />ol thc Bci.B ed PbfsioN Cod., and my lic.M n in full for€ &d .ret.
<br />c 1o-r cLo q q
<br />L t8 .-"**,, V9i4
<br />CONSTRUCTION LENDING ACEN'A
<br />I hcEty arBn udd p.nalry of pajory thrl thd. t a onllructiotr knding asac, for rh. pdlommc. oflhc sork to. siiich $a pann i!
<br />iss.d (Se. 309?, Civ. C.).
<br />Lddd s ddr6s
<br />-
<br />attllcaNl9ac!,a8arlo!
<br />I hoibyatrmundd p.f,ahy ofpsjury on oflhc lollo*ii8 ddlealionu
<br />D.molitio! P6mns-Asbdos Noti6c ion F.d6al R.gul,tions(TnE40, Pdl6)
<br />-R.quircd
<br />L-atd of Ndi6cdion
<br />I cdiry rhot lhc fcd€ral rcsularioB resardins 6b6tos Enoval de nol appltable to this prctd
<br />Lt cat\ty that t have '.ad th),s awtxsl
<br />ordind.6 dd Sisr. tj$ Ehriry 10 bui
<br />above mdlioned prorErry lor icpdrion
<br />ion ed sate thar thc abov. infomario! i! cor..l. Lsrd lo comply with aI Cny .od Couity
<br />hdeby aurhonzc reprGorarive ofrhis ciryand Countylo ar6 upon rhc
<br />Applionl or Eenl Sign{lur.
<br />Ptmilte nnnr. (prnn):9i
<br />frW Lelro
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht 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 />Bondinq / Groundino / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />lvleter Release
<br />Rough
<br />Service lt/eter I
<br />FINAL o /,/ t "r'Dih\4 rL+va
<br />Notes, Remarks, Etc I I
<br />Rev.08'07-2015
<br />DATE
<br />I, s oMs ofllr pbpdy. m cxclusi{ely co.tra.ting w n li.dls.d conlr.clo6 lo o.eto.l rh. Fljel (56. 7044. BEin*
<br />ad Eof*id Cod.: Tll. Co ,acror's Lics. Lrw do6 trol lpply to d omn ofpropdy who builds or iBprcld1h6@n.
<br />ud who cobrr.cts lor such projEls wirh a C. .ado{s) licaMd pluMl lo lhc ConlBclois Lic@. Lrw).
<br />I m .xdpt urd6 SElion-. B. & P C. fot lhis lwn.
<br />WARNINGT tuilurc to surc *0116 compoE lion covde. is unlavtul. dd shall subjd e mploy.r lo dininal Poahi6 ed
<br />civil fin.s up ro onc hund.€d rhouwd doll6 (1100,000). in .ddition lo lhc coe of .oor.elion, dmtgB a Fovidcd lor lh.
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