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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIT,DER DELCARATION
<br />I hoeb! sm,fl und6 paahy of pqjury that I d.r.mfl fmfr tn. Conlracto6' Licens h$ to, the follo$ing llen (34.7031.5
<br />BGin6 dd Prof6ion Codc): Any Cily or Counly ehich r.qui!6 a pmil ro .6nstud. alra. inp.o!., &nolish or r.pan ,
<br />socrure pnor to ils isslacc. also Equt6 lhc applic&t for such Fdnn $ 61. a siSncd stal46l lh.l h. or 3h. i! li.6s.d pu6uml
<br />16 rh. F)visions oarhe Conlr&clors Lic€nEd Law (CnaB6 9. Commcn.ins wilh Sdiion 7000 oaDivision I ollhc Busindt dd
<br />Pioacsions Cod.) or thar hc orshc is cxeBpl thrcEo ed lh€ bss$ lo. th. rlle!.d.rmplion Any violalion of Sdion T0l l sbJ,e,
<br />applicdr lor a p.mn subjErs lh. aprlicdr ro a .ivil p.nahy oa nor nue thm fivc hu!&cd dolld (S500)
<br />l. 6 o\rGr of lfi€ p.op.ny. or ny .iplorc wirh saa6 6 rh.ir sh .omp€Nrion, will do fic strt ald (h. {dr. b nol
<br />nndd.d or olTa.d for eL (Sd.70,14. B6ins md Prof*ioB Codq 1hc Cont,crois I-icmc lnw do6 nol alply to o owno ol
<br />rhe pmpd, Rho tnilds or inprov6 ln@n. ud sho do6 sch Mrll hnns.lf or hftcllot lhmush his or hE os dplorc,
<br />provid€d rhll su.h inprevocnrs rc nor inlqdgJ or ofisqi ror ek. !l ho$'da, fi. hildins or imprevml is Fld sirhin onc rtr
<br />ofcomplelion. lhe Of,r6 Buildg will hav. lhc tnrdo oaFoviru lhd h. or sh. did @r boikl or i6Fov. lh. pmpdy for the putlFs ot
<br />-1,
<br />s ownd of$cptupd!. m.rclsivcly conlr*tine wirh licased conrractoBro coGtrud lh. Fojccl (56 7044. B6ins
<br />ud Pml6io. Cod€r 'l h. cdnta.bfi l.ic.ns€ l-aN do6 nor ap,ly ro d o{nd olprop.ny who builds or nnpFvdlhddn.
<br />and {ho e ra.ls foi ech prcjd8 with s Coolrodo(s) li.m$d pxBmr ro Ihccont,crors Li.ft. llw)
<br />-l
<br />an .x.'npt wd< Scciion-. B. & P.C. for lhis Ben.
<br />Dit: Onner:
<br />uaatr!BLco!t2!,!,ta:ua!
<br />PICI.AIAIIgT
<br />I n rcb, silinn undd p.mny of pdjury ooe ol the lollorvins d6ltario6:
<br />I hale &d *ill mairlain a Ccil ilical€ of CoEmr lo S€lf-l6uE trr workdr conrp.nelio!, 6 prorid€d for by Sdlio. .l700 ofrh.
<br />bbor Codq for lh. p6aom&cc of Lhe woit for wi ict the pmil b isucd.
<br />-l
<br />har a.d will nri.rain workeG co,rpcBariofl iNurance. 6 rcqukn by Sdin 1700 6arhr tit{lr Cod.. fo! thc DqroIrucc or
<br />rh< s'orl lor which rhis pdnir i. isu.d. My *ort.B conrpcNlion i6ur c€ 6i6 ad poli.y nu,nb.r e.
<br />Policy Number:-Erpn.s
<br />I ceniryrhal in lh. p€rfornan.colrhc *ork lor $hi.h rhis pmn is issftd, I shall not mploy any p€.son in 6y m.d
<br />s. 6 b b..omc subj(l
<br />'o
<br />lh. sorl6' co,trpdelion la*s ofcalifomia. and a€r thal il ! should hdome sobja' lo lh.
<br />*orkqa comp.NarionprolisioBolSe.lionlT00oflhcL€borCodelshall.fonh*irhcomllysnhlhospmvisiofls..
<br />WARNING: Failur.lo sure wo*6d compmaliotr covdasc is uil$vaul. dd shalt subj€cl d enplolq lo mioal ,qElri6 md
<br />cilil 6n6 up ro oo. hon&cd lhousod dolld (t100.000). in rddnion ro th. cos of.ompcNttiofl. ddr.scs s providcd for rhc
<br />S€dion 1076 ofih. btor Cod€, inrq6r d rfrodryt f6
<br />UCINITD.COIIIACIAtr
<br />DECI,AAAIION
<br />I h*by atrm und6 psulty orFjuiy thd I @ ltdDql @do provision of Chapla I (cond€ocios virh Sdion 7000) oa Division l
<br />of th. Busins trd ProfsioN Cod., ed hy lic.e is i. lull aorc. jd .Itet.
<br />caNraJJcrlaNtllllM-acllcr
<br />I heby atlinn unds Foalry of p.rjuy lh.l rh6c i. a en$tuclion lodi,8 a86cy for lh. pqlomncc of lh. wotk aor vhich this pamn is
<br />iss!.d (s(.10r7, Civ. c.).
<br />ATII,ICATLDIOAAAIIA!
<br />I nd$,alrm u.da p€nahyoipdjuryon€ oIth€ lollowi.s dcltr ions:
<br />Demolition Pmib-Asb6ros Norificstio. tuldal R.aulaiio.s (1 nl.,l0, Pan6)
<br />-Rcquircd
<br />L€tts olNorinetion
<br />I cdlfr rhd lhe leddal resul.tioN res{diu Bbeslosrmoval uc nor appli.ab| ro rhis pojd.
<br />-l
<br />csriry lhar I hrv€ read lhis appli.ario. dd sra!.rnar Ihc ahvc i.aomalion is core.l. I aselo complyrirh.llanyand Coumy
<br />odin c6 dd Srarr l-a{s rlari.r lo buildii! co.sro.rion. ed lEeby audDlizc rcprMraliv6 o f lhis Chy and Coumy ro enrd upon rlE
<br />7r -27- t9
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fou ntains
<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 />Transformers
<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 Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Release
<br />Rough
<br />FINAL t248 -/A,)).1*v(7a
<br />Notes, Remarks, Etc
<br />sbo\ . mmhon€d prcp€ny tor rnsp<liorpurpo6
<br />arrt",, * ar",'sr"",r"rtZ---- - -:ZYL-4 D.re
<br />P*n*- "or"t,,
<br />v 'll^-,< Jr1ktA
<br />Service Meter
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