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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS OWNER BUILDER DEL('ARATION <br />I bd.by aftn undd pdally ol pdju.y thal I en.xe,npl fron rh. (ontricloc Liccnse Law for the lollowin3 rson (5€.?011.5 <br />Busin6s d Proasion Code): Any Cily or County shich rcqrire ! p6nil to coGtrucl, ah6. inprov.. &oolBh or raan tny <br />studdc, Fior ro irs suanc., also rcqun6 rhe rpplicdr ror such p€mir ro fiE r sisncd rardtan rh8l hc or sh. is licased pusumt <br />ro thc rmvnioB ot th. Conkrcblr Licen!.d Law (Cn!O( 9, Comnencing wirt s<rion ?000 ol Division ! o,fi. ausins dd <br />Pma.sions Cod.) or ilal h€ or sn. ir .rehpr lh6.6.m sd rh. b6is for ir rllcg.{ €r6nplio.. Any r iolation olsetio. 70J L5 by any <br />applicanllorap€milsubj€clsth€applicanltoacivilpcnollyoanolmoEthofivchundrqldoll6($500) <br />_1. 6 ownd of rhc popdly, or ny cnploy6 *irh was6 s rhci $lr co,nr.nsar io.. will do fi. worl dd rtc $1rc18 is not <br />i od.d or oiId.d lor eL (Se 7044, B6ins md PmfsioB Cod.: Th. aonaachis Li.me li*' do6 nor drply ro a. ownr ol <br />rh. Ix)trdy {ho boil& or in!6\€ rh6on. dd $ho do6 such *ork h,ns.lfor h6clao. thrcu3h his oris osndployc, <br />prolidc{j lhar slch i'nprcvcfurs d. nor inrdLd or ofIq.d lor s!€. ld ho**d. th. hrilding or nnpmlmt is $ld vnhin onc )@ <br />ol co'npktiotr lhc O$Td tt1]ik6 $ ill luvc th. hrdcn of Foving thd h. or eh. did ml hild o. inprDE ltc !{oFry for $. BtFe ol <br />I. .s osnd of rh. ropdy, m.rcl8iv.lycont.din8 wirh li.ssed contftroB ro conirud lhc projdl (S€.7014. BGins <br />Nd t'tltsrion Codc: Thccont,cror'3 Li.cosc l-a*'do6 nnr app\ to rqne'^rn'.pd) $ho buildsor iFp^".slhrsn. <br />and who co'nraclsaorsuchprojsGNirhaCoitEcro(rltrdcdpuR@r rortuconrsdor ! L'(,<.ll{l <br />I l,cichy xllnr rDrlc' ltnrh) o, |(rrLry on. o,1hr lnllo\nr! ltrclmrhns: <br />-l <br />hav€d * ill nminta'n a CdlificAte o I CoBql ro S€ll-lNur. for wdrkgs onrpeftarion, 6 previd.d aar by S(tion 3700 of the <br />t bor Cod.. lor the pdfofltr&c€ of lh. \eolt for whict the pdon i isu€d. <br />lhavcand willnraintain lvdikda co'npeBation iNurance. s raluned by S(tion 1700 ollhc tjbor cod..lor th. pgfonnecc of <br />lh€ s!.k lor which this p€rnir is istrcd. My worteB .omFas{rion ins!,ance c id dd policy nunbo &.: <br />IdicyNumber: Fipir6, <br />_l ccniryrhar inrhcprronnrnccorrhe$oik ror*hichrhiFnir is issu.d.l sh8ll nor oryloyanyFEon inanymun6 <br />$ 610 b..ome subj.d lo rhc qo*ss, compNiion laws olcalifomia. d asrelh.lilI should b.con. subjel <br />'d <br />rh. <br />\o.t6' o'npq$l ion prcrtions ol SElion 1700 oflh. Lahr. Code I slEll. fonnunh conply *irh rhor pmvisioG . <br />W RNINC railur€ to sue *ork6'compcNrio. covmse is unlasrul. &d shall su6jet o dnplo'd ro aiminal <br />.Nil lln6 up ro onc hunddt rhoue.d dolles ($l ilron lo rhc cosr ofcompcn$tion. dmaA6 6 plovided <br />S(rion 1076 olrtF L.bor Code inl <br />".,", t-/€i/fir/"7n <br />I hercby nllirn under p6ahy olpljry rhar I tun licnql u provi3io. dfch,pla 9 (coftindcing wilh Sdtion 7000) ot Dirision 3 <br />ol lh. Ausin6s ud ltofsF6Cod., od mylico,* is i', <br />Licm. Clals: Lic@c Nmb..: <br />COIIIA!{:IIONIIIDINC.ACENCI <br />I hd6,.rtru undd pdalry ofFrJorylhal thqei!. codtu.lion loding r86cy forlhc p6fom ccofth.rvor! tu whi.h tht pmnil t <br />irsucd (sd. 1097. civ. c.) <br />AIIITCANLDECIAAAIIA! <br />I hddry dmm undd po.hy oa pdjury o.c olthe follo$ing d(lddiotu: <br />D€nolirion PsnneAsb6ros Nolifi calion !-€dral R€sulsrions (Tirlc40. I'an6) <br />Rcqun€d lllld ol Norifi..rion <br />-l <br />c6lia, <br />'ha1 <br />th. tcddal r.gularions EBediru abGtos rdnoval de nol applic.blc lo lhis pmjccl <br />-l <br />c€nily llmt I navc rod lhis applicst <br />ordinrncB md Srarc rjws rcl5rins to bui <br />fl $d stalclhar lhc rlxrc iDlonnal ro contly *hh allCilyand Counly <br />ion. ard h6cby iurhorne r€F6dlal <br />.b.ve mmtioncd propdy lor <br />Appli.rnr or B.nr signrt <br />./*/ <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under SIab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />To uerng <br />Sub-Panels <br />Air Conditroners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilings (Hard & Soffit Rouqh 2-l+-t1 k'r!&)t <br />Ceilings (T-Bar Rouoh)q-4-J"l g.\lLtd\ <br />Meter Release \,, <br />Rough <br />Service Meter <br />FINAL Ale$h.4 Tt attvLh D) <br />Notes Remarks Etc .I ,ru <br />DATE <br />I <br />I