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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS O\'VNER BUI LI'ER DELCARATION <br />I hdcb, amnn u.d.r p.nally of pdjury lhal I d d.q,l fmd th. ConlractoB' Lrcei{ Las aot th. lolloeiny tqen {Sa.?031.5 <br />Bsines and Profsion Codc): Any Cily o. Counry *hi.h rcqun6 t Fnit lo conrtud. a1rd. inprorc, danolish or IqEir dy <br />srrucrurc, prior ro ns isrdca 6lso rcquiB fie .pplicml for srch Fmn lo filc a sisn.d dahdt rh.l he or sh. is licds.d p@dl <br />ro rh. p.olisioB oarhe Conlrlcloas Licen$d ttw (Ch.pt$ 9. comm.ncins Nilh S..lio. 7000 ol oivision I ollhc B*ins md <br />PDacsiofls Code) or rhal hc oi sh. is .rdno rnsdiom &d lh€ basis for rh. all.B.n .ranPlion. Any violarion oas.clion ?011.5 b,v anv <br />applicanr lor . p.flil subjec rh. applicd ro a civil poa[y oi nor mor€ rh five hundicd doll6 ($500). <br />l,6 oqs ofrhc Fop.nr. o.,n, mplor€ with was6 6their $le comp..srion. willdo lh. wolt ed lh. nn41m is nol <br />ioladcd or oflE.d aor eL (Sa 7044, Bsin6 md PrereioB Cod.: Th. Codrrcroas Lic@ k* do6 nol arplv ro d oMd of <br />rhepor€ny sho builds oi iq*o6 $con. od who do6 sch trlrk hin*lf or h*lf or throush ht oi hs own mplovc6, <br />I,ovided rhar such inpm\ onrs e rcl inl6d.d or ollaqj for e]c If. how6s. lh€ hoik ng or nnpml.rcnl is sE wniin om ,@ <br />olcorpLlioc lh€ Ofl6 Buil&r will ha!. dE b&.kn olFovin8 rhd hc or sh. did ool hild or inprole lhc pEpdty for dc Plrpo* oa <br />-1, <br />di 0*16 orrhc pbpaly. m .iclEivcly cootractins *ilh li..n*d coil..dou lo strstru.l rh. I,oj-:l (sd 7044 BEin6 <br />and PrDfsion Cod. Th. co.ricrols Licms. Law do6 nor apply to u oNld oaProp.ny sho builds or ioprovs ltdan. <br />.od $ho co.tr.cls for such FDjels *ith a Conlra.lo(, lictucd plB@r ro $. Conracrors Lic€6c L!*) <br />I tunere mi undd SNrion . B & Pc Lrrhr rNn <br />Dokr OFn.r: <br />WORI(ERS' CONIPENSATION <br />D&CLA3.63lrr <br />I h€r€by amrm udd.r r.daky of !6jory onc oathc aollotrins d(ldatio6: <br />-l <br />havc md *ill n,inr.in . Cslificaic ol CoBml lo S.ll-lc@ foi sltkql @nrpenslion, s Fovid.d lor by Scrion 1700 o I $. <br />ljbor Code. loi rhc daomdc. of lhc vort for shich Ihc p6nil E issucd. <br />_lhav.andwillm.intainwdrk.'conpc@tioniEurm.c,srcquir.dbySdlio..17u0ofrh.LoborCode,foriEFlollMc.oa <br />is i$u.d My workgr .o,npds.lion insurucc cdnd and policy numbs sc: <br />(\:\zoY- ZotT lo Zot <br />I cenirylhar in rh. pgaoman e oiln€ lvolk lor whichrhis p.mil is 6tudl I shall nor sDloy !fly pd$n i" ol nrmna <br />$ slo hc!,n. subjar ro rh. woltm' compctralioo la*s ofcalitumia, md.grlhal ifI should b. one subjd to th. <br />*orlda.omFsrionpmvisiodolScclionl?00oflh.trbrCode,lshall,tonh$ilhconply$ilhrhoslYovisioos. <br />WARNINC Fa,lue lo Kuc "ort6' conp€ffilion colcrdr. is unla*ful md shall sxbjtrl u dplolq lo anniMl psuhiG d <br />civil l'rn6 u, b on. hu.dr.d Ihousd doU6 (t100 <br />Sdion 10T6oathel2borCodc imct md aftorey s <br />tun ro nE con otcompdsar'on, d.maBes 6 prolided tot 'h. <br />Z-r I L,Z <br />Lrql).!rru-(l)-[Iu(x)l! <br />DECI.AAAIION <br />I h.rby .afm und6 poaly of psjury thal t @ licc$.d udd lmvisiotr ofch!916 9 {comocing trnh S.dion 7000) of Division l <br />or rhe Busins ed PrcasioN Cod€. rd nr liccr ! in tull fo@ dd.fiat. <br />I 911ztt <br />SNF 1116 r\ u'zol cr \i (L\^CTi er- <br />Ca!fi4l]cuolttllDlNc-acE !a <br />I hde1r, allm undd F.,lly ot psjuy lh.l th6. b a orntucion LndinB aSocy for thc pdfoll@cc of lhc *ott lirr which rhis Fmil n <br />isu.d (S*.3097. Civ. C ). <br />ATII,ICAILIIICIAAAITAN <br />I hqrby .Jtrs lndr pd.lty of pdjlry onc of $c follo$i.s ddl&alhnsl <br />D€DoIni,n PmiB-A3b6tos Notilication t.ddal Rcsularions (Titl. 40. Pd6) <br />-R.quircd <br />trn6 of Noiicalion <br />-l <br />cErifylhal rhc fcdrar rcruhriDB r+odins sb€stos renDval -€ tror.pplicable ro lhh prorect. <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 Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueino <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilinqs (T-Bar Rouqh) <br />It4eter Release <br />Rouoh l7'J-tg Y.tUrl) <br />Service Meter x <br />FINAL 124..IK \141,10 <br />Notes, Remarks, Etc.\-/ <br />Site-Work <br />L.nde, ! \,me _ <br />I end.' i AddrN <br />- <br />I <br />I