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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS tD/stG.COMMENTS OWNI]R BUILDER DII'ARA'IION <br />I hdcby ,m. unds p.nalry olpdjury that I m €rcmpr fron th! contrdots Lica$ lr* aor lh. follo\ing r.eo (56.7(}]15 <br />Bosinds .nd Profsion Codc)r A.y Ciry or Coudy *hich r.!un6 a pafri o .oNruct, ah6, improve donolish or qan &r <br />slructuc. prior to ns isuance al$ r.qun6 rh..pplic t ao. such pdmil ro fiI. a si8..d slalndt lhar h. or slE is liccBcd p6ud <br />ro Oe provisions oflh. Co.lra.lol! Licen.cd Lav (Chal,td 9, Conhcncins *itb Sorion 700() of Dilision I olfi. BNin6 Md <br />Pmltsions Cod.) or th6r lE or sh. is dcmr,t rn@Eoo dd rhc bdis loi lh. lllAcd danFion. Any viold ion of Scclion 703 L5 by a.y <br />applica aor a pmil subjds thc rpplicet ro.civilp.naltyolnol,nor.thd fi!. hund,.d dollus (5500). <br />I m€rcmpl undd S6lioi-. <br />\_.1,LlvLg - ty cr'! <br />DECIASAIIA! <br />I htr€by aflinn unds p.nahy of psjury on. ofthc followinr dclsalioc: <br />I hsv€ ud vill mainrah a Ccnificoic otconmi to Sclf-lmurc lor {olkdi conrpen3dion, ar pmvid.d aor by Sdion l?00 o I Ihc <br />Lator Code fo. fi. pdfommce o lth. *!rl lor N'hich th. pdmn is is$€d. <br />I have ond \vill mainlain \wrkcrs' conpeNat ion insurMcc. d requircd by Sslion 1700 or lhe tjbor Cod.. for rh. Ffonnmc. oa <br />lhc *ork tor whicn lfiis p€mil is isd. My worksr onrpensation insurlncc cris ed policy.ombs &e: <br />_l .fiify rhri in rhe pdaoman .of $. $ort lor whi.h rhh ponit is issueJ. I shallnol mploy any r,6on in dy mdnd <br />$ srob.co,n subjet to th€ Norkqs conp.Nalio.latrs ofcalifomia, andaxErhol ifl snouu h€on'e subje o lh€ <br />$oll€s' compaetion provisioN ol Sd ion I700 of th. Labor Code I shall. lonhNith comply Nnh rho* prclisiom . <br />WARNIN(;: Failurc ro mrc Nork6' conrpNrion ..vras. k unl.\rtu|. dd shall subj(t tr oployrlo oiftrnnl !.rElli6 and <br />.ivil lin.s ut ro one hundr.d rho8ed dolld (Sl00.0Lr0). in addntun ro th. co( olcompdsatioa. dan.8cs d providcd for lh. <br />S$lDn 1076oflh€ Labor Code int66r d,6ornel'! i€6.'\\-"v-\( <br />DECIAIAIION <br />I h*by amnn undr poulry o I prjury thar I m licasl udd provision ol Chap6 9 (comaci.e wirn Sdiof, 7000) of Division l <br />ol th. BusinN and Pmfdsios Cod€. dd ny licdsc is in tull lorcc ed cr6t. <br />rr- "t - [Y TTiT <br />colflBucltolJ,l;ll)tlc.dlilNcr <br />I hftb, artrD und.r lxn l(y ol pdju.y thd rhcc is r coNttu.lio. l.trdi.g a8ocy for lhc patortMc. ol lhc ro* for * hi.h lhi! ldnil ir <br />issucd (S(. 1097. Civ. C ). <br />artttca[Ll}}]cLA8Arl0! <br />I hq.tyatftnunds p.nallyolpdjury on offic followin8 dcclaatioosl <br />D.molirion P@il!-Asb6tos Notificalion F.dc6l R.gul.tio6 (Tirle 40. Pan6) <br />R.quir.d lrtt6oaNoli6oion <br />-l <br />.dify rhal $€ feds.l rcsulslions r.ssdins 6b6los Eno\ al r€ nol applicable lo rhis prcJc.r <br />-I <br />cdify thd I h,ve .ad thi! spplicdion rnd *ar. rnd rn abov. i.aomation is conat I agre ro coDply Bnh all City 6.d Counly <br />ordiNn.s ed Shlc LaM Elding ro buildine codtuction. a.d hd.by aurhorizc rcpremtariv6 oflhis Cirydd Counryro.dq upon rh. <br />trl)o\. nlrnri,nr.d lrxir&-'n] nr hspcdi.n <br />I U.\r-7Y-17 <br />(rf K^[ - <br />Applic.nl or Agcnl Sign.lurc <br />n"..U* "".u,r*r* <br />Site-Work <br />Unde round <br />Pole Bases <br />Light Standards <br />Spas, Pool, Founlains <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 Rough) <br />Meter Release <br />Rough <br />Service Meter A <br />FINAL s-\0-t7 X,WI'I <br />Notes, Remarks Etc <br />-) <br />DATE <br />I. a owneroathe poFny. oi m, emplorc rnh $asc at rhcir elcconlpostiotr. lilldo Ih. {orl udft ntud. a 6r <br />inldd.d or otr6.d for slc {56.7044, Busins ud PrcfBsioG c.d.: 'rh. contE.lol! Licas I {s do6 ool aa4,ly ro d oMs of <br />rhepDpsly who hril& or inprorB rhoaq and s ho {to6 su.h sd. hnns.lf or hs*If or lhmush hG ot hq os! rmployc6. <br />provd.d rh.r such im!rcvorda m f,ol int6t d or oflird lor eL ll how6s. rh. hildins o! impro!@nr is sld rithrn onc ,a <br />ofcon 'Elion. thc O*rs Build6 will hav€ lh. hirdd olFDvitrS lhal hc or shc dil ml hild or iftprorc lh. propqly tur Oc lJurp()e oa <br />l,6ovnsoflhc Fopsly. M sclusivcly.onrradins *nh lictucd coir6do6to codd.i th. Foj..l (56. 7044. B6in6 <br />an{ I,roisir. cod.: Th. Conrractor's Licme L8v do6 nor applyro m o*nd ofFopdywho buil& or inrprov6 rhd6.. <br />and qho conlEds lor .h rxoj.crs with r Conttlclorls) lic€.Ed puBudr ro th. Conrrdors Lictu. t w) <br />Lnd.irAdde:_