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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUIT,DER DEL(ARATION <br />I h6cby aflirm u 6 pdalryof prjury that I @.r.,npr f.om lh. Conlmckr6 l-i.d!.Irw for lh. follo*iry r.&n (sd.7o.rl5 <br />Rusin6s .nd Prol*ion (od.): Any Cily or Counly (fiicn rcqun6 a pnir ro onslruct. aha. nnprovc. dcmolish or r.rBtr mi <br />srtu.rr.. pdor io ns isu cc. alro r.qun6 rh. aprli.er for su.h Fmit to fiI. . sisn€d slalddl lhrl h. or slE i, licss.d puBuot <br />o rhc tovi5ions of $. Contraclois Liccns.d liw (Chaplr 9, Coohc.cin8 lvnt Sslion ?000 of Divtion 3 orrh. Busins and <br />Proi.siofls Codc) or lhar hc or !h. i5.r@fl rh@tom.nd lh. b6is for rhe allcs.d €xdprion Any violationofs.ction 7011.5 try.nyi <br />appl(a roraFdilsrbjdslbc.ppli.anttoacirilpcnaltyofnolnroi.ihdfiv.hundr.ddollm(!t00). <br />L 6 o\rnq o llh€ FoFny. or my cddotd wnh w.g6 s rh.t $1. composalion. s ill do $c *od{ ed $. stnnu. h nol <br />irroxld or o(rocd lor el. (S( ?044, ausins ed ProlsioN Codq Tlc Contadois Lic*. kN do6 .ol agply ro tr osnr of <br />lh. pmpdy who builds or inprorG lhaon. ed {to dod srch "t <br />( himsclf or hss.lror rhrou8h hh or hr own dploy.6, <br />prcrid.d rhar such imprcroffils e rct intdxLd orolH for sal. If, ho*66. rh. toiklins or iop.o!.l@r ir $U snnin on. )@ <br />ofcomplerion. rtc O*rd Builds rvill h.!. ll'. hrda ot Fovins lhal tu or shc did ool blild or inpror. lnc Propqly for lh. pupos of <br />l. 6ownsoflh€ pop6ty, dcl.lusivcl, contaclinA with licds.d conlmloGro coBrocl <br />'h. Projat (SE ?04,1. Busins <br />and Prsasion cod. rh.Conlracro.sl-iccnscl-a(do6notaprlytod.wnsoaprop.ny{hobuildsori,trroveth.ton. <br />and sln codracrs lor such pmjals *nh a ConGdo(r liccd pu6r6l lo lh. Co.tadoi s Li.cc Las). <br />I on dc'npl und6 Sdion <br />WORKERS' CO]tIPENSA'IION <br />OECI.ABAIIgN <br />I hqeby amnn und€r penallr oapajr'] on. olrh. tolloqinS dcl arions: <br />I hav. dd will nainrain . Cdlificd. of Conmr ro S.larNre for Nork6 snlpdsrion, s provid€d for by Sdi.n 1700 ofrh. <br />Lab.r Cod.. lor thc p6r..mec. ofth. wod( for $hich thc pdm n issu€d. <br />I har. and will ,nainlain \rort6 .oDpcnsrrion i.suran.c. d! r.quir.d by Salion 1700 ollhc bbot C ode. for rhc pqloma.cc or <br />lhc work lor *hich Ihis Dmil is isu.d. My*o.k6 conptuarion istrrecc.atriq and poli.y nurbd d.: <br />I .enifyrhal in the pglormflncc ollhe w.rr a.r $,hi.h rhis t.mn is issucd. I shallnol qntloy dypdso. i. any monr <br />s s ro b€(onc subjd to rh. $ orld' .ompdslion la\s ofcalifomia, and asr< rhal ifl should tEcomc bid roth. <br />sorkgt composarion povisions ofS.clion 1700oflhe kllr Codc,Ishall, aonh$ilh.omply wiltlhos prolisiod. <br />waRNlNG: Fohrc ro Kurc sorl6 .ompdehon cov@sc is u.la\yau!. and stullsubjd an dDloF ro anniml pcnahiG and <br />.ivil nn.s up to on. huh&.d lnousnd dolld {Sl00.C{0). in addni.n b nE cosl oacomp.nsalion. ddag.s a p.ovid.d lor lh. <br />sdion 1076 oa th. ljbor (ndc. inldd ud axonEy s a6. <br />!,lclrsED_coNla4claa <br />IIECIASAIION <br />I hd.ry amrm undd p6rll, of pdjury lhal I d licos.d undd Irovisioh ofchspia 9 (mmmci.s wilh S.ction 7000) of Division 3 <br />of lh€ Busins dd PDlBioc Cod., el ny licds is ir tull lora 6.d .ltdr <br />C.qIIIA]JEIIOIiIEXDIIC.ACEICI <br />I h6.by arfm undn Fnrl(, of pdjury lhal lnc is a atutruclioo kndos lgacy aot th. pafol:mcc olft. wl aor shich lhb Fnh b <br />issu.d (S( 3097.Civ. C ). <br />L..dr's Nmc <br />AITI,ICANIDECI,AAAIII}! <br />I hEtb, amm unds poally olFj!ry o.c oa thc follo*idB d(laalio"s: <br />D.not'rion Pmtrr-Acbcros NolillcalDn F.ddl R.suklrne (1[1.40, Pdot <br />R.qrn d Ldi6 of NolifEdirn <br />I .diay rhar thc a.ddal r.sul.tioN r€strdins dhcnos .d ovar de nor.rplicabl. to rh6 ptuj..l <br />lcedifylhorlha\.rcadlhisapplicarionddsrar.lharrlEabov.inaomotioniscon..l.lallclo@nplywilfisllCyaidCounly <br />ordina..s sd Srst. Liws Elarins Io buildiog coGrtucr ion, ai herc6y adhorizc reD.etllaliv6 ofthis Cily md Counry lo dld ul)on $. <br />aborc morio.cd phprny for icp..lion pulPos6. <br />ArDllca o.Agdrslgn.rur. <br />P€rmit.en.nc(pritrl): <br />Site-Work <br />Underground <br />Pole Bases <br />Light 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 />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Ivleter Release <br />Rough <br />Service Meter <br />FINAL 7.-l7llq ,(1/{h(?q/ <br />Notes, Remarks, Etc. <br />Sub-Panels