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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Own.FBuild.r D.cldadd
<br />I h.Eby ai6m und.r p.nalry of p.rjury lhal I m .x.mpt fom rh. Cont.cb6 Licds. Law for rhc aollowin8 rcsoh (r.c 703 1 5 Buins
<br />-d Profdsio. Co.L) Any City or County which Equird a pcmir rocMstruci, alt .. improvc, dcmolish or rcpon uy srrucrur., rnor lo irs
<br />tsuuc., also lcquird $c applicdt for iuch !.mir ro filc a sisncd st.tcmclr rhat hcorshc is licos.d pu6u&rrothcprovisionsoftnc
<br />Conrrcbls Lic.ns.d Law (Chrpr.r 9, Conhtrcing wilh S.crion 7000 ofDivision I ollh. BBinos ud Prcf$sioit Codc) orrh h.or
<br />rhc is .&nF rh@frcr ed $. bais aor rh. rll.8.d .rcnption Any viohlion ol Scclion 703 I 5 by d, .ppli@t for a p.6n rubjeu lh.
<br />applicdr to acivilpcnalty of nol Eorc th& fiv. hundrcd dollm (S500)
<br />_l,a oMd oa $c p.op.riy, d my mploy.r! wi$ wa86 B $cn solc @npo!.tion, *ill do ln. work od lh. .rtucuc n nor iDlad.d
<br />or ofia.d fG s.l. ( S* ?Orr,l, Bcin6 ed Prof*ions Codq Tn. Conh-.crols Li@. L.w doe not apply ro m oyns of rhc Fopcrry
<br />who builds or imprcv6 th@on, ud who doa suct wort hiNclar h@dfor $rough his or h.r oqn mploy4, p.ovidcd fi iuch
<br />inprcvch.ntr dc not inbdcd or offd.d fo 3alc I( hN.vcr, thcbuildin8or imprcvcmcnt is sold vilhin o.. yd ofcompl.tion, rh6
<br />Ownq-Build€r willhsvc ft burdd ofprovins $ar h€ orshc nol build tr improv. for th. purrsc ofsal.)
<br />_1, 6 ownd of rh. prop.fty, m cxcluivcly conterinS wnh [c.ns.d .onr.ci6 to co.strud th. prc]ar ( Se ?oaa, B6ir6s ud
<br />Proi*ion Codq Thc Conltutors Liccns. Ls* dB nol .pply ro M ownd olpropsry who builds or imp.ov6 rhd@n ,6d who
<br />coniracrs for slch projcdr vnh a Conr.do(,lieisd pu*uat to rh. ConEeror's Lic.nsc L.w )
<br />_l d cicmpt otla Setioi _,B. & P.C fd thir r.son
<br />WORKEXS COMPENSATION DECLAR-ATION
<br />I bf.by affim &d.r p...lry oi paj,ry @. oa $. loll@ins dccldatios
<br />_lhavr d eil, @inr.in 5 C.rlifical. ofCons.nt ro S.lfJNu!. lor wortd' @mP.hsarion, s providcd fo, by S6ri@ l?OO oflhc
<br />La!o! Cod., for th. p.rfmacc of $. wolk for*hich dE p€mit is irru.d
<br />_l havc ud will mainEin qortcBi cmP.netion iBUe@, d rcqun d by Sccdon .lT0O oa lh. tjbor Codc, for $. p.rfomecc of rh.
<br />vort ior which lhk pqmil iE isu.d My work.E comp.nratio. insur.n.. @i.r &d policy f,umb.r e
<br />Policy Numb6:.E-rpic, --
<br />.1^'*,n*n
<br />fi-.-. *6.,.
<br />nor b. complctcd ifhc psmir n for O.. hundrcd dolls {1100
<br />rh. pdfomdc. olrhc work i.r *hich thtimir
<br />$c worl!6 conpcnsarion laws of Califomid. ud
<br />3 700 of rh. Labor Cod., I shali,
<br />s*uE work?R cooFEaiion covc.a8c
<br />6n6 up to on. hun.lrcd thouiod dolld (l100,000),in .ddido lolh. @sl
<br />thc L.bor Cod., i.r.r61 ed .nom.y'3 lcd.
<br />on, dan.8a 6 providcd for rhc Scclro. 3076 ol
<br />LICENSED CONTRACTORS DECLARATION
<br />I h@by iflim und6 podry ol pcrjury rhar I M iicas.d undc provision of Ch4rr 9 (@mhcncins wnh S.di
<br />$. Bliin6r ud Profsions Cod., ed my ticosc t in full forcc snd.ft.ci
<br />I h6cby affim undd pcn.lty ofp.lury th* ths. is a coiettuctior lddi fot c p.{omsncc of $c wtrk for which lhis p.mit i5
<br />issucd (Scc 1097, Civ. C.)
<br />AP}LICA}IT'S DECI-,/IRATION
<br />Dcmolnio. Pcmill-Asb6l6 Notificdio, F.d.ml Rc8ul.tid! (Titl.,l0, Pd 6)
<br />_ R.quncd L.tt.r oaNo fiarim
<br />_l 4nify thal dr icdsd r.gula o.s r.8ddin8 6b6t6 rcmoval &c nol
<br />"ppl
<br />-Lni&
<br />thar I h.vc rcad thtr +pricdon sd I rsru ro @mply vill: all Ciry aod Cou.ry
<br />ordinaB ed Stal Lawi,cladrg lo
<br />abovc m.lrion.d !rop.n, ln inrp..rion
<br />v6of thii ciry Md Couiry ro
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lvleter Release EXPttrsL'
<br />^n{ORoughI gg.B. l {{,',".
<br />Service Meter .^" * aso,ttg'991
<br />EA$ww-"'-
<br />Notes, Remarks, Etc.
<br />FINAL L.ndd's Ad,.k$
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