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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OMcrBuild.r Dcclefio
<br />t hdby affin uidq Fi.lty oi!.rlory rh{ I m dnpr fm ihr Cdtra.to6 Lic.nrc L!* for rhc following r.son Gcc.?o3 L5 Buindt
<br />&d Proision Cod.) Any City o! Comr, *hich Equir6 a p.mit to conshct, alt r. inprcv., dmolish or rcpair e, slodu!.. prior to itt
<br />issusc., als r.qut6 thc rgpli6t for such psnit to filc a sign.d s!ar.ho! rhal h. or shc is liccns.d puGuat b $. Fovilioos of ln.
<br />Coir&rofs Licc6cd Llw (Ch.pte 9. C6m.ncio8 wiirr Scction 7000 of Division I of rhc Bsirs ud ProfBlions Cod.) or o'ar hc or
<br />cnc is cxmpl ln.Ef,om ed th. bais fo lh. .ll.8cd .x.hplion Anyviolation ofS.cion 7031.5 b, dy applicet for a p.frir rubjccls thr
<br />rpplidr b d civil pmrlty of not hoE lh& fivc hun&cd dollo {5500).
<br />_1, 6 ownq of lhc propcrty, or fry cnploys *illl qas6 d lhcir solc compcnsario., will do rhc *ork &d rhc rrucru. ii not inkndc!
<br />or ofad.d ftr i.l. ( S.c ?04a, Bsinss ud Profc$ions Cod. Th. Conrdor's Licasc L{w do6 not spply to !n o,nq of fic prop.ny
<br />who builds or inFovd thcr.on, Md who do.s slch worl hiccllor h6clforrhrouBh hn or bcr owh.mplorc*, providcd that 5!ch
<br />improvm.nE e. nor inr dcd d oafd.d for salc I( hocv.r, rhr buildinS or imp.ovcncnt i sold virhin on. y@ of cohpl.tDn. $.
<br />Own.FBuildd willhavc thc burdc, of proving $al h. orlhcnot build or imFov. for $c pu.?os ofsah)
<br />_1. a owiq of $. prop.ny, m qclusiv.l, coE&tin8 wirh licdscd @il'etoB to 6nrlrucr rhc projd ( S.c. ?044, BBind &d
<br />Prcfeid Codc Thc Cdtr&ror'r Liens. hw dG oot apply ro e ow.d of propqty who builds or inprovB rh6o . hd who
<br />coiE&E for ruch pbj.cE pnh ! cdrado(o li@.d puEudl to rh. conr.sctor'! Lic.nsc tzw )
<br />Im.xmptund.rs4 on ,B &PC fdlhiscaon
<br />WORKERS COIIIPENSATION DECLARATION
<br />I h...by affim und.r p.nalty ofprjury on. oathc lollowin8 d.cldalions
<br />_l hsvc ed will o.inbin ! Cmi6. . ofConsat to SclfJnrur. io, worlcB cohp.nsation, s provid.d for by Satio lToo of lh.
<br />Labo, Codc, for $c pdfotr@@ of lhc wdk for which thc pcmit is issud
<br />_l h.v. ed will mainrain edtcR @mp.hs.rion inrurdc.i a r.quiEd by Scction 3700 oathc L.b.rCod.. for dc p.raom&cc oflhc
<br />work for which fiir p.mit h issu.d My *ork.E' omp.nsllion insurlnc. ceir dd policy runb.r d.
<br />Policy Numbq Expt6*'x":::"
<br />bf*. ',6,.., ,"
<br />nor b. complctd iifi. p.mn is aor On. hun&.d doll4 lll00) or l6s)
<br />th. pcrfomsc. oa thc w.rk aor *hich lhis hmit
<br />lh. wort.E compcns.lioa laws of Califomi\ dd
<br />comp.nsario" provisionsofSE on r?00 of rh. L.btr Cod., I .h.ll, fdln*nh
<br />D,'.cd 2 -Lq-o L
<br />WARNING: Failurc to s.curc wor&6 comp.f,sario. covo.8. is ro criminal p.naltics ed .ivil
<br />fin6 up io on. hund,.d lho6md doll@ (l100,000),in .ddnid lo
<br />rhc L.bor Codc. inlct d anomcy\ f6., dam.r6 s ,rovid.d fm rhc S&tion 30?6 ol
<br />I h.rcby afiim und.r p.nalty of prjury fia1 I o liccnscd undq provnid of Chlpt.r 9
<br />,"",r'1 229 'lL
<br />I hscb, al6m un'jd p.nalty ofpc4ury fid rnft lh. pqfomanc. of ih. wdk fd *hich lhh p.mir n
<br />isu.d (Scc 109?, Civ C).
<br />APPLICANT'S Df, CL,{R,ATION
<br />D.molition Pmi'!-Asb6t6 Notiiicaioi rcd@l RcruktioB (Tnk.0. Prn 6)
<br />_ R.quircd L!e.r of Noillqtid
<br />I c.n'44ial
<br />'h.
<br />f.dR, rcgulanons E8sdh8 sb6rs
<br />z:l.ani, rhar I ha"c Eld !h,s spphc.rion dd dc rh.r conply wnl all Ciq and Cohry
<br />ordiioce dd S$t. kws rclafing to buildins of tfit City ed Colity ro orq upon rhc
<br />abo!. m.nrion.d prop.ny for insp*tion purlos6
<br />>--o/
<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 />Meter Release E{',IEED
<br />Rough rc,E : | ;iJlg
<br />Service Meter sAMc 8-4g, z0o_ rr. -^_
<br />FINAL
<br />Notes, Remarks, Etc.
<br />rh. Busi.6s Md Profdrios Cod.. ed my licci* is ii fulllorcc aid.ft.d
<br />L.ndcrr AddBs: _
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