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ELECTRICALINSPECTOR REGORD <br />APPROVALS tD/stG.COMMENTS Owid-BuilddDccldadoi <br />I h@by ,ffim undcr poalty ofpqjury tha! l 6 dcnpt fom rh. Conuetod Licos. La* for lh. follo*insE6o, (s.c 70ll t Busin*t <br />ed rrcfBsion Cod.) Aiy City 6 Counq *hi.h EqliB q r.mn ro coisrtuci all6 impbvc. dnolish or rcpat &y mduE. Fi6 ro iE <br />ksusc., llso r.qutc th. rppliant lor 5u.h Fmit ro fiI. . iigncd st.tcmdt th.( h. or shc t li..ntc<l pudM( to thc Fovnion5 of th. <br />Conrador's Licc6.d Llw (Chapt r 9, Cmm.ndns wnh Sccrion 70OO of Divkion I of fic Ssins ed PrcfqrioN Codc) or rh.t h. d <br />rhc is cx.hpl ihqcfrom ddlh. b6n ftr lh. all.B.d.x.mprion A.y viol.lio. of S.cion 7031 5 by any.ppliot for a p.mn rubjats fi. <br />.ppli@l ro acivilp.hahy of not n@ rh{ livc hui&.d dolls (5500). <br />l. a o*ncr of thc prcpcny. ormy cnployG si6 w.g6 s thcirsolc comp€nrarion, will do rh€ work and fic srucr6. s not in6dc.l <br />or ofi.,.d for sllc ( S.c.rO44, Bsi.6s &d Prolgsions Codr Th. C.nh..or's Licds. L.q dc not apply ro e owncr of th. prop.ny <br />who buil& o, inpovcs lhcEon, Md who do.s seh wolk hi clforhc.lforthrolghhi!orh.r.wn.mploy!6,prcvid.<!tharsuch <br />improv6..B e f,or inl.nd.d or ofa.r.d for r.l. Il howcv.i, thc buildiig or imprcv.ncil is sold wilhin on. y@ of compl.no., th. <br />Ow.d-Builder will hav. $c b|rdm of lrolin8 ftar h. or ihc not build or improvc for lh. purpoE of sal.) <br />_I. a own.rolfi. prop.ny. @.rcluiv.ly conElcrins with lic.$!dconlnctffi ro consrtu.t th. proj.d ( Se 7044, Buih6 sd <br />Pbfsio Cod.: Th. Conrdor'r Licdsc Law do6 not spply to s ovra oapropBty who build! q imprcvq $6@ , afld who <br />conrec for such projcds wnh a confacto(r) li@ed pu{!&l to rh. conlacrort LEc,sc Law ) <br />_l m.xcmFuiddSaioi_,8 & P.C. fs this r.sM <br />WORKERS COMPEI\SATION DECLARATION <br />I h.rcb, affim undfp.nalv of pajury onc ofth€ aollovin8 d..ls.rio.r: <br />_lh3vc d will mainkin a Cdifi@L of Coniot to Sclf-lns!rc fo. eo*6 @mpc.s.tioi,6 plovidcd forby S.cti@ l70O ofd. <br />Labor Cod.. fo. $c p.rfmucc ofrh. wo* forvhich rh. p.mn is i$u.d <br />_l halc d will mainlain wol*.n' cohFn*tion i.!urmc., 6 rcqut.d by S.ction 3 700 oi th. Labor Cod.. lo, thr pcrfomdc. of $c <br />work forwhich lhis pmil i issu.d. My wtrI.E cmpcnsation iniulanc. micr dd policy rumb.r . <br />(Thk s.ction f,..d not b. compl.t d ii ilc p.ron is ror onc hun&cd doll6 ]t 100) or 16) <br />,i/*n, ry rla . 'r'" p..i*-r. of fic \ ork lor * hich rhr p.m r NU.d.l <br />84.m.lubj.d toth. *ork.E ' .ohpa3aton la*rofCahfomra ed.sr.. rhlr if <br />oaS.ctim r700 of thc Libor <br />-6 <br />WARNING. F.iluE ro s6ur. wo t6 compcrsation covnagc is e oploy?r ro diminsl p.nahiB ed civi,6i6 up to onc hundrcd thoadd doua (ll00.o0o),in atBnioo ro <br />thc Labo. Codc, int.r. sd lttoh.rt f.B, <br />I hc!.by rfilm und.rp..iny ofpejurylh l d licos.d uidd provisio of Chlprd I ( <br />rh.B6in6s d Proidioi! Codc, ad ny liccnsc ir in fullforcc d cfccl <br />I ha.by a,Im unda pcnalty of pc.jlry rhat tha. ir . coort !cti6 ladins lscncy fd lh. Frfmanc. oi th. vdk for which rhii Fcmn is <br />issu.d (s*. 3097, cir. c.). <br />APPLICANT'S DECI,AR TION <br />D.mohion P.mnsAsb.st6 Notiljc.ion Fcdcral R.gulations (Titl. <br />_ R.qun.d Lcno of Notificrion <br />ply snh 6ll Ciry and County <br />City ud County to €ntcr upon rh. <br />abovc m.n.oD.d prop€ny for insp..rion <br />6) <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 />Air Conditioners <br />Roof Top Equrpment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release Frrxt I .l;D <br />Rough FFB N'?!,}:q <br />Service Meter <br />FINAL SAM\, o"ro' ll ru, sta, 067 <br />Notes, Remarks, Etc. <br />DATE <br />Sub-Panels