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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Ownd-Buil&r D.cla.lion
<br />I hcrcb, aflim udd pcnolty oa p.dury that I m .xdP1 lom (h. Co.rad6 Li6s L!* ld rhc follo*ing 60r (se.?o3 t 5 BusinB
<br />dd Profdsion Codc) Any Ciry or County which rcquirq ! p.mit ro coroloci ahd, improvc, dmolith or rcpai. ey s1ncrur., pfl6 to ii3
<br />isstrc., alrorc+ir6 0E appli@lfollch pm bfilcasiAn.dst tmmt thar h. c sh. ii liorcd poE! r lo dE provilic of rhc
<br />Cortr&br's Lttrcd L.w (Chaprd 9, Cmmodn8 *ilh S6d@ 7000 of Division I ol rh. Bsins &d Prca6i@i Codc) u fiar h. d
<br />sh. is dmpt thftftom md lhc b6is fa ihc allcgcd d.mplio Any violalid of Setion 703 L5 hy ey upplicar for a pcmn subjd(. $c
<br />applidr ro . civil p.hahy of not @c lhe 6vc hund,cd dona (lJoo).
<br />_1.6 o*nd of rhc prcpqry, or my mploys *nh waa6 a rhcir solc cohpctuadon, yill do rhc vork and thc sh.d. n nol inhdd
<br />or orcEd lor sal. ( sd 7044, B6in6 Md Prof6sions C.dc Thc conddor ! Licos. Lav do€! nd 6pply to m o*nd of rhc popcrg
<br />*no buil& or imprcv6 th.r.m, ed who dB rucn work hicclatrh6.lf or throogh ht d hd owr 6ployG, proeid.d lhar such
<br />improvoots G nor i.l..d.d or ofa.rd tor sElc ll how.v.r, lhc huildinSor improv.mmr ii sold widii. onc y.dofcompl.lo, rhc
<br />OMd Buil&r vill havc th. &rdd ol proving th.t h. or 5h. not build d inprovc for th. purrGc of satc)
<br />_1, 6 o*nr of tlE prop.n , m qclGivcly @nlretinS qnh licas.d co.rrc!6 ro @6trucr rhc proj.ct ( Sc 7044, aBins ud
<br />Profdsion Cod.: Thc Conrmbr't Lico!. La* docs nol apply b M omdofpropqty whobuil& d imp.oy6 lllmn, d*ho
<br />cqr&t5 for such proj.ds wnh ! Conreto(, lic.nr.n pusuan to lhc CqF&lors Lj6s. L.w )
<br />I m .i.hpr unlicr Scclion
<br />PolicyNumb.r: Expic
<br />(Thi3 selion ned nor h. .mpla..l if ltc pef,il i! fq On. hundr.d ddlm {l l0o} or 16$
<br />_l @rlify $ar in $. Ff@ eofdcworifawhichthnFmni3is!.d.IshrllnotdployoypcMineymenesocro
<br />b..m. subj..t !o th. vorl6 Mpdsltion las of Cdifmil &d aer.. O.r if I should b.em. subi.d ro rh. wdtcBi
<br />cmFns id provisim of Sdtio. 3700 ol lh. Latq Cod., I !nal,, fonnwid ffiDly pnn rh@ provisi$.
<br />*-ta ./a J
<br />wAlNlNG Failurc b seuE wdl6' MFnldid covnag. is uila*tu|, ed shall subjd e chployd to cdminal p.ndtdd sd cilil
<br />6n6 op to ooc hun.lrcd rhoMd doll6 (t 10o,000).in additioi 10 th. c6l of (mP..3!lio.. &mag6 s prolid.d fo $. S.crion 3076 of
<br />fi. Labd Cod.. htGt dd t@crt f6
<br />I-ICENSED CONTRACTORS DECLAXATTON
<br />I h@hy rtlm uidn Fnalty of pdjury 1h5r I m lic@s.d uods poyisid of Ch.tld 9 (cm6dng wirh Scdon ?OOO) of Divilid I of
<br />th. Buin6s ed Profsiobs Cod., md m, licos. h in full aoE ud .lI.d
<br />,f-zz/z/
<br />CONSTXT'CTION LENDING AGENCY
<br />I h@by amm und.r p6.lry of F.luy olar 0r@ is . @nstruction la.li,S .!.icy f6 rhc p.rfmec. of th. w6t f6 which lnii p.mir is
<br />isu.d (S.. 309?, Civ C)
<br />APPLICANT'S DEC:I-{RT{TION
<br />D.mlitio, Phil!-Arb6r6 Notrlicalj@ I.dd.l Rcg djds (Tnk 40. P.n 6)
<br />_ R.qut.d Lclid ofNodlicaid
<br />_l cdify lh8t th? f.d.r.l E8ulatio3 ESrding Eberd moval e io! appliciuc ro this prcjd
<br />_ I canry $at I h.vc r.ad thi5 applicdio. d !i.rc h.l rh. sbovc infm. on ii 6rer I .gE to cmpty with .tl Ci9 ed CMry
<br />ordinM6 ed SLlc Lrws rchti.g to buildjn8 @orEuctio, ed ldcb, luthd& rcpre.tative of rht Ci9 sd Counry to orcr upon rh.
<br />abov. matid.d proFty for insFction purpGe
<br />- Darc ,1-:-za /a /
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />a Y talr
<br />Ceilings (T-Bar Rough)
<br />Meter Release FCI] I Lnt0
<br />Rough 5AMU U-44,?80, 668,6(7
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc.
<br />WORKENS COMPENSATTON DECL{RATION
<br />I hftby !f6m uda pcr.lry of p.rjury on. ofth. follwif,a &clrdi@sl
<br />_l havc ed will m.if,trjn . C.nifiqrc of Cdsl lo Sclflnsur. fd wdl(6 mFn5!li@, B Flvid.d lo by Sedor 3?Oo of rh.
<br />L{5or Cod., ao tll. pdfort@.c of th. *ork fd which tn. p.mn is i$u.d
<br />I hav. ed *ill nainllin vdtc6' ohpc.s.lion iNu@cq s r.quircd by Sccrio 3?00 of tn. Lsbd Codc, fo $. pdfol]rfuc. of $c,orl fd *hich this p€nir t isud My wort 6 cmpoeijo ituuee @id dd policy Dumbs e:
<br />Li@$ Clas:_ Lic*. Nmbd
<br />L.ndE'r Ad&s
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