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ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS Ownd-B!ild.r Ddlmiid <br />I hftby ama mde pdalty ol pcrjury rhal I m cxmpt fom rh. C@tr..roB Licasc kw for th. folloving Eson (sd 701 I t Businds <br />Md Proi6sioi Cod4: Any City or County vhich Equt.s a Fmit to conrtn.1, .ltd, imp@tc, dcmolilt or Epan ey s@crw. prid to iLi <br />hsuec., aho r.luiru ln. +plist fd such Fnil lo filc a sisncd stslcMt that h. or sh. is licas.d pu6@l to thc psvisio8 ot djc <br />CoiB&br's Licdsd Llv {Chaplcr 9, C(),m6ci.8 wirh Scdon 7000 ol Drision 3 of $. Buinss dd Profsrions Codc) or lh.r h. d <br />sh. G dmpl th.r.6om s.l th. bais for 0E .ll.!d.xcmption Any violarion of S.cliM 703I 5 by y applic&l lora p.mn subj@ls rhc <br />applicdt to . civil p.n.lty of.ot noic d0 fivc hun&.d dolld ($J00) <br />_I, a M6 ol rhc For.ny, or ny .nploy6 wilh va8e 4 rhct sol. @mp.nsaion, *ill do fic wo* ud lh. sirucrs. is not intod.d <br />s o,I*d fo solc ( S.c 7044, aBi,N ed Prorc$iqs Cod. Tn. Conhcrd s Licas. riy do6 rcr apply lo & wnd ol . pro?.riy <br />who builds or ihF.vs lh.Mn, ed who do.s such *dl hims.lf or h6da q lhresh hir tr hGr (m oploy6, providd rhd iuch <br />imprcvmots d. not intadcd or oflocd fd solc. It howd.r, rhc hrildin8 q imFovd@t is sld *i$in d. y.d of.onpl.rDn. lllc <br />Omn-Builda vill havc lh. burdh ol prcvirg rhd h. or 5hc .or build o improvc for th€ prrpGc of sal.). <br />L a ovn6 ofthc proFny, m.rcl6iv.ly @nEacti.s with licds.d.onhctors to.mritucr thc Fojcl ( S.c ?044, BBiDBs ud <br />Prcr6sion Codc Thc Contretols Lic.N. h* dc nol apply lo o our of propdy who buildr tr improv.s rtftor , md who <br />conbr'l ld ruch lnoJels with a Cqllelo(9 licas.d pu6u&r to rhc Conoacror's Liccn!. L.w ) <br />_l m .x.npr D&r Seti6 _.B & P C fa riis l!.o <br />DdG: Owi.r: <br />WOfu(EAS COMPENSAT'ION DECLARATION <br />I h.r.by .inm undcr pa.lty of p.rjury on. of th. following deldti@ <br />_l havc ed willmai.iain ! C.nifidc of Cmsal b S.li IniuE ao wd*6' cmpc.larjon. s Drcvid.d for by S.crion 37OO offi. <br />Labor Codc, fotn. p.rfm c. of rhc wo* fo which rh. pcmit is i$ucd <br />lhavcodvillmai .in wnt6 cmFns.lioi6l@cqa.€quiEdbyS6ti63?0ooa(hcLaboc.dc.forlhcp.rf@dccofrh. <br />wort for vnicl this Fnit is isu.d My vdt6' .mpqBarion isurs@ ceid d poli.y nombtr ec: <br />Policy Nunbs ErpirG <br />(This *clion nccd f,ol b. cmpl.kd if $. pdnn is for Onc hundr.d doll6 lt l0o) or ls) <br />_I cdify lnat in drc pdfmde of th. wort fa wnich rhk Fmir is i$u.4 I shall nd dploy dy D.6o io &y mend !o s ro <br />bc@c subjdt to $. wqk6 comFisation la* of Califmi\ &d.gR rhar ifI5hould beMc subjd b rh. *dl.R <br />@mposatio prcvisions oas.ctio 3700 oad. Labd Cod., I shall, lonhwitt cmply wirh rh6. Fovi!i@. <br />WAf,NING FailuE to seuE woLcu' cMFnslion 6vd.g. ir ul.,ful, ed shall subjftt d rnployd ro qiri.al p.nahi6 dd civit <br />finB up lo o. hundrld thocdd .lollm (t 100,000),in addiri@ ro rhc c61 of cohp.nsars, d.na!6 s provi<kd for Oc S€tion 1076 of <br />ln. L.bor Cod., inrcEs ed aliohcy'i fB <br />LICENSED CONTRACTORS DECLARATION <br />I hcEby afrim und.r p..ally oapGjury drr,l I n licms.d undd povision of Chapcr 9 (@dh.trcinB with S.ctior 7000) of Divilion 3 of <br />th. B[i.a! d PrcfBions Codc, ad Ey lic.nr. is in full f(@ dd cflccl <br />CONSTRUCTION LEI\'DING AGENCY <br />I h@by amm uod6 paalry of F iury rhal rh@ t a coist uclioi lcndiis agncy ftr ih. p.rforll.@ ot $c wdi( fn which this p.mn i, <br />i$!cd (S.c 3097, Civ. C ) <br />APPLICANA'S DECI,/\RATION <br />Daolnio. P@i1r-Asb.n6 No{fi@lid F.d..l R.golari@3 (Tnb aq Pal 6) <br />RcquiEd Ldrd of Nolifi .dion <br />_l eniry 0'ar tlr Ldcral rcBuldios rcsrdi.s sbd6 Movd ft not lppticlbl. o $is prcjccr <br />_ I ccrtry $.t I hav. rcad rhis @plication ad shr. fiar rh. rbov. inlmadon h ffieL I agE ro c@dy *ith dt City sd Cdnty <br />ffdin&c6 dd Sralc Llws r.ldlin8 ro buildiig @NEvctid, md h@by lurhoie rcl{tslativ6 of lhir qry ud Courry to ar6 upon th. <br />abov. matiocd p,op.rq fd insFclio purpG6 <br />../1)a,/z/ <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 trYDItr EI\ <br />Rough FFBOI 20!9 <br />Service Meter <br />FINAL ,, soo, 667 <br />Notes, Remarks, Etc. <br />APPROVALS <br />Licdr. Numb.r _ <br />L.ndn r Ad.L* <br />I