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APPROVALS DATE tD/stG.COMMENTS OWNER AUILDER DEI-CARATION
<br />I hcrcby afirm undcr pcnslry or F.rjxry ihd I m.xcnu f6m rhc ContscloF Lic.n$ l:* ror ih. rouo(in8 rcrson lscc 70.11 5
<br />Busincss nnd Prorc*b. codc): A.y City or County Nhi.h rcqltc\ a p&mir h .otrnrud, altci imPlorc. dcmnhh or rpnn rny
<br />{fl.rum, prntr b irs issuflB. rl$ rcqutcr rh. aprlic,nr r.r skh Frmn b Iilc a siSned nd.mnr rhar heot ths n li..nsd ,)ur$ant
<br />rL, rhe polnion\ oa rhc Conl.rclols Li.cord L{w (Ch0plcr 9. Conrmemioa snh s..tn,n 70([ oI Division ] olrhl Busi .s ,trd
<br />Pofcssn,nsCtdc)orrhdh.orslEtcxcmplrhcrcaro$otrdlhchrsis,orlhenucgcdcxcnUlion.AnyviohtionofS.cthnT03lsbylny
<br />.ml'.trtrr r'or rlxrmn subjcdsrhc applicaor to acivilpenalrroloor 'noic thun nvc hutrdrcddolh6(S5{x))
<br />-1.
<br />!s owftr of rhc llhFdy. or my emrlorEcs wnh woBcs $ rhcn $k ompcnsrn,n, will do llr rork uxl ltr \rnth i{ mr
<br />i cnr.rr or ofi.cd f.i sl€ ISN.?044. Busimss and Pmlcssions Codq Thc C.trtucn, s Liccnsc ti* &er ml amlt lo d oqncr of
<br />rhcnm|)( y rhot lds or irom6 rltdn. drl wh dcs such wd( iimsclf o, hctsla or thrcxgh hk or hcr own cnlk,yccs.
<br />F)vidcd rhd soch inprcwEnts m ml iotendcd ororlcrd forsk.If. hos*c. rlf, tloiHirg ot i.{,mRftnr h$ld wilhirronc}e{
<br />o,$,{hrbn. rlEOwncr auir+r *i narc LlE todctr of lmlins ttur hc or sh. did n.t build or iry,rorc rhe PoFny ro. tr FUIID* of
<br />l. $.*ncr orlhc [opcny. arncrchsivcly coiiru.rins wnh licci$d contrnclor s lo conslrucr rtE roj{xr (Scc. ?044. Buiik*
<br />!'d hofssionCodc ThcConractolsLiccnscLowdocsnolonplylo!nowi€rorDm!.nywhobuildsorimPov.crh.rcon
<br />{nd Rho contncrs for such pn ccrs vifi a C.nrdcro(9 li..dsd ,)u6uonl lolhc Coflrracrors Lk..s. bw)
<br />I am.rem.r undcr S(tntr .B &PC forrhirrcssn
<br />Drr.: Om.i
<br />rrcatr[SulquflllaflrN
<br />DEILI.EAIION
<br />I hcrchyr,llnnundcr |[nnlry.lpcrJUry.ic.f rhcn,lbsi t dcchmriotrr
<br />-l
<br />hrvc dn*illnuinrlin !Ccniticarcofcon€nr bs.lr.ln{rc ld so cn' conr|.i.rri.n. n\ povid.d lor hy Scdion]7fi) ofrhc
<br />utxr c.dc. ror rhc pcrforntrrcc olrhc work tff shich rhc Fmir i\ issucd
<br />I [rvc rnd willnui air $orkrr\' conp.ikrtun in\uhn.t, N rcilui,cd hy Scdi,,n .]7(x) or rtu ljtxtr C)dc.lor rh. Frtornance of
<br />rhc trork tur $hi.hlhis |xnnir i\ iskl My*.rlt '..nrNnsrri.h irsurrtr.c caFicr ai Fnict nrmh(r m:
<br />I ccdilyrhrr in rhe r.rro nrRc ol tlrc work lor *hich lhh Fnn is i\\u.d,I shtrll mr cmtloyanrIcrw,n in rnynurnc.
<br />s i\lotx.oDEsub,cdlolhc*ork. smpcnqri h* orcalifonria. affl lsEc rhar irI thoukl bc.onE subjd ro'hc
<br />soikc' ( $mpensarion pm! i{n,ns of sdiio. r?(D or rh. Iihtr clnc, I shall. fonhwirh omply wnh lhot povnnnN
<br />NARNIN(; Frilurc r) {.trrr s.rk.r'conrp.nsiliflr.orrxg. i\ tnhtrful. tul nrll \un]ccr !n
<br />cnil ftr\ u! t, o c hundtud rhorsrtrd dolhr ($Io).lXXr). ir rknliri,nr k' rlt.,,$ ol c.nrPcnsll
<br />emtlnylr ro dini,al p.nllti.s aRl
<br />nn diEy( N ,'rclidcd ror lhcIS\.,rtr,n 1076,,frhc,Lrtrtr(.ic. i crc{ ind a(nrrcy'
<br />u,,", g l, ltb n,o,,_",,
<br />DECI.AXAIIQN
<br />I hcrcby otftrn undcr F.!hy ol p.rjury lhar I rm liensd undc! ,,o!nion ol Chapr.. 9 (mnurencins wilh Sdbn 7O{D) ol Divhion 3
<br />of lh. Busincss and PmfcssionF C.dc, and ny ltcn* k in rull lor.. dcrst
<br />caNsIal]cIlaNrENDMi-trE[Nl;r
<br />I hcrcby rffimundcr pcNlry.rPrlu.yrhailhcrc h 0 otrsrDdion bndins a-gency nr rh. !.nnnmmc ollte *or* n, *htrh rhis lcmri! k
<br />A{rcd (S.(. 1097. Crv ( )
<br />a.tluqaNlDlcl/n {u1}!
<br />I h.rc6y:'fiinn tr ndcr FonhyolF-rjrry onc orrtu rdlosing d..l*rrions
<br />Dcfioltion PcrniFAsb.$os Norilicrrn,n Fcdcrrl RcguLrnn\ ('I'irlc 40. Pan6)
<br />Rcqurcd Irnq ol Noliluri(n,
<br />l.cnrly d rhc fcdcrrlrcsuhri{,nsrugadirs a\h{os r.nr)ul arc mr {!li.$lc lo lhtpm]ecr
<br />I.cdilylh^t I h^c rc rhh aptlicalin 0nd nrre rhar lhc fi,vc inbnndir i is.otrcd I osN ro comlly wir h all Ciry ond Counr,
<br />odinatucsandStorcLlwsrcl0tingt.huildiigcoii cri.n.d hctcbyourhoflzcrcl)r.\cnrurNc\ofrhFC,unJCoutrryk,cnrcruFnrho
<br />itnrc rmnrnncd nmncnyl inrnccrinn pdrr'v* S t I
<br />Apprl.M'mAs6'5km,u*: A{r-\i-^F. ^'" ?tl' I tg
<br />p.frr*Mnc(prrn* G'+$4 l."r]- /tlsr* l-r S
<br />Underground ( V9\(/Qt&'n)
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Faclory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />l\/eter Release
<br />Rouoh
<br />Service It/eter
<br />FINAL )LI tg /,,L44 /i1
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
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<br />L.nilci\ AdLl.s
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<br />Site-Work
<br />Translormers
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