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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS owNER B(JX-DER DELCARATTON ' .-
<br />I h@by artrm o.do poalry oap6ju.y thal I an .ronB fton rhc Cona.ctou LiccM L,w for thc followins ra$4 (Sd 70ll 5
<br />Ausin6s md Proadsion Cod.)r A.y City or County whi.h rotunB r p6mh lo consruc1. ah6, impmve &noli.sh or rAai d,
<br />srtuc1u€. prior lo ils issuecc. also rqut6 lhc applicat for su.h r-nil ro 6L a sis,.d 3rat@r rhal L o. dE b licos.d putu-l
<br />ro rh€ FovisioN of thc ConlEclois Liccns.d Llw (Chaptr 9. Comnrcnciis virh S.crion 7000 ol Divis,od I ofrh. aGin.sr and
<br />PrcfBsions Codc) or rhat h. or sfi. i, .xmpt thd.tom md lh. b6si, ao. Ih. rlleBed .xdnprion AnyviolalionofS.cliotr 70:11.5 byany
<br />applicanl for a p€mil subjEls lh. wplica loacivilp.olhyolnolmo.erh tivc lD.dr.<l dollat ($500)
<br />I. s owns oalh. p(otEly, o! my e.ploy6 with waBB s rn.ir sle o'npcGal ion. vill do lh€ Nrl ed tlE slrucl@ a rcl
<br />inrsdcd or oltqcd for sl€ (56.7044, Busins ud Prol6ioB Cod.: 'I'hc Conldclois I -i..M Lav do€ nor apply b s ow( oa
<br />rh. Fopdy wh. hril& or inFov6 th6tr dd wh. dG su.h {o,1 hime lf or n6d f or lhmugh his or hd oM cmploy€6.
<br />ptuvidrd rhal such inprclddt & tror imod or offdcd for slc. l( hos66. lhc hlildDs or imFotoEn n $B *i'hin on. Fr
<br />olmopkiln. thc OsK Builds qill hair th. hn,el ofpovins fi& lE or s$c nid not hild or imprcrc |fi. proFry ror rh. puipos oa
<br />I, 6 o*rd olfic Fopqly, @ crcluriv.ly conrading wirh lic.ns.d coilractou lo conetud lh. pmjdt (SR. ?044, B6mN
<br />ud ITlfsioh Cod.r Th. Conllrclols Licas. Law doa not apply ro M own6 ofpoFnywho builds or improvGlh6e,.
<br />aid *ho co tlds for su.h F!j..1s {irh , Coddclo(3) licdacd ,u6@r i6 rh. Conb6.1or'3 L(.M k{)
<br />l inexcm undcrsccrkn .ll & P(' n! this(d..
<br />l)No O*nc.'
<br />tuQaf,fis:colltrNtarlo!
<br />DEOAAAIIO!
<br />I h6.byamm undd pd.ltyofpdjuryon offic folloviis d6ldaIio6:
<br />I havc Md will maintain a C.nificarc oacoost ro Self-lnsur. lu work6 .ompdsion, 6 prolided for by sc.tio. 1700 ol lnc
<br />Labo. Codr. for lhc pdfomucc ofthc wrt lor stich lhc pqnh is iseu€d.
<br />I havcud will mainlst wo.t6 comp.saliod insur.nc., s r.qun.d b, S€tion l?00 ollh. kbor Cod.. ror lhc pcfonnd.. of
<br />lh. mrt for uhich lhir Fmil is isu.d. My work6 ompmalion iNule. @iq ald polky truBb< u.:
<br />Expn6
<br />I ccniry thar io lhe pslorman .oalh. wort aor shi.h rhis p.mi is issue!. l Bhall.or mrloy an, p.uon in any munc!
<br />$ a to b.co,n. subjst to th. wortm comptr.tion l.es ofcalifomia,.nd aere ltal il| should tr.o,n. subj.n lo rhr
<br />rori6 compasriotr p,ovisioG ofS..rion lT00olthc Lator Cod.,l shall. fonhvith &nply rvirh thoe povisions
<br />NAR\I\(; l:irl c t, secure \.rk.'s (nnpo(nm..\c,38.,s trnLi\lnL. rnd n ll lihjc.r rtr
<br />d.Uds ($100,000). in ddniod h rhc.ost of
<br />imdd md dtomoy-s la 7)1,x
<br />r rr lErnioffi*IEiF---@-
<br />t heby artrm und6 pqrlry ofF jlry rhal I m Iic.E d undd dvtion ofChaprs 9 {codracinB *irh S6tion 7000) otDilision l
<br />oa th. Busina ed PofsioB Cod., .nd my lic.N b in full aorc. md cfl(t.
<br />,.tt./ -.'-kt
<br />I hdby lllm uidd Fnr]ly ofpqJury rhal lh@ Ls a otrddclbn
<br />iilu.d (Sd 1097. Ci!. C,).
<br />i.s asocy lor ttc ,slolr@cc of th. @r[ for which rhis pdmn is
<br />APSIICANLDECIdNAIIAX
<br />I bddry alft,n undd F.alry ofFrjury on. oalh. aollovioe dcle.t iod
<br />D€nolition PditeAsbclos Notilicdion Fcd@l Rcsularions (Titl. 40. Pan6)
<br />_R.quir.d L.rla olNolifi€lio.
<br />-l
<br />cdiry $ar fi. f.dcrd r.subrioN r.srdins abBros rooval @ iot pplicablc ro rha p6j.d.
<br />-l
<br />c6iry tnd I havc 6d thi5 lptlicalion a.d sbt. lhd lhc abovc irfonnaiotr is corol. I ogc to coftpl
<br />odnr.i.6 rnd sr^rc t.a\s rlarins ro ltitnrt
<br />ahovc mcnrbncd ptrrp€ny tu ftp€trion
<br />apprtrnr or aeenr slsnrrure F :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 I L\t-I t,Gq p"t t tt/ t"</frn
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />It/eter Release t11 t1 ,/LU/9 nx Al
<br />I
<br />Rough
<br />Service Meter 81 'fi,/a q(0 f{ A,
<br />FINAL ,(1// 4 7q./
<br />Noles, Remarks, Etc.
<br />.-\-7
<br />L'.dr.clrs: i I
<br />".,.,oFlot- | 17tl
<br />and Counlr lo alr upon lhe
<br />7,1
<br />a
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