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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER I'ELCARATION <br />I ncahy amrd lnder penrlry,,f pctory rhll I o ci€nrr fmm rhc Conr,acrod l-i.en\c liw i(r rhc following Rrsn (sc.7011.5 <br />Busincs and Proic$ion Cd.): Ant Cily or C.unry Bhi.h r.quircs r ,l.nnn lo .onstd.t. alrcr. i'n!rov.. dcmlish or rc,'ot any <br />(rucrurc. lrior ro ns ksuone. rlso rcqunes rhc imliconr for such I'emi o filc a shncd sllrcm.r rhar hcor\nc !r li.cnsd pu^n{nr <br />ro rhc Fovi\ions olrhr Conrractr\ l-i.cnrd ljw (Chlrrcr 9. c(,dn fting uith s..rion 7000 of Division 3 oflhc Bnsirc$ and <br />Piutesi.ns Codc) or rhrr hc or sh. ircxcopr rh.rcfrom od rhc lEsis rorrh.alL!.d.xcmprion. AnrviolorionofScclionT0ll.5l,yany <br />+!li.anlrorapcrmirstrbj.chrhc.mlica.rron.irilp.naliyornotmmihan6vchundrcddollors(S5m) <br />I. .s ostrn of rhc lrolrdy, oi <br />'ny <br />cflplqN! wirh wrgc\ rs rhcn v,h co rf.n.dr on. will lo rhc { (,* mJ rh. nflduru is mr <br />inrcndcn oroftrcd fo! slc (S( 7044. Dtrsincss.nd ProL$ioN Codcr Thc Co racroisLicen{l,rwdocsnortrPplyrornowncror <br />rhc poFny who huilds or iml,orc\ rlEmn. lnd *h. docs sch wo* hinNcllo! hcrclior rhrDsh hi\ or hcr own cn'tlortcs. <br />phvidcdrh iu.h nnln,wftnkm n imcndcd or omcd for eL lt lx)sclri rhc hiklin! or inlrx,vemnr n $kl withii onc ,qtr <br />ol co !,Lr [m. rh. Orftr auil]s will hrvc rhc burdcn ol prNin3 thll fu or shc did nor huild or inrrn)r rtc pmFny fir rhc puryns oi <br />l. aso$Dcroirhcnn|Eny. trnrcx.nNivclyconrr.dnrr wnh li.ctrscd contrrns ln drxrrud rhc proj.ci (Scc 7014, Bu\irc$ <br />rDd rhnts{i Codc:ThcCotrtr.roasLiccn\.Lrsdocsforrlplybnn.q $.rl(,pc y uh. brildsor tnttur.s thcrc.tr. <br />rntl *ho conkrcr\lnr \uchpri.(r\Nirhr (inrrru(r) li.pur\unnl lo rte Contr0cnn s Liccn$ hN) <br />I ri,.rrnr|n undcr sccti{nr <br />IIEII.ABAIIAN <br />I herchyamrn undcr pcMl'y ot psjury onc ofrhc follosins dcclaorions <br />-lh!!c{dwillnunaill.CcriilhatcoiCotrscfllr.sclrlnsurcrorerkcs'compcns.rion,aspmvidcdlorhrScclbn:17(l,olrhcLabor Oodc. lor rh. t.rforfrncc ol rhc vork fd whi.h rhc Frmir i\ irsucd. <br />rhc work f{trrhich rhis pcrhir i\ i\\u!al Mysuic$ conrpensarion insulrn.c crric. r F)licy nu'nb$rc <br />l.cdily thrr in rh. p.rfonmmc olrh. work for shi.h this ltnnir t i(sud- I shall Nr cnrploy ony lcnon ir atry mrnnc, <br />n r b lf,om su$jd b rhc rorkcn' conrr.nsarn,n hw\ olCulifoni!. aad ogrcc rld irI should bccoft \ubtcr t, rh. <br />(orl.ri co'np.n\rrionpfl,visn,n\ofS(rin17ff)otrhrlntxtrCode.lshrll.n,nhwirh.o lllywrihrhoscpn'visions.. <br />WARNINC: lailurc to surc rorkcn' conp.Darion <br />civil fincs u0 ro onc hundrcd thousond dnllm ($lOU <br />Setion.1076 ofthc L$or Codc. inrcrcst lnd 4nomy s <br />Dde: Appllcnl: <br />I rn cmnl,),cr n) rifri',alF-mlric\ n <br />nrllc,srii,r drn g.! r\ fnirnlcd lnr rh. <br />DECI.AEAUAN <br />I h.rby nmrd undcr ri.nak, ol p.riurr rhar I ad licenEd undcr EovnionolChrprd 9(conmRing *nh sft'htr r0tn) olDivision 1 <br />of dc Ausim$ nnd Poti$ions Codc. ud my licrns ir tull lorcc md cifcd. <br />COISIBIJCtrON.LE DINGACDNCI <br />I h@hy aftirn lnder p.nahy ol Frjury rhd rh@ i* a ..nnrudi.n hnding rgcfty lor ln. penonum ol rh. so* for which lhis Frmil is <br />isslcd (Scc. 309'r, Civ. C.) <br />AIIIICANLDECLBA.II!]N <br />lMy.fmlnd pemllyof pc,jlryoncorltcfollowin8dcclaErions: <br />lxnblilion Pcrmns.AsiEslos Norificalion Fcdcrsl R.Eulnlio.s Onlc 40. Pan6) <br />-Rcquncd <br />Lcllcr ol Notiarc ion <br />I ccnilyrhrr (hc f.d.nl r.guhrt)n\ mg&li',g nsbc{os rcRxrl rr. norrpFli.nhlc b rht UojLrr <br />-l <br />ccnilylhll lhrvc rcodlhh rnplicllion ihd thc r6ovc nrn)nn ior i\ cor.cr I i8rm h co ,tl <br />. rcn,r*nrrri!.\or rhn ( irordirtrtrccs lnd Srorc Lnwsrlrin8 ro bu <br />rlhlc nrnrioncd ptupcny i(tr insDccr <br />ADplacanl or AA.nl SiAMhrre. <br />ral <br />){ h rll 9t y Jn'l C/td y <br />vd corrhyro.nrlr unon Lh( <br />$u(ct <br />Un derground <br />Pole Bases <br />Light Standards <br />S pas, Pool, Fountains <br />Signs (monument) <br />Lile Safety /Low Voltaqe <br />Fire Alarm i Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueinq <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 Rouoh) <br />It/eter Release <br />Rouoh <br />,t <br />FINAL filqr llK 'thty**)?*,T_T-tr -----------_Notes Remarks, Etc <br />Site-Work <br />Service IVleler <br />l <br />tt <br />I