Laserfiche WebLink
ELECTRICAL-INSPECTOR RECORD <br />DATE ID/SIG.COMMENTS OWNIiR BUILDER DETIARATION <br />I h.r.by .fiirm undd pcnally oa psjlry lhal I m cx€n ion rhc Conrradon Lic.ns. t e for thc lollowins rari. (S.. 7o:l I 5 <br />Dusin6s ud Profdsion Cod.): Any Cir, or Colnt, which r.q s a pqrnit lo conslruct. ah6. inprov., danolish or r4at My <br />srtuctd., pdor ro ns isumce, also requir6 thc applic4l lor such p€mil to riL a sig..d slrGnc lh.t h€ or srE is lics.d p6ugl <br />ro rh. rolisrod of$. Conlraclors Lic.ned kw (Chagd 9. Comm€ncitrs Nith SElio. 7000 of oilision I ofthe ttusios &d <br />Profsions Cod.) or lh.l h. o, shc is cx.mpt lhq.fron ad thc bsis lor rh. rllcs.d crmp(ion Any violationofselion 70115 byany <br />applicant for a p€mn subj{rs lnc arplic&t lo , cilil poan, of nor morc rh& fivc hund.€d dollrs (5500) <br />-1, <br />6 ownd of th. Imp€rly. or ny employt6 Bilh *Es6 a their sole comr.tration, $ ill do lhc wort and llE slodm is nor <br />inr d.d orolls.d fo, *lc (Se.7044. Buli.e ed Pof6io.s Cod.] TtE Conl6c16f3 t,iclG liw doc nor sPpl,lo mow!€t ol <br />nr. polHy \fio hdil&or inlpror'Blhq6n. dd wbo do6uctso.L hiosclloi hd*lfor mush his ot hd own .dPloy6, <br />Drovidcd rhal such ioFoisds mnoi hrad.d or ofidur for sk.Ii hoqBq,llE buildins.r nnpoldMr is $ld vhhio o.. )ar <br />ofconpldion, lhe O*rq Auil,l6 vill hlvc lbt budn oaFoviig lha h. or sh. did M hlild or inprcv. lh. FlrEry to. lh. purpoF of <br />l. s owrer ofrte prop.ny, d€xcluriv.lyconracring *irh li.cB.d corlEdoElo comlrud th€ rroj{l (sd 7044. B6ins <br />dd PmaBirn cod. Th. Conlr&lor's LiccDsc l-atr do6 rcl apply Io & ownd olprcpdy trho builds or imptovd rhdon. <br />and *ho conlEds lor such Fojc.ts$ith a Conhdo(s) lic6.d pu6uMl lo thc Conh.rois Lictu. tiq) <br />la c\.n'Dr undd S(hon .8 & P(' l,r,h's,.8'{r <br />D.le: O*nei: <br />uoBtrt;luau8;Nsa.MN![c!aaar!a! <br />I hs.by arlrm und6 pgrahy ol pdjury onc ollh. follo\ ins ddldariod: <br />-l <br />hav€ ud vill <br />'Minrai! <br />, Cdilicare of coNd ro s.lalNur. ror rvorksr con,pcn3trion, 6 providcd aor by Sclion :l?00 o r lhe <br />Lab.r Codc. for lfie ,sfomdc. olthc wo.k foi sdi.h th. ,@ir ir irsu.J. <br />-l <br />ha!. dd wiu mai.rain work.rs .omp.Nsliod iBurec., s r.qutcd by Sdl io. 1700 ofrh. tjbor Codc for lhc pdfor@c. oa <br />th. Mrl lor whicb $ir pdnn is isu.d. My work6! compcnetior insumcc cdnd a8l policy nunb< a.: <br />5\"^.,k .("J <br />'1,/t ttlct'/7 <br />l1 <br />I cenilrthar i! rtc p€.loroamc oflhc wort lor *hichlhis pdnrn is isued. lsnallnot flployanyF$. i6eymmnd <br />$ s to h.cod. subjdr 16 th. wo!k6' comp.nalion lavs ofcolifomiq od ase rhat il I should b<om. subj6l ro thc <br />woikcc.onpcBarionlrovilioNofScdionlT00oflh.tibor(tdc.lshall.hnhwithcomplywirhlhosprcvistud <br />WARNINC: I,ailurc lo wurc wort6 conDasalion .or6sc i. lnla{lul, ud shall subj*l tr mplotq lo dininal FEhi6 and <br />cilil lind lP io oo. hundrcd thoMd doUd (5100.000). i. addnion ro lh. cosl ol€omFtualiotr. <!an ees a provid€d lor lh. <br />serio. 1076 of(he Lator Code inrd6:l sd.tonry'! 16 z4 <br />l,rcr.Nsl{) (oN I tl,\( l()ll <br />DICLIts|fla! <br />I hs€by amm u.dE F@lry 6l p6ju.y lhd I m lic6$d und6 Fovision otchaplg I (.omedcing {nh Selion ?000) of Dirilio. l <br />ol th. Busins md PmfsioG Cod.. and my lic@ i! in aull forcc ad .Iral <br />?7Sbos <br />I <br />COISIAUCUONIENDIIGICIICI <br />I hd.by ,mrm ondd p.nahy of p.rjury lhal lhqc is a on$ruclion lddins asocy aor tnc psfomaflcc oflhc work fot which this p<mil G <br />issucd (sd.1097. civ. c.). <br />AfII,ICANLDEq.AAAIION <br />I hsd'yafmundn pdahy olpcjuiy on of th. fouowiq ddlualions: <br />I)emlirion P6mits-Asb6ros Noritc{iod F.d6.l R.SuldioN (Tirl. 40. P616) <br />-R.quircd <br />L.tr6 or Noti6caion <br />I .dl iay rhd lhc acdo nl r.!ul.lio6 lesudins db€slos rsnolal re nol applirable ro this prored <br />I cdlilyrhd Ih,!emd lhisapplicslion d slat€ rhat lhc abo!€ infodar i.n G coud. I ssrE to conDly { ith ,ll Cny ed Counly <br />hss r cl,tins ro hlildios coNtruclioo. and hr.by aurhoinc <br />p.ny for imlarion purpos6. <br />'22;4 <br />D/-/r.16 la, 1.,. r <br />eF6@r iv6 ofrhi! Cny rnd Co6ly lo olB <br />'por <br />dE <br />//t t/t4// tr/'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 />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilinqs (T-Bar Rouqh) <br />Nileter Release <br />Rouqh <br />Service Meter <br />FINAL tL'tl-/fi ?czl <br />Notes, Remarks, Etc. <br />APPROVALS <br />I Y <br />I rlde' \ Addr6s: _ <br />t--