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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS <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 <br />Rough <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc. <br />Om-Buildq Delrntion <br />I hrcby affrm unda pcElty of pdjury thtt I u qcmpt fom thc Conln(,on' Li@uc kw for thc bllowiag tleu (re.703 I .'i Duriacrr <br />ud Profosion Codc): Any City or Couty which roquiro a pmit to @EEuca, dts, improvg dmlirh or rcprir rny nructrg pdor totrr <br />irrucc, rlrc rcquiro tbc rpplimt for sch ptrnit to 6lc r ligncd artcat that hc or rhc ir liccud prput to tbc poiliou of tbc <br />ContEcror'! Liccucd Lrw (Chrpt6 9, Co@ocing with Sction 7000 of Divisioa 3 of thc Buinac ud ProfElrioro Codc) or thrt ho u <br />rhc ir acmpt thadrom ud th! buit for tbc dlcgcd coptim .Ary violrtior of Scaioa 7031.5 by ey rpptiqr for r pmil sbjcd! rhc <br />appliut o r civil pcndty of Dot morc tte five hudrod dollu (1500). <br />-I, <br />u omq of thc prcpqty, or Ey .mploya with wrga u thcir rclc ompcoltioq will do tho wort md thc nrudre ir rct id@dcd <br />or ofcrcd for rdc ( Se.70,14, Buciur !trd Profccriolr Codq Tha Cont&lq'r Licre hw dG oot rpply to u ow of thc prcFty <br />*ho buildr or improvo tieoo, rod who dcr mh wort himrclf or h@lf or through hir or ha m cmploycq puidod tlrt acl <br />improvcmcrlr re not intqodcd or offcrcd for dc. I{ hom, thc building or improvmot i! rld withh oe yd of omplaioq thc <br />Oma-Buildd will hrvc tho bwdcn of prcving thd hc or lhc rct build or improw for thc Frporc of dc). <br />-I, <br />r omq of thc propqty, m qclu3ivcly ootrraiag with lic.rued @rEdoE to @Etrud tha prcjet ( S*. ?ot4, Burioqr ud <br />Prcfcsion Codc: Thc CootrrctoCt Lieoe hw dm aot rpply to u ow of prcp<ty wbo build! q inprou tlsor , rod who <br />contncts for sch prcj@t! with r Contnctor(t) liccred p|mmt to thc Coarartor'r Liere hw.). <br />_I m cxcmpt urdr Scrion <br />-B. <br />& P.C. for thit mD <br />Drtc: <br />WORI(ERII COMPENSATION DECI,ARATION <br />I hacby r6m urda pcmlty of pcjury oDG of tbc follwing d*luatiou: <br />I havo ud will uintain r Cqtifiqtc of Corent to Sdf-Iruc for rcrt@' ompcnsstioo, u prcvidcd fu by Scdioo 37OO of thc <br />Labor Codc, for thc pcrfomanm oftlc rcrt for wiich rhc pmit is ilscd. <br />I hrvc ud will rointrin wortm' ompcutiotr iMc., u rcquircd by Sction 3700 of thc bbor Codg for thc pqfome of tbc <br />work for which thir pmit ir irrucd. My mrkm' compeotuion inrwe uir urd policy mbc rc: <br />I Poliry Numba Eniu: <br />|cntitrotion* oil*l- <br />for which is iud I rhdl ncr ogloy iamyrmarcuo <br />thc wuto'md thd ifl thould <br />ompcnstion ofScction 3700 ofthc <br />WARNING: Fdluc to rrucwsk6' <br />fin6 up to onc hudrcd thoumd dollu <br />ltd rhrlt sbjEt u cmployq ro qimbd pcsdtis rnd civil <br />addition cost drmgu s prwidcd for thc S6tiotr 3076 of <br />thc L8bor Codg irtqqt Dd domcy't f6. <br />LICENSI D CONTN CTORS Df,CIIRATION <br />I hacby r6m unda pcnrlty of pajury thrt I m li@lcd utrd6 prcvirion of Chtpta 9 (ommciag <br />rhc Buircs ud Prcfssiou Codq rnd my licru ir in 6rll fore rnd cfca. <br />with Sction 7000) ofDivirion 3 of <br />Liw <br />Drc: <br />b <br />r /t <br />I hccby affm uoda fEnrtty ofpsjuy rhrr <br />ir0cd (56. 3097, CiY. C.). <br />Lcrd6'r Nuc: <br />rgcscy wuk for wbich thir pmit is <br />Lcndcr'c Addrcss: <br />APPLICAN?S DECIIRATION <br />Dcmolitiotr Pmit&Albcnor Notifcation Fcdcnl Rcgulrtionr (Iitlc 40, prrt 6) <br />_ Rcquircd kaa of Notificdioo <br />-I <br />thc fcdanl rcgulation! rcgrrding ubcrtor movd e not qDliqblc to thir prcjEt. <br />I r€d thi! rpplicltion ud stdc thlt th! rbow iofomation with dl City nd Comy <br />ud Coutrty to @td upon thcrclsting to building orstIuclios, <br />rbovc pupos. <br />Appliont <br />I <br />for <br />ILLrA/\^. €-R xttt-,7? <br />t/