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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/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 />Torqueing <br />Sub-Panels VzP/z)/Zc2 D <br />Air Conditioners rT <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rouqh) <br />Meter Release <br />Rough t*t/z)R-c-2 4 <br />Service lvleter <br />FINAL /zo,/zD Acx 7 <br />Notes, Remarks, Etc <br />OWNgR BUILI'ER DET.CARATION <br />I he.try amfln undd F.alty ol psjury th0t I m er.mpl fron thc Contradon l-ic.@ kw aor fi. lollowin8 !@. (Sd.70l I 5 <br />ENins ald Prol6ion Codc): Any Clry or Cou.ry which r.qut6 . ps,nit ro odsldcl, ahq. improv. d.,nolish or rcpai ey <br />(dcrrc. prio! to its isumcq also Equt6 thc applicel ao. such pdnit rc nE a rig..d slddndl $ar l'. or sn. is lictr.d pllrsMl <br />ro rhc prolisioc oi$c Conta.loi s Liccnssl Lsw (Ch.pld 9, Commdcins vnh Sdio! TOOO oaDilirio.1 ofrhc B@i.6 ed <br />Proasions Cod.) or thli h. or sh. ie .r.ry,t thq.iiom ud lh. hasis for th. aU.s.d d@paon, Any violarion of Sdio. 701 L5 by ey <br />applicanr lor ap.mtsubjccrsthc appl'canrro acivilp.n.llyoano( mor.thm 6!. bun&.d dollds($500). <br />l. 6 omd of rhc prcp.n). o ny e'nploy6 {irh wa!6 a thct el. compcnsation, will d. th€ wotLnd thc slnd@ i5 tor <br />intqd.d or ofiqcd lbr sale (Sd 7044. Bsins dd PofsioB Cod.: 1 h. Cont!,clois Licsc t w do6 not apply lo e oso ol <br />th. p6pd, who toil& or i,nFo€ lhm.. ed who d(E such trllt hinscla or hGcllor llmllh his ot hd oM mploy6, <br />provid€d thar snch inptuvdaa ftnor ima dl orofid.d lorel€.ll how€vq, rlE hlildin8 or improv.mot is$ldvilhinonc )@ <br />ofcompbnrn. lhe O*nE Build6 s ill ha* fic hrd6 of prcving lhd h. or dE di.j ml hiB or in{,ow lh. popory to, lh. Erpoe ot <br />I, s owns of$. Frp6ry, m crclBivcly cof,rracrins with licc.s€d cotuadots to coGtiucr lhc Foj6l (Se. 704!, BBir6 <br />dd PBftsb. Coder Thc Co rociols Lic€nsc Law do6 not lpply ro 6 oMd ofprop.ny wno buil& or nnprovB tha6n, <br />and who co lids for su.h projdls wirh , conticto(s) [c.os.d puBu-rt lo th€ c.ntadoas Lic.& t!w) <br />_lm€xrmpt u.ds Scdbn .a &PC forlhisrason <br />Dr(.: O*ner: <br />rYa8xEslco!4ElNt4rq! <br />oE(taxalta! <br />I h.r.by oillrm und{ p.n.llyof pdjulyonc of lfi€ followin8 d6l drioB: <br />I hav. dd will @intain a C.dii.arc olcoMr to sclf-l6ur. aor wrk6s compqtsalion. d providdl aor by Setion l70o o athc <br />Lrbor Code, for fic pqfofln&ce oitn€ wo aor wtich lhc pgrnit is isu.d. <br />-.zifiNc and willhainlain *0r*6 .onri.tuarioo iBuran .. d rdtui.d by s.dion 1700 ofth. L.bo. c.dq for th. pilimdcc ol <br />lh. wo,t lo' uhrhrhcffin 6 su€d M\ *o,t6' cohmd,on Nuec rMi( edml,c\ oumbo m: <br />PaticyNnnbs@\pt.s:z/ts/za <br />,l cdifyrhar in rh. pdform... oflh. *ork ior wnich rhis FDir is issucd, I shall nol @ploy dy po$. io an, nmne. <br />so a ro h€.oDc subj.ct ro rh. vork6s, comlEsar ion laws ol Calirodi.. Md agrc thd il I rlbrld b€comc sbj(l to lhc <br />wor*6'conpssrionpovsio.rofS<tidnlT00oltn.rjborCode.Iskll.lonhwilhcomply*ilh$oepreli5ioa <br />W RNINO: Failur. ro src workc6' conp.Narion .ovd8c is unlawful. dd slBllsubj{l d @ployq to oininal poBhie dd <br />civil fines up lo one hu.dr.d rhousd dollN 1$100,000 <br />Ssrnrn 1076 ollhc Lr&tr cdde. inl.rd Md dbm.y s fd <br />to rhc co$ oacomp.Mrion. d@g6 a <br />,u", c Z,/.tQ ha1'-'t- <br />I n@by amm undo p6a1ty ol pojury I <br />DECIJTAIION <br />undd ForisionoiChaptq 9 (.o'rddcins wirh s&1io6 7000)ofDivisiod l <br />of lhe Buins &d P(n6ioB Code. ed my licN is in full force ad etlEi <br />/o3ag 7 <br />27/r/o o7-( <br />I hftby afilrn und.r Dqalty of pcriury lhal <br />isu.d (se. 1097. Civ. C.). <br />corelruclion lading as6ry for th. p6folrM.. of th€ wolk lor {hich this p6mit ie <br />AEIIICANLDPC].A8AIIAN <br />I @ afrm und6 pc.alty of p.rjury onc otlh€ followi.s d.cldaliosl <br />Denolilion Pdnits-Asb6tos Notificalio. Fcddll Rcsulaliors {Tnt 40. Pan6) <br />--Requtc{ <br />L-al6 oaNot6clon <br />I cdliiy $ar rlE tedsal rcBuldioB ns.dins 6b6tos reno\.jde not appl@bl. ro tht pmjel <br />L I cdify that I havc iad rhis .prlicarion @d slar. lhar th. abov. infomarion Ls cor.d. I arrE to comply * nh a[ Ciry &d Comy <br />ordin.ncs and Stalc liws rchi ins ki ildins codrdcriol dd hdcby authortc rcpr6mlalivE o hhis Cny ad Coul, kJ 6la upon rhc <br />abovc,nolioncd propcrly lirr <br />Rev.08-07-2015 <br />D,L.., 4,,{<-o