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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE tD/srG.COMMENTS Owna"auil.Lr Ddlelin
<br />I h.Eby lmm und.r pcrdty ofpdjury th{ I m.xcmpt fm th. ConlEclm Lic.,$ Llw aor lhc aollowio8 Eaon G6.703L5 Bci.Br
<br />Md Proi.riion Codr): Any City or County vhich EquiB s r.mn lo cdstruci 6118, inprcv., ddolish or r.!.i, -y sructe. p.ior !o it!
<br />issuuc., also r.qut6 rhc appli@r td su.h pmil ro fiI. . signcd st t n. d.l h. n rn. ir licoscd puBumt to 0r. prceiriod oldE
<br />ConLrlor's Liccisd L.w (C1laprr 9, Cam.ncinB with S.dion 7000 of Division 3 oa thc Busirss ud Profgsios Cod.) or 0!rt hc 6
<br />sh. n cxcmpr thcrcfrcm od lnc bci, fd rl'r .llc8cd cxmprioi Any violaiio. of S..tion 7031 .5 by dy +di6t for . p.mit tubjccrs thr
<br />applicant to a civil pcn.ltyolnot horc th& fivcliundr.ddollds(J50o)
<br />_1, G oMd of fi. propaty, or my mployG ei6 *ag6 6 th.t !ol! cohp..s.tion, will .lo lh. work ed thc clrucr@ ir nor irr6d.d
<br />or offdcd fd ial. ( S.c 70a4, BEinq od Prof6ii6r Codc Thc Contlaclol! Licas. I-3w do6 no( apply lo& ownr oa $c pror.ny
<br />who builds or imp!.v* $.r?on, d who doq ruch worl hircelf or hc.lforthrcu8h ht o, hcr own hploy*!, providcd $.t tuch
<br />improvmcnt! dc nor int nd.d or olf4.d for s.lc It howcv.r, $c b ldin8 tr improv@.ni ir sold wilhir onc y.u ol co6pl ctr on, lhc
<br />Owns-Buildq will h!t. rhc bordo oi proviig $al hc o. rhc nor build d impov. fo dE purp6. oi s.l.)
<br />_r, 6 ow.d oa rh. pop.lry, m dclusivcly corlrelinS witn lic.ns.d conlractors lo costruct th. prcj.cl ( S.c.7044, Buin6 Md
<br />Pbfsim Codr: Thc Conlricrd! Liccns. L.* dM not apply [o d o*nd oi prop6ty who buil& s i6prov6 rh@on , od eho
<br />conr@rs ror such prcjec ei$ a conuelo(, liqscd puBuei ro thc clnr.acror's Lims. I-3v )
<br />_l d cx6F undd Scdion _,B & P.C lor lhis r.aor
<br />EAAKEII-CO!{TENIAIION.DECIAI4IIIIN
<br />I h.r.by amm undd pnally of p.'lury on. ollhc lollowi,g .lc.ladioN:
<br />_lh3v.udyillmai rh!C.rtifiet ofconsdttoS.l nsur. for wo!k6' @mP.nslrion, a prorid.d for by S.ci.n 3700 of $.
<br />L.bo Cod., for rh. pcrfo,i@cc ol$. woft ftr which lhc Fmn ii i$ucd
<br />_l h.v. ed will m.inbin work6 mpcntalioo iButue, B rcquiEd by Sation l?00 oath. llbor Cod., fq th. palmucc of th.
<br />wolk fm which rhis pmil ir issu.d. My wort6' @op.nratioo insur.n* caEicr dd policy numb.r aq
<br />llhE 5r!6rn..d nor b. compl.'.d rf,h. pm 6(mon(hJnd,cddol16 ill
<br />/"^rr,n^.,n, *r*-*or rh. wo* r( \h,ch rhi pmn n is'u.d. t
<br />hacu. subjcc' ro rh. wdk.E ' cmp.nauo l.{s otCal'ami\ Md ags rhn
<br />Qo
<br />ofrhc Labor Codc, I ihall,
<br />.-o
<br />WARNING Faihrcto s@uE wdk6' omFnstion
<br />finB up lo m. hundrcd lhoced doll4 {l100,000),in lddi
<br />rhc L.br cod., inrcGt dd arromcyt f.6.
<br />rh. @ ol.omp..*tion, &mag6 6 povid.d for $c Sction 10?6 ol
<br />I h.rcby allm oda p.n.lry ofpcjury $ l e liccnscd uidaprovtion ofCh.fld 9
<br />llc Busiisi dd Prof6ri@s Cod., Md my li..nic ir in full fore ud cfLca
<br />I h.rcby amm und.r p.n.lty ofporlry $n thcc is a rh. p.rfmdc. oalh. w6k for
<br />I issucd (s( lo97.civ c.)I r -.r-t N.-.
<br />APPLICANT'S DECLARATION
<br />D.boliriM P.mits-Aib6r6 Noiificalon F.dcrrl Rc8ll.rios O c a0. P.n 6)
<br />_ R.qlied L.nd of Norificrioi
<br />-Ao^*tc fcdnal rcsul.tioro
<br />'c8&diis
<br />6b6ts
<br />I hav. r:d $t lpplicdion ed !Et.y witfi lll City Md Counry
<br />oldineco md Sht. L.ws r.lains to blilding City dd Counry ro .nrq upo. $c
<br />lbovc h.ntion.d prcp.ny for inlF.tion purp@6
<br />-o
<br />s-6L
<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 />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 />Er\a 'I T\E.IJ
<br />Rough I iia^
<br />Service Meter
<br />sAN.4C 8-41 , 290, 556, (67
<br />Notes, Remarks, Etc.
<br />Transformers
<br />FINAL Lddd s Addd
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