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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE IO/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 />[Ieter Release Fxp lptrrr
<br />Rough FF'R II i
<br />Service Meter
<br />Notes, Remarks, Etc.
<br />Owor'Builda D.clda or
<br />I h.rcby.tfim und.. Fnalty ofpdjury filI nlxdpt fom $c Contracloa Lic.nsc!.w lor th. tollowins rcsonGe.7031.5 BBi.6s
<br />dd Profesion Codc) Any City or County which Equirq a p.mn to @nsirlcl. rlr.., improvc, d.nolilh o. rcprir &y srnct@, D.ior !o il3
<br />iislecc, olio !.q!tB lhc .ppliem for iuch p.mn io fi lc a sisrcd ah..r th.t h. or Eh. t licdi.d puEudr ro rhc FovilioN of ltc
<br />Contrador's Licas.d L.w (Chapr.r 9, Commdcing wnh S..iion 7000 ofDivision I olrhc BusiiB dd Prof6sions Codd or $at hc d
<br />thc is cx.mpl thcEfrm d rh. bais ie rh. rll.g.d .r.(ption Any violarion oi Scction ?01 I 5 by &y applicdr for . p.mn $bj.cs rh.
<br />applicmr ro acililpcnalry of nor morc rhd fivc hlnd,cd dolle (1500).
<br />_I,6 owoo of $c prop.ny, or my cmploy.6 wnh wag6 s rh.ir solc compcnsarion, will do th. *ork od rhc rrra.lu is nor inladcd
<br />or off6.d for salc ( S* ?0a4, Bsin6 ud P!oa.$io.5 C.d. Th. Coiftclofi Li@nsc Law dG not apply to ar ovns of $c prop.ny
<br />*liobuirds6riFprcv6th@tr,.lwhodoasuchworkhirucllo,h6cllorthroushhisorh.rown.mploy.s,prolidcdlharsuch
<br />ihprovm.nb e nor int.ndcd or olIcEd for sal. Il ho*cvca lh. buildingor inprov.mc.i is sold wnhin on. yce of compl.non, rhc
<br />Own.LBuild.r willhav. rh. bordo ol provinS $ar h. o, sh. ror build or improv. fs rh. purpc. ofsal.)
<br />_1, a ownqolOc propcny, m dcluivcly conretingwnh liccns.d conreloB to coisltud lh€ projat ( Scc. ?0a4, B6,nB ed
<br />Prof6id Cod. Th. Co.ra.brt LiccBc Lav dc not apply to u owoa of propciy sho buil.ls or ihprovB rh6@n , ed who
<br />conrrca for such prcj.* wnh . Conr&ro(r lidcd pusu r ro rhc ConE.cror'! Lic.E. bw )
<br />_l m cxcnF undo Serion .B &PC fdlhis rcaon
<br />conp.nsatio. provisios of $c L.bor Codc,I shall, lonhwnh
<br />WARNING F.ilurc io laurc work!6' comp.n$tion cov.rag. is lo sininal p.nahics udcivil
<br />fi.cs up to on. hu.dr.d inoosaddollm (S100.000),i, addnior ro thc cost of damag6 d p,ovid.d for rh. S.clion 1076 of
<br />rhc Labor Codc, int.r6r ed ariomry t f.6.
<br />LIaENSEl) (t)^.,',r RA( t (X{5 pLCLARI I IO)r
<br />I hdcby rfijn undr pcoalry of pc.jury thrr I 6 licas.d und.r p,ovisioi of Chrrrq 9 (
<br />d. Busii6i ed Profsios cod., and ny lic sc is in luU fo!.c dd clfccr
<br />)
<br />I h.r.by .mft u.dcr pcnaliy ol pcdury lhat th6. is.dstrxcrion l-ding ag;ncy ftr rhc p.rfoman.c of rh. wort for which is p.mi! ii
<br />issu.d (S.c. 1097, Civ C.).
<br />APPLICANT'S DECtAR,4TION
<br />Dndition Pmils-Asb€bi Norilication fcdcBl R.gulalioni {Titlc 40, Pm 6)
<br />_ R.qlncd Lcti.r olNolill€tie
<br />t ...r,r,.6i ,t'. i.t..t .g,lauons ,csrd,hs
<br />I .l caify th l hsv. r.ad rhh repliuid dd IsSErocomply *i$ all Ciry Md Counry
<br />ordinMc6 ad Starc Lrw! r?l.ting ro buildin8 ofrhi! Ciry ed Counry to drd
<br />abov. mcnrion.d prop.ny fd inspccrio.2
<br />FINAL
<br />WORI(XRS COMTENSATION DECLANATION
<br />I h.r.by .ffim unda p.mlry of Fjlry onc ofdc follo*ing d..lmrions:
<br />_l hav. 6d will E.inllir a C.nifiqat of Coiat to SclHtuur. for wd*a'cmp.Barie, $ povid.d for by Sarid 37oo ofrh.
<br />Lalor Codc, for 0E p.rfmdcc of rh. wd* fd *hich thc p.mit is i$u.d
<br />_l hav. dd will ruinliin *6lc8' ceF trim iEumcqs rcqlied by S.ction 1700 oflhc Labor Cod., aor fi. p!.fomec. ott.
<br />wtrt for whicn lhis tmil i! isru.d M, qortd' cmFnt.tio. iNUs* @icr ud policy nomb.r sc:
<br />Lftdd s Ad.Id
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