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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Ownd-Buildd D@lmtim <br />I hftby aflim und.r pcdhy ofp€iuy that I m cxmpt aoft th. Cont&rou' Lie.s Law lor $. lollowin8 Bor Gd.7o3 t 5 BBir6 <br />dd Prcfaim Cod.): Any City d County which EquiG r Fmit ro consrud. allo. improv., ddolish d rcpair uy slrncru... rior lo irs <br />i$uecc, abo r.quir6 rhc appli@r for such Fmit ro fi|. a si8n.d st tdat th{ h. d rn. ii licoi.! pBudt 10 th€ Forisim of rhc <br />Conlreltr's Licas.d Law (Cn.Fd 9, Commocing *id' Scaion 7000 ofDivision 3 oftt. BBind d Profdions Codc) or tn.r hc o <br />sh. is .x.mF (nq.fton Md dc bais fd 6c allcs.d .xmflion Any violarid of Sadon 703 I 5 by , applicdl for a ps,nn tubjcB lhc <br />,ppli@r ro t civil pnalty ol nol nN lhe fiv. hnndrcd doll6 (1500) <br />I, s ow.cr of thc prcp.ny, or my mployG wnh yas6 s $cir sl. cohF.sion, will .b tn. *ork dd U. sfucn . is nol inrdd.d <br />or offd.d ls salc ( Scc 70.aa, Auin.s ed Pml6ri@ Cod.: Th. CoEerork Li.as. La* dE nd .p!1, !o e oM( of rt. prcpcny <br />wno build! oi improvB th6con. &d vho do6 such wor* hiBclf d h6.lf or drcush ht o. hq wr mploys. provid.d lhd such <br />improvmcnl5 e nor intcnd.d or oftcrc.l lor salc. If, nowlvd, rh. bdlding o ioprovmdt is sold within onc y.s of comptctid, th. <br />Ownd-Build.r will h.t. lh. burda of proviig in l hc or sh. nol build or inprcvc for lh. purp@ of ial.) <br />I.ao*ndofth.prcp.rty,o.xcl6iv.lymntr&tingsithlicdscd@nFdctoEroc6{rudthcFojer(sc.7044.Buin6dd <br />Profgsion Cod.: Th. CooE&lor! Liccnsc Inw do6 nor alply lo e (Md ol propqty who builds s improvG ln@. , ed who <br />cona&ts for suh prcjea qnh . Conb&to(, liersd pu6@! b fi. Conu.crGt Li..tu. Lav ) <br />_l 6 .xmfl u& Serio. _,8 & P.C. fa $t ,!en <br />Dlrl Oma <br />WOiKERS COMPENSATION DECLr'{RATION <br />I h.tcby allim undr p.nslty of p.rjury m. of lh. followin! d.cleti@ <br />_l h.v. ud will m.intain a Clni,icalc of Cdmt b SclHmur. fc wor*6 @mt .sdio.. s prcvidcd aor by S6tio 3700 oa thc <br />L.bor Codc. lor tlc pBfmdcc of th. wd* aor {nich tn. pmir is is!.d <br />_l havc ad will mrinLin wtrkc comF8.rio ins!dc., a rcqli&d by S.ctio 3700 of tn. llbor Cod., for 0tc p.rfdmee of Uc <br />work ftr which $is pmn it isu.n My won 6' cohpdsado iruutr@ csid ud policy numha m: <br />Policy Numb.r ExpiG <br />(Tlis sfttioo n..d no1 b. trddcd if $c pdnn i. tor Onc hundrcd doll6 {l 100} o, 16, <br />_l cdify tnar io lhc paforl@e of $c *ort fs which rhis pdmn is iso.d,I.hall nor dploy dy D.r3on in &y mMnq so 6 bb.@. subjd ro drc uorlcr ' cdpas.tion la*s of Czlifooi4 &d asr.c $!l if t should bc@m. subjer !o rh. *otc6' <br />comp..slrio. p.oftions of serion 1700 oltnc La6or cod., I shall, lonfiwirh omply wirh rh6. provisions <br />WARNINC Failur. lo seur. wdk6' dmp.nerion covdaSc is unlawful, &d shall subj.cl m cmployf ro qimioal pcnaldcs dd civil <br />fina up ro onc hun<!..d thosed dollm (t loo,om),in addition to th. c6t of @mpcDs.tion, d,mg6 s prcvid.d for lh. S€tion 10?6 of <br />th. Labor Cod.. intcrBt dd artoh.yt f6 <br />LICENSED CONTRACTORS DECLARATION <br />I h@by zffm und.r p..alry .f plr!ry $.t I m licc.scd undd PIovisio of Chspld 9 Gmmmcirg wio Scdi@ ?000) of Division I of <br />lh. Buhs Md Prof.$ions Codc, dd ry liccns€ is in full i@. dd .f.cr <br />CONSTRUCBON T,ENDING AGENCY <br />I h@by aifim u.ld ,..6lry of F.jury $Ir 0r@ h a @islruclion lddins .gdcy fm ih. !.rf@ec ol rllc *dt fd which thh Ffrn ig <br />isu.d (S.c 3097, Civ. C.) <br />APPUCANA'S DECLARATION <br />Dmdfuon Pmih-Asbcnd No{i6cari@ F.d.El R.e!l.rid3 (Titlc 40, Pan 6) <br />_ R.qut.d L.n6 ofNoific{io <br />_l ccnify lhsl th. f.dcral E8!lati@ Egdding ab6rc Emovd a. ror appliebl. b rhis proJet <br />I co dfy lh.l I havc rcad 0 s .pplic.dm &d $.rc di.r Oc obov. infmalis k @ror I la.6 to @ply wirh sll Ciry Md Co@ry <br />ordinec6 dd SLtc La* rclating to buildinS @srru.!i6, &d htrcby .urhdia rcfl66ladv€s of rhis Ciry ed Cout, to 016 upoi $. <br />a!or. mntiocd proFny f6 inspedq purpce <br />.-C--22 ,/a s' <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 & Soflit Rough <br />Ceilings (T-Bar Rough)EYrlIE'EN <br />Meter Release <br />;FB n I 201 <br />Rough <br />Service Meter SAN[(i 6-+J, ZVU, CC <br />FINAL <br />Notes, Remarks, Etc. <br />I <br />I