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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS Ow.d'Build.r D.clra oi <br />I n@by affim und.r F.rlty olpojury tn.t I @ cxnfl fm Oc Con!-ad6 Licos. L!* aor th. tollo*ing rc6oo {s*.7o31.5 BEios <br />ud P.olc$ion Codc): Any City or County which rcqutB a p.mil lo construcl, alt r. imprDvc, dmolish o. r.Prn uy 5tD.te. p.ior to itr <br />issudcc, aho cqunB dE arpli.&t ld luch pmn lo filc . siF.d sl!lm!.r rhat hc or sh. ii lic.ns.d puBudt !o 6. provisior ol dic <br />Contlcror'r Lic.Ds.d kw (Cn.ptq 9, Comh6dn8 witi Sedoh 7000 of Division 3 ol th. Buein6s dd ftofglioir CodO or lhlt h. 3 <br />shc is cx.mp rh.rcfom ed .h. bEii fc t. .ll.e.n qoptio .Any vio,atio. ol S*tion 701 L5 by dy appli@r for . Fmn slbj.cr rhc <br />oppliot to ! civil p.ialty of rot moE t\a fivc hundrcd dolla (J500) <br />_1, a omd of thc prDFny, m ny mploys wifi wsae E th?t iol. ompasstion, will do lh. work Md th. slrucrw i! not irt6&d <br />or o,I+d rd $1. { 5@.7044, Bciis &d Prcfei@ Co&, Tn. ConL!.lq'r Lic s. Lav do6 nd lpply bs ownq oa $. pror.rq <br />who blil(b or imFovB $a.on, ud who dG such wqt hiruclf or h6clf or otrcu8l his o, ha @n mployB, provi&d th.t rlch <br />irprovdciE e ioi iicnd.d or oftd.d fd $lc Il hd*cr, rh. buildins d imp,ovndr ii sold wi6in or. yta of @npl.lro, lhc <br />Ownq-Build.r yill havc lh. burdd of provinS thar h. m th. .ol build d ihprov. ftr ln. purpG. of 5al.) <br />_1, 6 owncr oflhc prcp.rtrt m crclaiv.ly @ntredns wnh licns.d coitr&toB lo cd{rucl th. proj.d ( S@. 7044, Buind ud <br />Prcrei@ Cod. Thc Cont .ctor'r Li@.sc Lrw do* nol arply 10 u ownn of propdty who builds .r improvB rh@oo , dd vho <br />@nrrers for such pojerr with a conE&!o(, lic.ns.d puBu4r (o rhc conreb' 5 us& Lz* ) <br />_l h .xmpl und6 S.clion <br />-B <br />& P C fd lhir r.aor. <br />WORKERS COMPENSATION DECLARATION <br />I h.r.by ainm und.r plndty of pcOury on. otlhc follwin8 d.cl&.tioN: <br />I h.v. ad will m.intain ! C.nifiolc ofCo.rot to Sclll$uE for *dL6' compas.tion, 6 providcd for by S.cd@ 1700 of$c <br />Labor Codq for th. Frf(mae of lhc wo* aq which lh. p.mit at i!tu.d. <br />_t hrlc dd will m6inlaii sol6' @pcnsation idutucc! a! rcqutcd by S@rion 1700 ol thc tibor Cod., for ln! pqfmu@ of fi. <br />work for which diis pmn ii i$ucd. My wdtd3. cmp.Nrlim i$ufue 6iq ud policy nuEb.r e: <br />Polig Numb.r: I Erpne <br />Z,*,n^-,n" <br />bc cmplctcd it $. pqmir n ror oic hyn&.d dolla 1l l0ol or l@) <br />pdfofidc. ol th. wort for *hich rhis pmn <br />work6 ' .mpdatioi l.s or caliromi\ ed <br />ofih. trbd Codc, I st.ll, fonhwitf3=-o <br />WARNING: FaihE to seurc work.B' conp.nsdion covcralc E <br />fin6 up lo onc hun.lrcd thoBdd dolld ($ I00,000),in ddnion to <br />hc Libor Codc, inr.r4t &d atlohcy! f.6. <br />6 provid.d for $. S.clio 3076 of <br />LICf, NSED CONTRA'TORS DECLAf,ATIO]{ <br />I h.r.by afio unda p.n.lry of pqlury tb.t I M lhm.d 6ds prcvilio. of Ch6p|6 9 ( <br />tn! B6in6s od PofBtiN Codc, ed my li@r. is in full fo@ ed cffet. <br />I h@by aflim ud6 p6.lry of ,qjury tn.r rhft is . .@Eucri@ lcnding .a.ncy f6 lhc Frfffiu@ of rhc vdt lq which lhil p.mii it <br />isllcd (S.c 3097, Civ. C.). <br />AIIIICAI]-iDECLASAIIQN <br />Dcmolition !cmnnA5b6t6 Notificatio. r.d.ElR.guladoN (Titlc40, Pan 6) <br />_ Rcqut d Lcrd ofNoifidtion <br />-Ko <br />th3t thc fcddrl Egulations ESading ab6(6 <br />tnat I h3vc r.!d lhis.pplidion d !lal.ply wnh lllCity Md Couniy <br />ordinoce dd Slarc Law ..latns lo buildins <br />abov. morion.d pro!.n, for insF.rion <br />* <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Bu ilding <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Cellings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough)EXP!F IED <br />Meter Release <br />Fh.U U I <br />Rough lAn c a-43 20 1.56A €n' <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc <br />Site-Work <br />Pole Bases <br />Sub-Panels <br />ffi <br />tltl <br />=