|
ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Oqd-suilds D.cl&'tid
<br />I lucby aIfim und.r Fo.lty ofpdjury rh.r I d cxcmpl fom lnc Co.nrcroE' Li*dc Law lor rhc tollovins a6oo G.c 703 Ls Bqi.ss
<br />and Prcf.$im Cod.): Any Cil, or County which Eq!t6 . !.mi! to co.rlDcr, al(4, improv., doolish or r.!.n dy nructw, Fior b iu
<br />issu c., aho Equts rh. applicul for slch pcmil ro fiI. . si8n.d natn.nl thst h. q sh. is lic.ns.d puuudt to 0r. povisioni oi $.
<br />Co.l.mlofs Licc.*d Lav (Cl'afl.r9, Con6ocins wnh S6rion 7000 oaDivtior S ollhc Busin6s d Prcfgsios Cod.) or lhal hc s
<br />shc h cx.mpl lhcr.fron ed thc bdis fd lhc allcs.! .xmption .Any violalion of Sation ?0r1.5 by uy applicut for. p.mit subj.cts th.
<br />appli@t to 3 civil pdllty ol nor hoE tl& fivc hundrcd dolld (tJ00)
<br />_I. B omd of dr. Fopqty, d my @ployd *id *!96 a thrt solc @mp.nwion, will do $c wort &d th. sFu.r@ ir rot irr6d.d
<br />o. oficrcd fa d. ( S.c 70a4, Buin6r ud Prcfgrioni Cod. Th. C..E&!ort Licdr. La* dG.or rpply ro in osq oa th. pro!.n,
<br />who buildi or imFov6 6cen, ed ,ho da iuch wdk hirolf or h6.lf or thrcu8h hi! @ h.r own @ploy6, prolid.d ln{ !o.h
<br />improv.mats ec not inrdd.d d off.r..l lq s.1.. Il how.v.r, lh. buildinS or imprd@6! t sold wifiin on! yc, of compldo, fic
<br />Ornd-Builds will hN. tn. burdo of ptving du! h. d rh. not blild d imp.o,i for fi. pu?sc of salc)
<br />_1. a ownr of rh. prDFriy, m dclsiv.ly ontutina eilh licc6.d con&roE lo @slrucl th. prcj.ct ( Se. 7044, Buine ed
<br />Pofsion tuG: Tn. Cmfiaort Li@nE L.w do6 nor.pplr ro s ou6 of propdty who build! or inprov* lllc@n . ud who
<br />contrac6 ror ruch Drcj@B with . Cmb&!o(, libscd puBuet ro thc conk rtr r Lic6r. L:v )
<br />_l u d.mpt undn S.di6
<br />-B.
<br />& P.C. fd rhis lt&n.
<br />Ddq o*n6
<br />Policy Numb.r: : ExpiB
<br />|Jnisytnrc.n
<br />r*-.*i.,.
<br />nor bc @opld.d if U. pann ir for on. hui&cd doll6 {llo0l o' Iqd
<br />rh. p.rroMcc of lhc woL fo which $t pcfrir i
<br />lh. wtrtcrs comptnsation las ofcaliamii\ dd
<br />d ofScdion l'700 ofrhc L$or Cod., I shrll
<br />WABNING failur. ro reurc work6' @p.nra,rion covd!8.4t M.mploy.r to oioiml paaltio ed cilil
<br />fins up ro oi. huhdEd lhoBeddoll6 (lloo,ooo),ir addirion
<br />thc Labor Cod., inlBt ddt m.yt f.4.
<br />on, de.A6 6 p.o dcd lo! thc S.cd@ 1076 ol
<br />LICENSED CONTRACTO(S DECLAR{TIOI\
<br />I hacby alllm undd p.nalty ofpdjury lhlr I a li@.d undd provisi@ of Cn.F.r 9 (
<br />ll\c Bu$nBs ed Protdiotu C.dc, edny licosc is in full aorcc dd cffat.
<br />-o
<br />I hmby amm ud., p.nalry of ,6jury rhrl tnsr ii r @3rrucri6 lodiDl
<br />isu.d (Se. 1097, Ci!. C.).
<br />Frfm&c. of lh. wcl fd which thi! pmt i,
<br />APDLICA]IT'S DECLATTATION
<br />D.nolnid PmrE-,4..h.dcn Nodficltion F.deil Rcslldidr (Tid. aq Pul 6)
<br />_ R.quiEd Lcttcr of Notific.rio
<br />I c.nifv thar fic t daal r.rulaLioB r.rrdint-Ko,n^, n*. *.
<br />^t, *r,-;" -;to c6ply wid lllCity dd Counry
<br />ordineca ed Srarc L3ws r.ktiDS ro blil oi this City dd CouiIy 1o cnt.r upoi $c
<br />BSov. E.nrioncd prcFrty fd insFtiotr
<br />I
<br />-o
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough EXPIRI iD
<br />Service Meter
<br />FINAL rE,E U I 'ltlg
<br />Notes, Remarks, Etc.
<br />WORKERS COMP'NSATTON DECLARATION
<br />I h.Eby rftim uids padty ot Frju., on! of ihc followif,8 d4lolio$:
<br />_l lBv. sd will mai.hi. i C4tjli.5. of Co.$it ro S.lflsurc for port6' @6porai6, s pmvid.d aor by Sedd 3700 of $.
<br />Llbor Cod., for $c Frfol]rDG of rh. wo* lor whi.h th. pcmil ii is$.d.
<br />_l h.vc ed willmiiir.ii *6k6 @mpmatid iNu6c., { EquiEd by S@tion l?00 of th. L5bor Codc. for $c p.dm&@ ol Ocwo for which dris pdnn k i.rucd. My wmr.R' .@p@.do i6umc. 6i4 &d policy rumb6 &c:
<br />L.r.ls ! Add@
|