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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Ovnd-Buitda DcclEdion
<br />I hd.by amm und6 p.nalty of pqjury |hd I m cx.n$ lm lhc ContBcto6 Lta$ La* for (h. followinS l*on G.c 7031 5 B6in*
<br />ed Profesioi cod.) Ary Cir, * C6Wly shich r.qliB a pcmi( !o @nnnc(.1b, ifrprovc ddolish o, Epst ey i@de, !60r ro irs
<br />isudc., also r.quiB $. .!pli6t for sucn Fmn lo fil. . si8n.d Elalml $!r h. or shc t liccnscd pdudt to th. prcvisions of lhc
<br />ConEEcror's Limscd Law (Ch,prd 9, Cmncocing wi$ Scdiq 7000 of Division 3 of $. 6Nins dd Prcfsios Codc) or tMl hc g
<br />snc is dmp fia.Em sd tn€ bsis ld thc 3ll.s€d cxdprion Any violarion of Scctio 701 I 5 b, ey appli@r ad a pcmn subjars th.
<br />agpli@t to . civil p.n,lty of Dol hoE fiai fiv. hunrtd don6 (t500).
<br />_I. a op.d of th. prcFn , or my mployr6 wirh waa6 a $.t sl. 6mp.nsdion, will do thc wor* ed lhc slructR is nd inrddcd
<br />or olid.d fr salc ( S.c.7o44, BEin6c od Pmfsio3 Co&: Th. Cmt@tors Licasc L.w {tc nd aprly to d wn . of th. Fopcny
<br />*ho hui,d! 6r imprcvB thcltfr, ed who dc auci wsk hiru.lf d h6clf or thrcqh his o. h6 Nn cmployG, provid.d fi{ sucn
<br />improvco.nr5 e nor int.nd.d or ofdd fm sd. li hw.vd, tn. buildin8 or imprDvhdt is sold wilhin ooc y.s of compl.nd, th.
<br />ownd-Buildd *ill h.v. th. blrdcn oa !rcving thal hc or rhc nor boild o imp.ov. for th. purpc. of salc).
<br />_t, a omd of ih. proFiy, m d.lBiv.ly conhcling with licas.d.dttrG to dr|uct th. Fojd ( S.c 7044, Bsin6 ed
<br />Prcaesio. Co<tq ThG Conn_&!oa5 Lic6s. tls &d ,or .pply ro d oud of propary who h{ilds d improvc thald , md wto
<br />@nrors fG sucn prcj.cls wilh a cofr.tq(, lic4cd puEusr ro lh€ cont*tols Lictuc L.w )
<br />_l m.xmpr ddtr S*tid _,8 & P.C. fd this r€6on
<br />WORI(ERS COMPENSATION DECLATATION
<br />I h.rcby a,nm undr Fnalty of pcdury ur of drc followins dcclaErio.s:
<br />I h.v. dd will m.if,uin . Cdificar. of Colei ro S.laluu!. aor work E @mFnssrion, a povi&d lo by Srctio 3700 ol th.
<br />Labor Codc, lor tlE pc.fmdcc of $. eorr fo, which th. pmn is isEd
<br />_I hav. Md will mainEin wdt€R! cmFnstion insurocc, s r.quircd by S*tion 3700 ol lhc Labor Codc, for lhc p.rf(mM.. of ihc
<br />wdt fo. which this pmit i5 is!.d My wort.E cmp.f,stio insurM@ @id ed policy numb.r uc:
<br />Policy Nrmb.r : ExpiEl
<br />(Tlis setion nccd oot b. ffidd.d if th. pmir i. lo, Onc hon&cd dollG {S l00l or 16,
<br />_l cdiry tnd i. fi. Ffolruc. of thc wdk fs which rht pmn is isu.d, I shall rot dploy ey !.Ron ir any lm,o so 6 lo
<br />b.cd. subj.cr to fi. vod(6 ' cmF.saio las of C.lilomi4 &d asc $.t if I should bc@oc subjet to lnc *ots'
<br />conF ario. Forisi6 of SdiM 3?0o oa thc L.bor Cod., I sh.ll, fonhwilh €mply wnn tnM prcvisions.
<br />WARNINC Failurc lo seur. vorlcR' cmpcnsation cov66s. is unlawful, dd shall rubjct d dployd to oininal Fn6tli6 dd civil
<br />fin6 up ro d. hufldrcd thoEud dolld ($, OO,ooO),ir addirion ro rhc c6t ol cmpdsation, d.m6g6 6 providcd for lh. Sdion 1076 of
<br />1he Labor Cod., iht.r6r ed aron.r'r f.6
<br />IICITSELCON.IBACIOBiDICIAIA[ION
<br />I hBcby amm undq rcnalry ofpdjury lliar I M lic..scd udrprovisid of Ch.p{d 9(commocing wilh S.crion 7000) oiDivisioh I oa
<br />$c Businds ad Prof6sios Codc, ud hy licds. is in full lorcc d cif.cl
<br />.l- .a ,ao /
<br />coNgrBuflla!-LrdDllct9rNcv
<br />I hftby afllm uidi po'.lty of F ilry $n th6c ii a @nsEuctid lddins as6.y fd rh. p.dm.@ of 6c *d* fc whi.h thb Fmir i3
<br />is€d (S.c. 3097, Civ. C )
<br />AIEIICANI]IDECIANAIIAN
<br />Dc@liim Pmi!$Asb6l6 Notilicado Fcdaal Rcguldjo.s (Tidc ,'0. Pan 6)
<br />_ R.quircd L.n6 of Notifiqdq
<br />I ccniay lhd 6. fcdnal rceulali@5 r.g&dirg abd6 rmovdl &c iot applicau. to fiis prcj.cr
<br />_ I .airy rhat I havc r.ad this applicdion ed srzt lhd th. abov. infomdion is coroL I aa@ lo cmply wilh .ll City &d C@nty
<br />ordindc6 dd Stltc kws rclari.8 to buildin8 cdsrruction, &d hcr.b, .udori& rcpMtativ6 of this city dd courty ro aG. up6n thc
<br />abov. mc.rion.d prop.d, lor iNperion purp6B
<br />-{-zz;./- a
<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 />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 EXPIxl =L'
<br />Rough rF.-\
<br />Service Meter s \MC 6-43. &0 566.,i6i
<br />Notes, Remarks, Etc
<br />Air Conditioners
<br />FINAL
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