|
ELEGTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/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 />Meter Release
<br />EXFIRI IU
<br />Rough
<br />Service Meter rE[l u I
<br />FINAL MC 843, 290.556.667
<br />Notes, Remarks, Etc.
<br />OMd-Build.. Del@tid
<br />I h@by lmm undd p.oalry of Fjlry lnal I m .xmpt fom th. Conlracld' Li@s. Low fc thc foll@in8 160, (sc.70l I 5 B6i.6s
<br />od ftoidio Codc)r Any City d County which Equt6 . pcmir lo coslrud, altcr, i6provc, d€molish or rcpan &y sirucrw, prio, io iB
<br />iswc., also r.qun6 lhc appU@r for such pdtrit ro filc a dgn.d nalhil $a1 hc or sh. is licds.d pua@r lo rh. provisionr of ln.
<br />Coiba4d\ Licoicd tre (Charld q Cmma.iiB vi$ Serid 7000 of Dvision I of thc BNins od ProfBi@3 Co<L) or th.t hc q
<br />sh. is .x.npr thdclrom dd rhc b6is fo rhc allcBcd .xcnplioD Any violarion of Sccion 701 I 5 by &y applicdr fo a p.mn subj.ds dE
<br />.ppliml ro ! civil pcnalty oa not mm lhe fiv€ hun.!.d don@ (t500).
<br />_I, a own.r of in. Fopqty, d my mplorB witn *.96 6 dicir 3ol. .mF6.ti@, will do tnc *orl ed fic smcturc is nor imdd.d
<br />or ofi6d ls s.l. ( Scc ?044. BGin6 dd Prcfdios Cod.: Th. Cohctor's Li.ds. La* aes .d .pply to d oM.r or th. ptropdy
<br />vho huilds tr improvB thffi, ed who dG swh wo* hirucla d h6clf or thmd hir or hr own mploy6, pmvirt d that such
<br />improvfimc e hd in!!nd.d or offd.d ftr saic lf, howd.r. tn. buil<lrn8 o imprcv@ot ir sold widin on. yo of conplclron. thc
<br />oMd-Buildd *illtuv. $c burda ofprc rs rhd hc d ihc not build or inprovc for $c puoe oflalc)
<br />_1, a own6 of lh. proFriy, u cxcluiv.ly ontding witn liccns.d c6r.doE to co.ih.. th. p6j.cr ( S* 70.a, BEin* dd
<br />Prcrsie Cod. Th. ConFactors Licnsc Law do6 not apply ro owndof prcp.ny who build! n improes rh@n. dd who
<br />@nmcts for such prcjds with a Con!&lo(, li@scd puEle( ro rhc Contr&lor! Li.dsc tjw )
<br />_l m cxcmfl undd Sedon
<br />voaxDBico!4tEtsallox_DEclaBArloN
<br />I h6cby amm udd Fnalty of pqjury on. of $. following d€ldado.rl
<br />I ha{c ed y,ll tuint in a Ccnifrcar. of Cons.nr to S.lf-lnsuE for wotk6' mp.nssrion, 6 prcvid.d for by Sdion 1700 of lh.
<br />L5btr Codc, for tnc p€If(muE of th. wort fd wnich thc pcmil is isucd
<br />_l h!v. and wi,l m.inEin wtrt6' .omFnsatio i6ua.., B rcquir.d by S.ction 3700 of tnc tlbor Cod., for tlc p.rldTsa of $.
<br />work ftr *hich thir Fmii iE isu.d My wtrtd .mpasari@ ironmc. coi.r dd poli., numb.r e:
<br />Policy NuEb.r-Expic:
<br />(This $ctio n..d nol b. @mpl.r.d if ln. p.mn ir for On. hu.dr.d dolls It l0o I or 16)
<br />I cdif, thai in thc Ffmde of 1h.wo* r( which fiis tcmn is issuc4l shall nd.mployuy pcEon in dym ndsoalo
<br />bMc subj.d b lh€ worr.6 cmp.nsatio laws of Califmit, dd aer.? lhat iaI sholld be@. iubjEt ro th. w6r.6'
<br />cofrpcnldioo provision! of S.crion l70o of th. Labor Cod., I shall, fonhvilh comply wirh thc. prorisions..
<br />WARN ING Failurc ro sdur. work6' cmFns.rim @vca8. is onla*ful, ed sh,ll subj.d e @doy{ io dininal pdahid 6d civil
<br />fin6 uptodchu r.d lhoNud d!ll6 (l l0O,O00),in addition ro thc.Gl of omFnnrion. d,mag6 a provid.d f6 thc Selid 3076 ol
<br />$c Labo Codc, intcrd ud arlod.yt f6
<br />LICENSED CONTRACTORS DECI,,/IRATION
<br />I hdcby .flio uid( p.nrlr, of pojury thll I m limsld u.dd provisi@ of chrycr 9 (cdh6ci.s with s..Io" 7000) of Divhid 3 or
<br />thc Buin.$ dd Prcfeionr Codc, ed my licai. is in full f(ru dd rffcd
<br />4- za-lz /
<br />cox$aucuoltrE[prtctcErcv
<br />I hcFby .mm udd pddty of pojury lhlr do. is . @is1rlclio lddirg .g6cy fd th. Frfm.. of rh. *dl f6 qhich rhi5 pcoir i!
<br />isu.d (Se. 1097, Civ. C.)
<br />J:>Ja2./a/
<br />I
<br />APPLTCANT'S DECt,AR fION
<br />D.molilion P@ns-A!bd6 Norific io Fcdc6l RcBularions (Tidc 40, Pm 6)
<br />_ Rcquircd L.[d of Notifietio
<br />_l enify $ar 0'. f.dcral eeihidi Etediig abds mov.l e. Dor sppliclbl. to this prcj.cr
<br />_ I co'rify th51 I h.vr rcad d 5 .pplied6 ed sl.& l1).r rh. .bov. inlmaio is @@t I lgE to ced, wilh .ll Cit, sd Cdnry
<br />ordin c6 dd St.r. L:ws r.lating 10 buildjnS @iru.tid, &d h*by aurndia EF.slaiiv6 of thh Ciry 6d Coumy to drd upon rh.
<br />abov. m6ti@cd prorcny f6 itupdlion pu.pc
|