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ELECTRICALNNSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Ow"d-Buildd D.cluarion
<br />I hcrcby aflim undd p.nrlry oap.rjury thrt I m.r@pt fom th. Co[acloN Licdsc Lv lor thc tollowins @on G6 ,031.5 Bqin6
<br />ad Prof.$ad Cod.)r Ahy Cny s Cou.ty which EquiB a p.mit to consruci shd, improv., tlholth d rcpan dy strdctE, Fic ro ils
<br />issuMc., .lso !.quir6 th. .ppli@l ftr such pmil lo filc a sis!€d .lalmat $ar hc or lhc is licos.d pu6@t ro $c proyisioc of thc
<br />Conrrurols Liccns.d Llw (Cha$d 9, Cmcncin8 *irh S.crio. 7000 of Divilion 3 of t. Buinq! d Prcf.sims Codc) o tlat h. d
<br />sh. is .xdpr lh@frm &d th. bsis lr th. allcsld .xdption Any violriq oa S.cri@ 703 I 5 by dy rppli@t lor a Fmn slbj@ts rh.
<br />applidt lo a €ivil p€Mliy of not mrc tte fivc hur&cd .lollm (1500)
<br />_1, a oe.a ol $. Fop.try, d my cmployc wnh wag6 a ln.t sol. 6mp.nsalion, will do rt. wdl Md fi. shdu. is nor int6d.d
<br />or o,Id.d ftr sllc ( S.c 1x4, Bsin6 ud Prof6ions Cod. Th. Conr.dor's Li@ns. Law dG nor apply lo u own.r of fi. pror.dy
<br />who b l& or imrr.vd ihcMn, 8d *ho do6 swh wsk hilMlf or h6dl or lhrcu3t his or hd @. coploycB, providd thar slch
<br />inprovd.nri @ not intadcd o o6.rcd for !.1. Ia, how.vd. ihc building d imFovmml k sold pitfiin onc y6 of comlldi@. thc
<br />Owna-Buil.lcr will h8vc rh. burdcn of proeinB lhat h. o shc nor build d imprcv. lor $c purp6. of salc)
<br />_I, 6 owna of th. prcp.ny, d .xclaiv.ly antulin8 vnh li.dscd conhdoE 10 cGlruct th. prcj.c! ( Se. 7044, Bcin* ud
<br />Prof$sio Cod.: Tnc Co.tulort Licd$ Law dod .ot .pply !o M omr of propsty who builds or imp.ov6 rh6mn , sd who
<br />cotr&lc for such proj.cE vith a contracto(, li6s.d ruRuot to $c conrbas Lic4c Llv )
<br />_l e cxopt undr S.clion _,8 & P C fd this Bon
<br />Dal.: OM.r
<br />Poli.y Numbd: Expi6
<br />(I'ir setio. n..d iot b. cada.d ia dE Fmn ir for Oo. hudrcd ibll6 1l l0o, or l6s)
<br />_l ccniry $at in thc Ffomuc oa lhc *ort fc vhich this F.mit is issucd, I shall nd cmploy dy pcEon in cny mMnu so 6 to
<br />b.cm. sublet to ih. wo*6 ' comFnsalion las of Crif@ir. Md agr thar if I should beom. rubj.cl ro tn. wdtcB'
<br />comFnsatio provtions ofs.ction 3700 oflhc kbor Codc, I shall, tonhwilh comply with lh6. provhioN
<br />WARNINC: Failurc ro sftlE voit6 @mp.isrid covaagc i! ela*lul, dd .hall subj.d & mdoy.r Io oihaml p6.ltid ed civil
<br />fii6 u, to on. hundrcd Iho6&d dolla (l100,000),ii addiion ro thc 6r of @mp.nsition, .hmas6 6 providcd fd O€ selio ,076 of
<br />dc Labor Codc. inrcBr dd atroD.y'! fc
<br />LICEXSID.CONAACIOf,iDICLAAAIO!
<br />I hocby a0jm undo pealiy of pdxr, |Jl!r I m licascd undd prcvisio of Chafld 9 Gommaci.S wi0 Sccdon 7000) ot Drision I of
<br />th. BBinBs ad Profdions Codc, dd my liccnsc is in full forc ud cffar
<br />CONSIBUqIqEIEBDITGJCEICI
<br />I ha.by .mm Mdd p.n.lry of pdju.y thd t@ is a co$nacfon lcrdins r8ocy f6 lhc Frfolfu@ of di. vdt fd *hich rht pmir is
<br />i!s.d(S@ 10e7. Civ C.)
<br />arrllca{rsDEel4&glo!
<br />Dcnolirion Pcmns Asb6r6 Notifi.atio. Fcdcrsl Rcgu lalio.r (Titl.40, Prn 6)
<br />_ Rcqutcd Lcn rofNotificution
<br />I ccnily rhat thr fcd(dl ,csulalios r.Eedins db6lc rcmoval d. nor applicablc ro this projdl
<br />_ I c.,n ry that I hav. rcd rhis .ppli.dion ed sb!. lnar th. abov. inaomarion ir co@L I ag@ ro compl, wirh all Ciiy Md C@nt)
<br />ordindB ad Stzl l,ws r.ladnB to buildinS dsrrucrion, dd hd.by surhtriz r.p@lsliv6 of this Ciry 6d Coonry lo atd uFn $c
<br />abov. ncntion.d propcny for ins!.crion pu.p66.
<br />1:
<br />.Zz.lz /Zr2-t
<br />-a-/2,/a/
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough E, TIl\E,.t
<br />Service Meter rEbnl 1t't0
<br />FINAL
<br />Notes, Remarks, Etc.SAMC B-43, 290, ss6, 667
<br />WOf,(iRs COMPf, ItSAfl ON DECLARATION
<br />I h@by .ffm ud6 F,.lty oapajury on. of tn. following d*ldims:
<br />_l h.vc ed will mainhin a Cdifica& ol C6s6t 10 S.lfltuE ftr vslcR' {MFnsatid, a proyid.rl fd b, Setion 3?00 offi.
<br />libor Cod., for th. Frfol]]ee of lh. *ort for which ln. Fmn is i$ud
<br />I havc md sill ruinbin vdk.a @npolatio. iNu@e, a EqoiEd by S.dio. 3?00 of rh. bh.r Cod., aq {h. pcrfotuee of d.
<br />*ork ad whi.n itis p@nn ii issu.d My wo*6' .@p.rslio. insorde @id ud policy .umb.r d.:
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