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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS Omd-Build.r DaleioD <br />I h.r.by .mm und.r F dty ol pcjury lhl1 I m .xdfl fm lhc Contr6clo6' Lic4c Law for th. followiis Bon Gcc.7ol I 5 BBinB <br />ed Prcf$id Cod.), Aiy City or Coury *hich Equn6 ! pcmn lo co.s$ud, altcr, inprcv.. doolish or rcp.ir M, slrlduE. Fior ro iB <br />ksudc., lho rcquiiB d'c.pplicat for iuch pcmn ro fih a si8r.d sratcmot $ar hc o. sh. ir lienscd puBudt ro dr. provisions orfi. <br />Coirdol5 Lic.,&d Lrw (Cn.Pl{9, C@m6cina wnh Sedo. r00o ofoivisio 3 ofrhc Busins d kofdiorr Codc) or thdr h. q <br />sh. is cr.mpt thscfrom &d lhc bais fd tc allcecd ddprioi Any violotio of S.ction 7Ol I 5 b, dy a9plicdt for a p.mn iubjeB $. <br />applicant to acivil pcnalty ofnot noE th& fivc hundrcd dollds (1500) <br />_1, s own6 of th. prop€rty, q my cmployG *idr wa€6 s lhct sol. @npcnsalion. will do rh. *ork dd th. truct& is not irra&d <br />or ofi.r.d ror sal. ( s.c.70a4, Bcingr ud Prcf6sions Co&: Th. Conmcro, s Liccns. L.r dc nor apply h d wnc! of rhq pDpcny <br />who buil& or imp.ov6 rh@on, edvho d6 su.h eo* hiruclf or h6.lf s$rough his or h.. ow..mdoyd. providcd $.l such <br />ihprovmcnE dc nor iicndcd d o!I6.d lor s6lc Ii hov.vs, thc blildinsor inprov.mcnt k sold qirhin onc ydr of comDlclon, thc <br />Owns-Buildcrpill hs,.lhc bud.n ofproving thal hc orshc nol build d improv. aor thc purpc. ofs.l.) <br />_I, I own.r oi th. pDFty, m.xclusiv.l, con!_&tire wid licdscd co.rr.crn to consrtucr $. prcj(l ( Scc. ?044, BEii.$ dd <br />Pbfdio Cod. Tn. Con@iort Li@n* L:w do6 nor.pply to d osr ofp.opqty who buildr d ioprcve d@d , Md who <br />@nrrcs ror such prcjets wnh a contr&to(, liffi.d puBuut to n!'. Cot *tor't Lic.ns. l:w ) <br />I m .x.dpt und.r s.ction <br />WOR('RS COMPENSATION Df, CLARATION <br />I hcrcby ainm undd pcnalty of pcrjury on. of lh. aollowinS d.clmlioni <br />_l hav. ed will msinldn . Ccnifidlc oi Cons.nr lo S.lfiBurc ior worl6' cmFns.n6, s prcvid.d fo. by S@tid 3700 of$. <br />Labd Codc. for dE p.rfmcc oldE *ort for *hich rhc pcmit is isu.d. <br />_l h.v. ud will mintlin wtrk6' @mp.srti@ iNr@c.i 4 r.qun d by Setion 1700 of O. Labo, Cod., for thc Frf.m&e olrhc <br />wort lo! which d:i! p@ir ii islu.d My wot<d' conp.tudrion ituur&c! crid ed policy numb.r dc <br />(This $crion i@d oot b. @mplctcd il thc pmit ii for On. hu.dr.d dous {1100) or <br />.Z^,*n^nr*..i*,,"th. psfomuc. ot (h. work fd whi.h rhis <br />lhc Lalor Cod., I shall, fonh <br />and dolhs (1100,0m).ln addiI , &maBq a povid.d fo. <br />inlcrd sd:llom.yt f.6. <br />I hocby rmm undcr pcmlty ofp.rjury th.r lic.os.d und* prolisioi of Ch (commocins wnh Scclion <br />dc Busin6s ud Profesions is infullforc.dd ef.ct <br />, Civ C) <br />APPI.ICANT'S DECTARATION <br />D.mdnio Pcmns-Albdc NoIficldon Fqldd R.sll.lionr (Titl.40, Pdl 6) <br />_ RcquiEd Lau.r of Nolifiadon <br />_l c?nify thar thc f.d.ral ESulalio6 rc8&ding 6b6is <br />Z'flc.nif, d{ I h.v. E d rhir rpptr <br />'ordrno@ ed Sur. L!*s rcl.urg 1o <br />.bov. mc io.cd prop.ny fd inrprcrion <br />Site-Work <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 />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 Ei(t'II iE.U <br />Rough rEo - <br />Service lMeter SAMC 843, 2 90, 656, 66i <br />FINAL <br />DATE <br />Pole Bases <br />Notes, Remarks, Etc. <br />L.nds! Addr6. _