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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS oMd-Build.r Dcclratio <br />I hdby afim undcr pcn.lty of pdjury thd I m .rmpt fom lhc Co.ltu1oE' Lico3c La* for lhc iollo*inB r.!s (ra.70l 1.5 Bulins <br />.nd Proidsion Codc)r Any City or Couory vhich EquiB . p.mil ro con{ruc! allf, inprcvc, dcmolish or Epair &y llructurc, pri to iB <br />issuec., ilro r.qut6 rh. lPpliEnl for such pcmit io fiI. asign.drr.tchdt rhar h. or sh. t lico3cd puaumt lo $c proviiions ofl,E <br />ConrBtort LiHscd Llw (Ch.ptcr 9, Cmmhcin8 *th Scction 7000 of Divirio. 3 of $c Bsin@ ud Prof6iN Codc) or th.l h. d <br />rhc i5 cx.mpr rh.Earom d ln. b6is ld lh. allc8.! cx.mplion Any violaion of Scclion 701 I 5 by dy appliol for a pcmn $bjalr th. <br />lpplicer to acivilpc.alry ofno( moE dd fiv. hund'.d dolld (t500). <br />_t, s opnd of fi. prcpdry, or ny cmployc with wrg6 s lhcn solc conp.n$rion. *ill do thc *orl dd lh. tlruduc t nol i.rad.d <br />or off@d fr s5l. ( Sc ,Oaa, BGi.4 &d Prol*iotu Codc, Th. Coihacror's Lie.s. Llw dB nd .pply ro s own.r or thc prcp.8y <br />who builds or inprcva lh.@n, d*hodo6sEh*o hiBclf or h6df 6 drough his or hcr @n .mploy.d, provid.d lhal such <br />implov.m.nri & nor intdd.d or offcrcd ftrs!lc.I( howcv.r, th. buildin! or imprcvcddl i! sold *itiin oncy@ofcompl.xon, rh! <br />Owr..Blild.r will h.v. th. blrdm of provinS that i. or shc rcl build or inprov. for thc purp6c of salc) <br />_1, 6 @nd of $! prop.ny, m q.lBivcly coE&tins witn ltoscd coilicroF ro @Dr.qd 6. Foj6i ( S@. 7044, Bsins sd <br />Prcf6rid corle Tnc Coft.lcrq! Liane trw &6 iot .9ply ro u o,.* of propaty who buil& or imprcvB d6o , Dd who <br />cot'&r5 fo' such prcj@E wi6 . C@u&to(, li@!.! plFusr !o $. Cono&tors Uc.@ Llw ) <br />I _l e d.hpr lidrs@rion <br />-,8 <br />&Pc r&rhisrcsM <br />YOB(DBS-COMIENSAfi)N.OEC&4BAIION <br />I h.rcby smm und.r p.mlty of pdjury onc of rh. follovilg d.cleatioB: <br />_l havc dd *illm.inl.in i Cdtili.dc of CoN.t to sdtIBuE fd vo*d c@p.nsrio. B povid.d iq by SeId l7o0 oflt. <br />L.!or Cod., fd lhc Ffme of lh. wort for vhich th. p.mit ir isrud. <br />_l hzv. Md will nlintrin w6t6i @mpalatio iEu@cq s r.qut.d by S.cdon l?00 oa thc Labor Codc. fo. 6c pcramm* of th. <br />wort for which this p€mn id issu.d My work.G' cmp.nsstion inlurdc6 @i6 dd policy nunbd arc: <br />PolicyNlmbs: I E pi6:'x:":;. <br />F*"*6;*,.,r'. <br />b. cmpla.d if rh. pdnt i5 for Onc <br />FrfomuE of th. vork for <br />WARNL\lG <br />dolld (l I OO,oOo),ii addind to damasc 6 providcd for rh. S.crion 1076 of <br />I]CETSID-EOIIBACIOAjiDEEIABAI(D <br />I hcrcby aillm und., p.nalry of pajry d.t I m liccns.d uido prcvtuio of Ch.pt6 e ( <br />lhc Busin.s ed Prof.$ions Codc, dd liccis is in lull forcc &d clTet <br />of p..lury rhat tdc b a @isrucdon ldding dgcncy for thc p.rfMsnc. ot rh. wtrt lor which lhis p.mit h <br />AITLICANL1DECLABAIION <br />D.dolilon PmiE,tubsrd Nodticadon F.dBll Rcsllrron! (Tnl. 40, Pan 6) <br />_ R4uir.d L.tt r of Notificdion <br />.mply wnh dllCny dd <br />abovc m.llion.d prcpqly lq in5p€lion purp66 <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 <br />ts;iPil iL.u <br />Rough int6 <br />Service Meter rtrD - <br />FINAL SAMC 8.43, 2r )0,550, 667 <br />Pole Bases <br />Notes, Remarks, Etc. <br />-T- <br />I <br />Ii--H <br />I