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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG.COMMENTSAPPROVALSDATE <br />Site-Work <br />Underqround <br />Pole Bases <br />Liqht Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />I t ,aaUnder Slab / Floor <br />etil\l "€9Bondinq / Grounding / UFER I ,l tw'{) <br />Transformers I <br />Torqueinq <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 />12Ceilinqs (T-Bar Rough)I l du!(\wMeter Release I q loNolr 14, <br />ww1Rouqht,q W)'/.))s,WService Meter t,lola <br />c1FINAL <br />Notes, Remarks, Etc <br />r)\\ Nl:rr Bt tLt)t R r ) r:1.( ,\R,\ I ()N <br />I hd.by amn. undd lc6ny ol pdju,y lh.r I m qmfl aron lh€ Co4lt 06 LiccBc La* lor lhe followinA l.sn (Se 70:J I 5 <br />Bsin6s &nd Polsion Codcl Any Cily or Co!.r, \fiich r.qut6 . pdmn Io codrucl. altd improv€. &rmli.h or rcFr. dv <br />srruclue pnor ro ns isuanc., also .cqun6 $c aPplicanl aor sucfi ,enni lo frlc . sisn.d slaldnl lhat h. or slt i5 licd$d lu6ufl <br />ro rh. provisioas ollhc Contr.ioas Licenscd lr* (ChaFrd 9. Com'nencins *ith S€clion 7000 ol Dilirion 3 oflh' BBin's md <br />PDlcssion! Cod.) or thd he or sh. ! ermpt rh6.arom ed lhc beeis aor rh. all.a€d c\d$io. anvvioltlionofs.dion 70115 bvanv <br />appli..dforrlcmnsubjelsrh..pplicanlloacivilpc.alryoanormorelhufiv.hr.drcddoum($500). <br />l. 6 o\y.n ofth. prop.ny. or hy eorlo)B wnh vas6 6 th€t el. .o.rFns5lion. Nill do lhe wod{ od lh€ $r[1u' ir nor <br />inrqxLd or oird.d fo; ;e ISc 7044, slsind ed Pml6sio6 ( od.: Ilc Conrddor's Li.ffc LaN do6 ool applv lo oNrof <br />rh. polEly *ho h ldt o. ihprov6 rlE@n, snd who dE $ch sdr him..lf o. hwlf or lhonlh his or hr os c6plor'6 <br />pr6{idcd lh.r such iml,iroMrs ec noi inrnlcd or ordd aoi ele. I[ hoso'd. rlE boildins or itrprorcld i! eld wirhin on' ,6 <br />;f ehplctioi. thc Osns Buik!6 will haw $e hr&, of provjns rhd h. or shc did nol build or inpmw thc poldv for thc plrFE of <br />I, s osns ollhc prepdly, dn .xclusively cod.ading wnh kmscd conlradon <br />'o <br />codrucl thc pojd (S(. 7044 B$ind <br />d PFfsDn Code: rhc Conlracloas L-ic.nsc Law do6 nor aprlv lo d osnd of proFflv who builds o! imprcv6 thd.on <br />6od $ho co Eds for such projd8 wilh o ConlBlo(s) licdE d porswl lo lhe CDnt.ctois Licd* l-aN) <br />I n.rc'rpr u 6 Sdlion- <br />Orn..: <br />.ts &P( forlht retr$i <br />DECLAtsAIIOI <br />I h.rcby amm undd pdahy of pEjury onc olrhc lolbwnB dcltralions: <br />I h0!c d Nill darrain a ccnificalc olco*or lo s.lf-lBur€ for slrtE - .on!.Ealion. 6 Ooridcd ao. bv Sclion 1700 of th. <br />l-abor Cod., for rhc pdfoman . oflh. work aor which lhc l)6nit is isucd. <br />l harc flnd $rll mainrai. Rorkds comp.Bdrion insur...e.6 rcqun.rl lt serion lT00ofrh. tlbor Codc. tor lhc per'minc€ 'r <br />rhe \vort tor rvlich rhis pmn is issued My $ort6 comPoel ion iNu@.. (eis ed policv numbs ee <br />;ul <br />ly rhar i. rhe perlornaNc oflhe {ork lor !hi.h this pemil 6 $nul. I shall nol otrploy,ny pd$n in 5.} nmcr <br />_s <br />as lo h..omc subjel lo llE \ ork6 comFsr ion laws oac6liaomi.. and as,e lhar if I sho,ld b€tom€ subjer to rhe <br />NorI6'.omp.sorionprovisioBoaserionlTOOoflhcliborCodqlshtll.fonlllnh.o,nplvNilhrhoepovirions <br />$ARNINC: Fai\,c b seurc llotks comPdr iof, co\ms. is unlatvtul. .nd shall subj<t d mPlotcr lo sitin.l pcrnie od <br />ciril nn6 up ro one hundr.d lhoMd dolls ($100.000). in <br />S{rion 1076 oflh. Labor Codo iolrd ed atomcy s fs <br />con orconp.N(ion. danasd 6 provid.d for th. <br />l-7 -2o <br />I h.'tb! alfilnuidc' psrlr) olNrlurlihal I !fr li(nslal t*l.i*ict apro s t"o,nn,-cinB {'ilh ssrion Tooo) of Dilisio. l <br />of rh.B6insa ProlsioN Cod.. and my licosc t in tull fn(. dd cfl(t <br />('/ o <br />3 -2ozo <br />+/o36))o <br />c"",,.",,", S-a-. s c, s H €J-l (L <br />CONSTRUCTION LT.INDIN(i ACENCY <br />I h.cby amrm und6 rEnalry of pdlury lhal lhqc 6 a.oNtudion lddins.sdcy aor rn pdfomoc. oi ihc $ ort fo! *iich lhis df,n is <br />i$ucd (s.c. 1097. Civ. C.) <br />knd€as NeIn.: <br />lgd{ s Addrs <br />APPLICAN'I DECLARAIION <br />I hdrt y amm under rcnaity of rdjury one ol lh€ lollo*ins delar.r ions <br />Dcmolirion Permits-Asbe1os Norilic0rion ljcdgal Resulalioft { I nt 40, Pan6) <br />Rcquired t-clrer of Nolifi.ariun <br />I cd ifo lhal lhc tcdcral r.lularioN Esedi.s dbclos r€mofal ar. nol applicable lo rhis proj.d <br />t1 cen ily r hd I hn\ r r.ad rhis .pplical ion and nar. rhal rlr ahr\ € inlomd,otr is .ond I trgre lo conply *i h all Cily and ( o$lt <br />ordinanc6 dd srar. l.arvs El0l i!,g to b! <br />above nEnlioned propen, aor i.spcction <br />hq.by .urho.i2. r.prMtal iv6 ol rhis ( ny ud Counly ro mrq uPon 0E <br />Ll <br />appliL.nr or ,rg€nr Sig rltrr€IA4 L 7-?6\/ <br />,-< <br />tru{vt <br />I\Vb&t <br />Ltry.thl?ot t)fy^W <br />e l()..