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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS rD/srG.COMMENTS Om.FBuild.r Deleali6 <br />I hcEby atlm uda pc.alty ofp.rlury tatl m cxapt aom th. Co.iBci@' Limk L5w aq th. following Eson G6 70ll 5 Aain.$ <br />ed Ptua.rsion Cod.): Any Cny c County which EquiB . p.mn b construcl, ah€., improv., dcmolish or rcpair sy shcrurc, pflor ro rls <br />issuucc, aho r.quns lh. appli@l for such pmit lo fiI. a sig..d n mat thal h. or sh. is li*nscd puRuul lo thc pmvisims of thc <br />Conu&rofs Licd$d L.q (Chap6 e. Commmdns *irh s(tid 7000 of Division I ol thc Bsin6s &d Prcl6iois Cod.) or rhar hc o <br />sh. is dmpl thdclrom ed thc b6is fd fic dlcs.d .x.mplion A.y violdiM of S€lion ?Oi I 5 by ey atplicut ftr ! Fmn 3ubj.c$ lh. <br />.pplidt to 5 civil p.nrlty ofnd mw ihe fivc hutrdr.d dolld (1500) <br />_1. a 6w.r of G. Fop6ry, oi ny mplord ,iG vdg6 a t .ir rol. .onpc.rdion. will do th. *ork ed thc rhctu. is not inrod.d <br />or ofidcd fG salc ( Scc 70,14, Bcin6 od Prcfdios Codq Th. Cohdu s Licasc Laq do6 nd oppty b e ownd oa !h. prop.ny <br />who buit& tr imFov6 th.r6,, od who dc ruch ea.k hiru.ll or h6.lf or thrcu8h his M hd @n nployes, prcvidcd dal such <br />inprovd..a e nor intc.d.d or offdcd ld srlc Ii how.vcr. ttc buildinS or ihtrovdd! is sold vrlni! on. ya oi @mpl.!o, d. <br />Own.FBuildd willhav€ lhc budd oiptovins thct hc nshc nol build or improvc for thc purpe ofsalc) <br />_I, a o*n.r ofd. propdty, n dclaiv.ly corb&ting,idi Iicdcd c@lrrb6 ro @n ruct $. p.oj.cl ( S.c 70aa, Bsine ed <br />Profdsim Cod.: Th. Conlrefft Licd. l:w &6 .or arply lo M ownd of proFny sho buil& o improve $a@ , ed who <br />cotr&E ls such projcclr virh a cohcro(s) lihscd puRuet to rh. cdt ..hr't Lim. L5w ) <br />_l d ampr ud.i sdie <br />YOATEBIIO!4IEISAIIOX-DDCIABAIION <br />I hdcby amm und.r pcmlty ol pdjury onc oa lhc aollowin8 dccle.tions: <br />I hav. ed willmaintaio a C.nifiqc olcotudt to SclflBurc for vorkmr.mporsarion, s Fovidcd fd by S.crion 3?00 of$c <br />L$or Codc, lor lhc Frfd]:m@ of lhc *ork fo which |h. t mn ii i$u.d. <br />_I h.v. sd will mini.in wdt6 comFBari@ rtuum@, a rcqut.d by S4rio.1700 ofthc t bor Codq aq rhc Frflm6e of rh. <br />wtrI aor *ni.h thL Fmn is iis!.d My edtft' @mpos.tid ins@.c @in ed ,olicy nmbd oc <br />I c.n,ry $al in lhc p6fome@ of lnc work <br />b.cffi. subj.ct ro rh. wort.R comp.nsario I <br />is issu.d,I shallf,ot dploy ey FRM in e, n&n.rso B ro <br />a€r.c thar if I should b@om. subjct lo rh. wd*.6' <br />.mpc.sation provisions of Sdion r?0o oarhc Labtr cod., <br />L L4 <br />WARNINC Failurcb seurc *orlc6'cohp.nsalron covcraac s un hwful, dshall subjctm <br />nnB up lo on. hundr.d 1ho6&d dolls {ll0O,O0O),in dddnion to rhc c6r of compdsadon, d.mag6 6 provid.d for lhc Sccrion 10?6 of <br />ih. Labor Cod., int rd md alton.y s f6 <br />LICENSED CONTMCTORS NECLARATION <br />I h@by amm uo&. paalty of Fjury rhar I h li6s.d unda pmvisi@ of Ch.ptd I (cmmad.g virh Sario 7000) of Dvi.io. I ol <br />thc Buin6 ed Profsims Codc, md ny licac k if, tull fo@ ed .ft@l <br />l^,u <br />CONSTRTJCTION I I]NDING AC}JNCY <br />I h@by .ifim ud.r Fn.lty of Fjury tnd $ft i! r @osEuction lddiog rgocy lor thc pafmc of tn. wdt a6 which lhi! p.mt is <br />isurd (sa. 309r, Civ C). <br />AIIIICA{I]iDECIAEAIION <br />Dcdolilion PcmillAsb.slm Notificdion Fcd.ral Rcguladons (Tnlc 40, Pan 6) <br />_ R.qun.d L.tcr of Notificado <br />I anify Ihar dr. f.dnal rcguhrionr rc8&ding sb6l6 rmoval s. ior appliable o $is prcjccl <br />_ I cdtify th.l I hav. ed rhis .ppli.dion d 3i.rc ttal lh. !bov. inf@atio is @r€t I ryB b .6pl, wid ail Cny ud Couhry <br />lo building @on ucri6, dd hrcby erho.iz r.pr&nu1iv6 of this Ciry ud County ro dr.r opo. 0E <br />abovc mc"tioncd prop.ny <br />,d hT C4 t1 <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 />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 tvltdqt ra <br />Service Meter <br />FINAL vits/w /a]: <br />Notes, Remarks, Etc <br />DATE <br />Communications Cable <br />Policy N!frb.r Expir6: <br />Gnis scrioi .c.d .ot b! @mpld.d if th. pmir is lor o& hundrcd doll6 {t I 00, d Is, <br />f------T------