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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />-1. <br />ar o*ncroilhc prcpsly, or my strplore silh w.g€d lhei sl€ compdsalio.. villdo tlt *or( a.d thc atru.lEe i no! <br />inkxLd or6rn d lor el. (Sc.7044. Buin6s od EDasiom aod.: I1E Conlrrclols Lic.M r,w &'6 not sp?ly ro M o"n6 of <br />rhc pop6l, who tuilds or nnFove fi66.. and *ho do6 such No,l himsclf or hc6elf or lhmush his or nd orr cmploy6. <br />provid.i rhal such inl'ovlfuB ft mt hrod.d or oll6.d aor eL. I[ ho*e6, rh. buildi.E or inpovffir is $kI wirhi. on. ]ar <br />ofcorpl.rio( $. (xTn Buith wiu havc lhc hjrdo oaFovin8 $d h. or sh. dt nor hlild or i,hprcv. fi. p6Fty for ihc Anpos of <br />l. soMd olrhc lr.pdn d.iclusi!.ly co.rraclins with liccns.d &rntmdo6 ro consdd thc projcd (S(. 7044. tssmB <br />tud thlsion Code The Conlnctors Licose Law do6 nol atply 16 e oM6 o apmprny uho builds or ihprorcs Iho@n. <br />and who conta.B for su.h Foj.cls wirh a Co Ecro(, lics.J plurBnl to ihc Conlrocrois Licsc b\v). <br />_-l d cxempl undd Sdl <br />lroatrESs:.c0MtrltAua! <br />IECI.AAAIIAN <br />I hs.by a,Im unds p6.llyofpdjuryon offi. fouoei.g d..leliotu <br />I hav. ad will nainrain r Cdlitr.arc oaco.$t lo S€lf-lNUc for ert.rs conipcnldion, 6 Drovid.d lor by Serion 3 700 o t rh. <br />Lab.r Co&, for rhe palomdc. oflhc worl for shich th€ pqnl n issued. <br />-l <br />harc and v ill nrainlain work.n comp.Barion i6!ra..e. a rcquncd br S<r io. 3700 orlh€ I abor Cod€. for th. paf.fr@c. of <br />rhe rvork lor which this pnnit is isu.d. My worker! compdelion iNurec. .ei6 dd policy nunb.r d.: <br />Cmo: <br />-I <br />cotiry lh.l in lhc p.rforMc. of thc wo fo. shi.fi thi3 p.mit ir issx.d, I shall .or mploy try !.Bon in rny m&,6 <br />e s lo b.$m€ sobj<t lo $. mdr6 comF&rion laws otcalitonia Md asre lhal it I should b€com. subjd ro thc <br />worl6' orpNtion povirioB oas*tion 1700 oilh€ tibor Cod..l slEll. fodhwilh omplyvnhrhosprcvlsioN.. <br />WARNING: Ir.ilue ro $uc *orLe6 cor.pcBarion corcr.s€ is unlawtul. dd sh.ll subjd an mployd to aininal peuhiG a <br />civil lin6 xp ro on. hdn&.<t rholsd dotla ($100.000), in addiriofl Io 1fi. cosr oa comp.Mrion, danase s prolid€d aor thc <br />S.dion 1076 of rhe t bdr Codq inro6t ed ato.Ey! f€6 <br />ucDlslD..qoNrxacroa <br />DECIASAIIO! <br />I h@by atttrm u.dd pmlry o f pdjury ihar I @ liensed u.dq provisi.n olchapla 9 (Nnmdcins yilh Se.lion 70C{) of Division l <br />of lne Bcin6 and Prof6ioB Codq did hy lic.e is in tull aor.. ed €ifel. <br />Licccc Cla:_Li..c. NrnbG <br />Co r..to.: <br />COIIIB.I](:UOIIEdDIDC.AGEITI <br />I hftby aliim undd paahy o t pEjury that $6. is ! oNrrucrion loding lsocy for U. pdfomdc. of rh. *orl for whi.h rhis pdfti b <br />isu€d (Ss. 109?, Civ. c ) <br />AfIUCANIDECI.AAAIIO! <br />I hqetr alltrn und6 p..alt, oapdjury o.. ol th. follo*i.* d(ldal ions: <br />Dcmohion Pm eAsb6r Norin.flion F.d@l R.sulalions ('Iill€d0. Pan6) <br />-R.quted <br />Lelid oaNolifi c.lio. <br />I rdily rhal lh€ f.d€ral rcaulalioN Essdins db€stos r cmo\ .l .re nor arplicahlc lo this t)iojer <br />_l cdiry Ihar I h.ve r€ad thix applicario. and {.relha rhe ahvc infomalion is cordt. I asr* ro complyvnh all City MdCounty <br />odinencs m'l St.l. l2vs rcldins ro brildinS .otr{tucl io( &d hd.by ruthnriz Epco$ri\'6 of rha Cny ed Coury lo fti6 upon rhc <br />abovc mationed pmpdy for inspclion purpos6 <br />AppUc.nr or Ag6t Slgn.tur: <br />Site-Work <br />Underground <br />Pole Bases <br />,9p6rs, Pool, Fountains <br />Signs (monument) <br />L ife /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <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)EXPIREIJ <br />Meter Release <br />eFP 13 '''' <br />., <br />Rough ^ -,n arA. 667 <br />FINAL <br />Notes Remarks <br />/J <br />Liqht Standards <br />Service Meter <br />Etc.t //I /.v"- | \-./ <br />OWNER BUILDER DE'CARA'TION <br />I hdct y aflim und{ paalty oa pctury rh3l I m dempl 6onr lhe C o.lrr.lou Lic.nse l.tr for thc lollowins rgen (S* ?0.1 I 5 <br />aosin6s ed ltoi*ion Cod.): Any Cily or Counly *hich r.qrir6 a ldfrn ro coBrrud. rlrd. inprov., <tmolish or Epdr d), <br />sh'.lrc. Fio. lo ils irsu&c.. also rcqutc rh. applictul for such p.mir to fr1. a sigfl.d darndt lhat h. or sh. is licms.d pGud <br />ro rhc Imvaioru of thc Co r.ctoar Licensd Law (ChaFo 9. Coom..cios wilh Scrion 7000 oi Division I oallE Bain* ed <br />Proa.sions Cod.) or rhal h. or sh€ is €xmpr ths.&om &d lhc bsis aor th. rllegdl dmFioi. Ary liolarion oasd6. 703 I 5 ty rny <br />applicanl for a pemil srbj-b thc alplicd ro a civil penalty oa nor mo' e th fiv. hun&cd dolltrs (1500) <br />L.nda's Ad<L*