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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DI]t,CARAI'ION <br />I hdcby amm und6 paally of p.iury that I m cxcmpl fror. thc Contraclom Liccns ljw aor lh€ followins r@. (:_!. 701 1 5 <br />Businds ad Prol6sio. Code): Any Cil, or Cou y whi.h r.qun6 0 Fmil kr coNltuc1, alro. i6Pb!( ddnolbh or rS t &y <br />$runuq rior ro irs i$oec.. also !.nrir6lhc @plicel for such pqmil lo 6L a sisn.d stdmot $d h€ or stc b lic@c{ pri@r <br />Io thc FmvisioG oldc Conltlcrd s LietrFd La* (chaprd 9. Comncn ins wilh s6rion 70oo oaDirision I oflh. Bsinds'dd <br />PrcLsions Cod.) or rhat hc or sh€ ie cxmpr lhdcEom rnd lhc b6i6 aor th. allcB.d .rmplion Anyvioldionofs-1ion?011.5 by any <br />spplicdi ior a !.mir subjels rhe applicom ro , civil p.mlty o af,ol nEr€ lhe fiv. hu.dtol dollds ($500). <br />L as o\$d o llne FoFny. o! my dnployG rilh was6 I rhct slc .ompoerion. siu do lh. soft ejd thc .rin lr is ml <br />intsdal or ordcd fo! elc (58.70,14. Busins dd Pmf6ioG Cod.: TtE Conlrsclors Licos. lrw do6 nor tPPly to u oMr of <br />thc ptupdly *ho btril& or impmvBlh@n. ud vno do6 such Mrl hins.lf or hdscllor threuth his or hd om mploy6. <br />prcvided thal such imprevdmt e nor inlo{H or oficcd for $L. If, howdr, lb. hlilding or intpremol is Fld wilhin .n. )d <br />ofcompLrion. tlE O*'ns Bui!:ld *jll h.ve th€ hldo !f Foving td h. or sic did d boild or imFov. fi. pmpsiy for th. BITE of <br />I. 6 owncr oflh€ p.op6ly, d .r.lcilely conli.crinB qnn Icm.d conlracto6 to co6ttucl ih. Fdd (56 7044. BBme <br />and Prla*ion codc Th.Conlrscloi. Licds€ L.w do6 nol apply ro d ownd of ptopedy who builds or inprcrcs lhdmn. <br />and Nho conlEcls lor such Fojcls wirh a CodBdoi, lic@d pusul lo thc conln.lols Licm t w).I <br />I m cxenlpt und6 S(l 5r\", e. <br />D9CIdEAIIAN <br />I hs.by ,mro und* p.nalt, olpsjury onc ol th. follo*ins d4lsr.tio6: <br />-l <br />hav. ed will moinl.in a Ccnificar. of Cotuol ro S.1.6u,et.r$ork6r compehsrion,6 prolid.d aor b, S..lion 1700 ofth€ <br />llbor Cod.. aor (hc pdfommc. o f Ih. Noli for stich th. pmil is sud. <br />-l <br />hav. a.d will maimain wortcrs comp.Nlion iBurancc, a r.quiEd br Sd tun 1700 oil h. I rbor Codc. tot th. pdlomEncc ol <br />ihc sor I for rhicn $is !.nnil is isucd My workers comDd$rbn idsumce cari6 md policy numb.r d.: <br />Policy Nurhs <br />-Erpircs <br />I ccnifylhst in the pBlormamc of lhc work lor Nhi.hlhis pemn is issued. I shall not snploy3.,Pmon inanym ns <br />$ a ro b€onr subj<r ro rh. No*e compderion hNs ofcolilomii dd asd rhat il I should b.comc subjxl lo tb. <br />*0116 conp@tion pmvGios of Sdioo lT00ollhc llbor Codc,l shatl. aonh\lnh comlly *ilh lhos prortioB. <br />WARNINCT l:ailure lo sur. *!&od .onp@^rion .ov.rasc is unlawful. and slFU subj(r M dploy.r lo oiminal F.hB e! <br />civil fin6 up lo onc hu.dr.d tho6dd dolld ($loo.Lto). in .ddnion ro the coe ol cosr.Nrion. d{Ms.s 6 Povidcd ror rh. <br />sdrion 1076 of rh. kbor Cod.. inrs6l ud anonEy's fG <br />c.. C/uz <br />DTCIAEAIrcN <br />I heriy .ttm ondd part, oI pdjury $al I dn li6s.d undq F.Gio. ofchapld 9 (com,trocins wilh Sdrio. 1000) of Division l <br />ol lh. BsinB ud ProfBios Cod., md my lic.N ie in tull fo,cc a.d .lrtl <br />Licec. CIB:-Licsc N@b..: <br />- <br />CONSTRUCTION LFNDINC ACTNCY <br />I lEreby amro dd6 Fnrlry oa p6lu.y thd 016. is a cotrnEcli.D Lndios agdcy aor ih. psfom&cc of 6c *ort for $ hkh lhis Fnil it <br />isu.d (S( 1097.Cir. C ). <br />ATIIICAILDEC'JNAI]ON <br />! bdlrry arm undd p6ahy oa pqjury oo. ol th€ lollowing ddL(al ionsl <br />Dcnoliion PmneAsb€rd Nolifi.otion F.dd6l R.suldions ('I itlc 40, Prn6) <br />R.qun.d L.lrd of No{ificdion <br />-l <br />cen iry lhal thc ledqal lcsularionr orardins a66bs ra.ov.l de nol applicabl. to lhis proj.cl <br />-l <br />csrify thar I hare rkd lhi applicarion and statc nd fi. abo\ c inlomalion n coftd I arre ro .omply wnh all Cil y ad Cotr rt <br />ordina.c6 and SIarc lrws r.lar'.g ro blilding .oBhclion. od hd.by oulhorn€ rqtrdc ariv6ofrhisCity d Cou.ly lo drd ul.d th. <br />Cyr.lZ D.,. <br />abo!.n6'ioncduopdy tor inspdn,nnurp.s . <br />Ap!,ionroraEq,shn*u... X SiLkl <br />Pcmile Mnctpn ): <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 />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueinq <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Rough I <br />Service Meter l/,tha rl)L,trtt ) <br />W't'[rq\W-k.tu I <br />Notes, Remarks, Etc. <br />FINAL <br />Cv vL <br />Lendeir N.m. <br />- <br />L{ndd . <br />^dd6 <br />- <br />I <br />I