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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OT N ER BI] ILD€R DET.(ARA ION <br />I hdlby amm und6 D.nally oi psiury lhal t d d.oDI ion lhc Conrtaclo( l-ic.nse liw for thc following rce. (Scc.rll l t <br />lrusin6s d Prof6sion Cod.): An, Cily or Coury trhich r€qrirG a !6Dit to co[ntud, .ltd, LnPov€. dmolBh or (p@ dy <br />srrucluc, Fior lo ils Nudce also rcquts the opplicel tor such ponil lo 6le a siSn d sdmal lhal hc or shc i5 licoMd plmot <br />lo rn€ provisio.s oflhe Conlrtiloas Lic.n$d tlrv (Chapr.r 9, Co,nm.ncinB Nith Sdrioo 7000 of Division I ofth€ BBin s ed <br />PmlNions Cod€) o. rhar h. or rh. is cxcmpl th6.fio'n ed th. b6is for lh. au.scd.rmprion. Any viol.lion olsclion 7011.5 by anv <br />.ppli.ant for a pcmn subjclslhc applica b a civil p€nalty of nor ftor.I he 6rc hufldred dollffi ($J00). <br />I. 6 oMs oirhc pmrErr. or ny .mplot€6 wnh w.86 6 then sE cod!.Balion. *ill d. lh. $trt dd thc slru.l@ is @t <br />i oded or ofld.d ior ele (S{,7o44. Bsins ed PolsioN Cod€ Th. Conlnclol s Licm* LaN dod nol apply lo e omd of <br />ih. Flpqiy vho hiild! or op!o6 tt66n. dd who <,06 $.h rEa hnn*ll ot h.elf or ltreusi tis or her osr.mPloyc, <br />provid.d lfiat s!.h nprovddl3 e @! inhdql or oftd.d i)r eh. I[ ho*'d6. llE trildios or inprovml is $!d wnhin onc ]6 <br />of conplcrior rh. OM6 Br&t6 will ha!. rh. hnd@ orFovi.s rhd hc or shc did nor hild or imprwc lhc FDFty aor rh€ puloF of <br />-1. <br />d o$nd oaihc Fop.dy, on dclBiv€ly conlracrins rvirh licoscd coitru.lo6 lo co6ttud lh. F@i6l {sc. 7014. BGin< <br />,rd P'ofeion Cod€: The Conrr.clof! l,i.c8. Law do6 nor apply ro M oMo ofpropgny who buildr or impiovd lher@n. <br />and who efl6.8 for such Foj..lswilna ConrBdo(s) Iicorcd pusudr roUc Conradois Li.me L.w) <br />ldn.\.'nd ndd sNl'.tr B & Pt lo, thB rcMn <br />Dote Orno: <br />voSs8Bli:cgurulsarq! <br />DEClASArrq! <br />I hdeby amrm undq p.nllyoapojuryon.ofrh. followin8 ddlaratiom <br />I hav. md Nill mainrsin a Csrifi.dl€ olcoMr to self.lcu. ao. sorkers con'Fnsarn,\ 6 rolid.d for b, Sdion 1700 orlhc <br />bbor CoJ., for lh. Ffommcc of tlE worh lor which lh. r,6mil is su.d. <br />nBnce, 6 r€qlncd by Sdlion 1700 oarh. tibor Cod.. to, lhc Faorrm.e of <br />com!.Miion iNurdc€ cenc ed poli.y auBLs ac <br />lJ <br />-l <br />c.niry rhal in rh€ r6fo@nce of tfu wo lor which tnh pmil is issu.d, I shall nor snploy ey pssoo i. 6oy nsner <br />s e tu bcone subjd ro rhc worl6 co'np€ns.lion latr s or Clliirmia, md a8r that if I should b..omc subjd lo lh€ <br />wo m comp€Mlion ,,Rrvlsiod or Selion 3700 oflh. l.alri Cod., I sh2ll. lonhwith comply wth tho* lrolisioB <br />WARNINC: rzifurc lo Kurc \ork6 compds.rioi covd.ge is unl,$ful. d shaU suhr(r e Flplors to oimital poFhi6 dd <br />u onc hund!.d thous d doU6 ($l in ddnion ro the cosl or n. dmag.s s Eovided ror rh. <br />ltnalty ol F€rjuo lhal l an li.4{n u d.r iotr otChapraI (cornrcncint wiih S.crion 7000) ofDntion l <br />I rh. Btr{in*{,.d Pr.acsi.trs2 Codc. md mylicose is in tull hrc.tud <br />br C (O 1{o\gg <br />t (, <br />p€naliy o I p.,jury rhal lhs. is a .oNrtucrion lmdins .sacy lor rhe !oaomd.. oarhc "ork lot Nhrh rhis lfnir is <br />issu.d (Sd 1097,Civ. C ). <br />APPLICANTDECI ARATION <br />I hudy alift und6 pdah, of pGjury o.. oalh. follosine d..ldalions <br />Danolilion P.mis-Ash6tc Nolificalion F.ddrl R.gnlarios Gnk 40, Pan6) <br />-R.qun.d <br />L.rl( of Notii.aion <br />-l <br />cdriay rhal I havc r€d rhis ion is cor6t. lasr(ro comply{ilh 3ll <br />o'di',.tr!.s SlarcLNs'clitiiBI hor;. rcp 6mlariv6 oflhis Cnyed <br />aboc menliorcd propeny lor i <br />^rpli.,nr <br />or ,\gdrt sienrlure:v\lgq z.qeqil <br />l dr <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 />Torqueing <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />ltileter Release <br />Rough <br />Service Meter <br />FINAL '>-zi.-/,-2.#u // <br />Notes, Remarks, Etc. <br />Sub-Panels <br />\. \.\.,.,W+-'--- <br />-l <br />csriS rha lhe r.ddnl cSolaliom EBedinI 6b6los rmovsl d. .ol applicabL ro lhis prej<i. <br />t---+---