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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS
<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 / Groundinq / 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 Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />[/eter Release <^<,<,o ()9
<br />Rouqh -ti6
<br />flService Meter p:FINAL u 8/,n
<br />Notes, Remarks, Etc.
<br />OWNER BUILDI]R DDTCARATTON
<br />I hdety rrm und6 pdslty of p€rjury lhal I d cxnpl ftoln rh. Co.t6clor' l,iccns. L{p for lhc rolbwing rc&n (s-.7011.5
<br />AosinBs d Proasion Code): Aoy Cily or Counly which requtc a Fmn lo conslrucl, ah6. inptov., dcnoli,h ot Epat my
<br />slructuc, rior to its ns@c€. ebo 6qun6 th. .pplicat aor such Fmil lo file a sisn d $ddar that h. or stE ii licosd pleanl
<br />ro rh. previsioB of rh. Contia.roa. Lic.nsed Liw (Chaprd s, Comb..ci.s *ith Scclion 7000 ol Division I oflh. ausin€s md
<br />Prorsions Codc) or lhar h. or sh. is ex.mfl thdcftoo dd the bsis for ln allegcd dmflion ,^., violalion olsdrid. 701 I 5 by an,
<br />appli.rm lor apmn subjds lh. applicanl lo acirilpdallyofnot moclhd lir. hundr.d dolles (5500).
<br />l. s o$nd of the Fopcny. o. dy cdplo)G *nh $ ,gc s rh.ir $1. comp€rsalion. qill do rn *or* dd $€ stM@ is rct
<br />inrhdel oroll6.d for sl. (Se 71144, Busirs and PDl6sions Co&: Th.contactois Licas L.w do6 nol tppll ro d ownB oi
<br />$c popgly who b{ilds or iiipmv6 lh66( md who doe sucn rclt himrelro. hd*lf or rhrough his or hd own cmpk v.6.
<br />prolid.d thar such inprcqEtrls 6r oor i'n6!H oronqqr ror ek I[ hosd6. rhc triklins o. iqrer.]6r i! $ld Nithin nrc ]w
<br />olcoopl.lion. rhe o* nd Buitld sill halc lh. hrdd oflrovin8 thd hc or sh. did nor b nd or i,npmrc thc pmrEly for $c purss of
<br />l, s orvtrd of lhc plopcny. an cxclusivrly conkaclins virh licdrcil .onlractor ro conslruct th€ projel (sd 7014. AGD$
<br />a.d Pofisio" Codc: Thccotrrsdoas Licose Las do6 not aDply to an orvns oaDroFny Rho blilds or imProrc th6on.
<br />old {no cootrmis aor such proj6,ls wirh a Conr6cro(, hc@lcd pu6uMr lo lhc contadois t-icd* h{)
<br />I on cx€mpr utrds Sction-, B & P.C for this r@o
<br />O*ne
<br />]laatrE8g-cq!4lENSAUA!
<br />DECLARATTON
<br />I hmbyliltrm undd Falyotpojuryon onh. fouowinS de,mtioB:
<br />-l
<br />naE ed will n,inrrin a C.nificab olconsdt lo S.lt-lcuc fot rcrl.m mnpcnotion, 6 providcd lo. by Sdtion .1700 of th.
<br />L!bor_]}d., ro' rh. po foll@(c o f (h. m for u hich rhc p<trir E i"rsuci.
<br />(ba\ c and *ill trEDtarn q olt..,!' comp<M, 'on '6drnc.. s '.qun n by scrion 37oo of rhc t bor cod.. ror th. psrom&c. of
<br />th. work for which rhis pq n is iscd My work6! @np@srlion iBuMc. tris !.d lolicy nuhbd r.:
<br />vtidc
<br />v C<_\t?,9(Z A.o7 -3 t'l
<br />-l
<br />c.niiy rhar in rh. pdaormancc olrh€ sort lor which rhis p€mil is ssu.d.l shdll nol nplo, ony p.mn in an) ndnd
<br />$ sto b€.omcsubid lo lhc rort6' comptsalio. las s of Caliaomi{ and agE rhar ilI sr'ould b.ton strbjd Iolhc
<br />eo*6s compaetionrrevtiotu ols*rion llT0ooalh.I*o. ( ud.,l dEll. fonh*ilh co'nply wirhrho*Pmvisions
<br />WARNINGT Failurc to ww worl6 cooptualion ovc68e is unbwrll, and shall subjccl D oployd io anninal p€Mlti6 and
<br />.ivil nnB up lo oD. nund,cd lhousd doll6 ($100,000), in addnion b rh. con of conrp.Mrio.. d.m86 6 ptovid.d aor lh.
<br />S(rion 1070 utih. b6.,r Code, rr66t
<br />D.* ) t-llo'r b
<br />lzr(j,lut!.!al
<br />I hmby .ftm undd pdally ot pdjury that I m licoE€d undd provieiot of Ch.pl6 I (commocins vilh s.<ion 7000) ol Dirisiofl l
<br />ol lhc Busins ed ProaNions (od€. dd ny licme is in luu lor.. dd .lldr.
<br />1L1\/
<br />LL-1b-l
<br />CCIII8ICITONIEIDIXC-AGENCI
<br />I hftby a,Itrm undd Fmlry ol pdju,) Oal rh@ is a co6loclion LndinS astry lor th. Paaor]@.. olln work lor vhich thir Fni i3
<br />i.su.d (Se 1097. Ci! C)
<br />AIIIICANI.I)ECI,JNAIIAd
<br />I hcEty afim und6 Do.hy ofpdjury on. of$.lollosins ddldariotr:
<br />Dcmlilion Pmits-Asb6tos Notifi.alion F.dral R.sularions (Till.40, P0n6)
<br />-R.quircd
<br />Lclrd ol Notifcation
<br />-l
<br />cdiry lhar rhe acddal r.rularioB rcSedins 6b€sos rdnolal ec not appli.abl. b rhis Pmj..l
<br />I.dify thd I halc read lhis applicalFn and iarc rhd rhc abov. inaomalion is conccl. I asra ro.tmply$nh all Cityaod Counly
<br />ordind.6.nd Stmc Larvs rektins ro buildios coturruction. and hdeliy autho,tc reprsataliv6 ofrris Cny ond Counlylo dr6 upon rhc
<br />al$ c nbr n,ncd prupeny lhr
<br />rptrlicn r o, gr t Sigflrl r.mi chtcl 4ox/eleotg
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