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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Spas, Pool, Fountains
<br />Si NS monument)
<br />Life Safety /Low Vo
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Rough)
<br />hCeilinSHard & Soffit
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc.
<br />OMq-Buildd D.chr*id
<br />I h@by tffim un.Lr pc,alty of pcdury lhd l u qdpt fm th. ConEet R' Li.ft. L.* fd lll. fo,lowins 160r (ac 7o3l 5 BEin6
<br />dd Prcf6sid Cod.): ,{Iy Ciry o CMt, wtich rcquiG a pdmn ro ffi.r alto. improvc, d.nolish or Epajr ey sructurc, prior ro ic
<br />i$@e..bo rcquiG 0'. appli@r ldiwh Fmn to fiI. a ri9cd s1llcnht 6a1hc or sh. b licacd puBuer to rhc provisios of $.
<br />Contrclolr Li€asd L:w (Ciapra 9, Coomcr.irs {ith Sdtid ?00l) of Division I of rh. BBin6s dd Proadrim! Codc) or thar h. orih. ir q@pl ficrcfM &d d!. bsis fc $. .ll.g.d .xmption Any violalioD of S.ctid 7ot t 5 by &, .9ptic&t fs I Fmi! subjccts th.lppliki lo . civil p.f,.lty ol noI tuE $d fiyr hu.H dolla (tsoo)
<br />_I, a omd of lh. Fop.rry, or my mdoyG wit ysge s 6cir $1. compa$ri@, *ilt <to lhc wort Dd inc stlct@ is,ot inLndcd
<br />tr offd.d fd sal. ( Scc 70.14, Buinqs ed Prolsions Codc Th. Co.r@to,s Li@s. tlw dB not appty to e omd oa th. prop.rry
<br />*ho buildr d ihFove th4o,, sd who d6 such w*t him.lf or hd.lr d tiroush hi! n h6 M .nptor.6, Fovjd.d rhd suctimprcvd66 e n i intad.d d ofiatd for s.]l Ii howcvcr,6c b{ildins * imprcvmr t iold wirhh on. y@ oa@opldjon. $.
<br />Omd-Buildd will hwc thc burd6 of prcvin8 lllat h. tr sh. nor blild o iopEvc fo th. purpc. of $1.)
<br />_I. a omn of tlr propdy, m d.luiv.ly conradins with licas.d mhcroB ro .mtruct th. po.iet ( 56. ?044, Bcine dd
<br />Prcfdi@ C!d. Th. C@Eactols Li@. tjw d6 not apply 10 u oMcr of propc.ry vho builds tr inr6v6 th.l@ , &d who
<br />mrr4B ftr sucn poj4ts wirl' a cdE&ro(, li@.s!d p6@r ro thc cmfrcte,s Lictu. Lay.)
<br />_l e qmpr und.r S*dd
<br />WOfii(ERS COMPENS TION DECI-AXATION
<br />I h6Eby lffim ud. F.lly of pajury 6. of rh. follsi.g dccl.rari@:
<br />_I nlr md*ill6.int!in 6Clnifi@of ColMrroS.I DW fo wot6.compoMliq, s Fovid.d fd by S..rim j?oo of dt.t hd Cod., fd th. pdfme of th. w6l f6 which th. FDn is isucd
<br />11 h!v. ud will mainrain vdl6' .@p63!!id iMllfu@, s rcquiEd by S.c1io 37Oo of 0tG Llbd Co<lc, td fic p.rfmd@ of tn.
<br />ihis pami is hru.d. M, work B' cmpcaiaio. insumcc 6i6 sd policy numbd dc
<br />OL L
<br />t-5 D-rg ot3-
<br />b. @nplcl.d if th. F,iri{ is fo. Onc hun&cd dollm lt t 0o) tr 16,
<br />_l cfiiry $!r in lh. Ffmc. of d!. *ort for which this Fmir ii isuc<l I sha]t nor mdoy ay Fsm in dy mund rc s lobd.ft rubjc.t lo 0!. wd*d @p.rodj@ laws of Cdifmil. sd agre rh.r il| shout.t b€m.
<br />Sedon 3700 offi. Llbe Cod., I shll,
<br />s6urc wort 6' .mFErri6
<br />rnoaed doll6 (S l0o,00o),in
<br />subjd & @ployn b dininal pcn.iri6 ud cilil
<br />o, dmag6 a providcd fe thc Sfttion 1076 ol
<br />IICENSED CONTNACTORS DECLAR-4IIOI!
<br />I hcEhy afiim ed.. pcoalty of p..jury tll.r I o lic6s.d undd prcvti@ of Chapld 9 (commd.ing ,ilh Sfttion ?o0O) ot Dvisio 3 of
<br />th. BBin* ed PIofsians Cod.,4d ny li6s is in fult fm. dd €lI*1
<br />u
<br />I hr.!y affim lnds Fnalty of pa;,ry rt ar O* ir a oriaraion totA,,g awy
<br />i$u.d (Sa 3097, Civ. C.)
<br />thc p.rfmc. of lh. vort for vhich rhis p.mn is
<br />APPLICANT'S DECLARATION
<br />Dsn lirion Pmir.-Asb6loi Norificnd rcdfat R.Sutdions (Tirtc 40, pan 6)
<br />_ R.qutcd Lald ofNorificario.
<br />_l .s{ry lnzt lnc lcdcol rcguldions rcgrdin8 sb6ts movrl & .or appticabl€ b dris Fojcr
<br />, A*,n^
<br />f,Einucaua s
<br />I h.v. r.!d this arpliclrion od shr l'.r tn. obov. in u c@ct I !8rE io .ompl, ,ilh all Ciiy md Couq
<br />Light Standards
<br />Walls (Conduit)
<br />Rough
<br />t-i2.&ralZ/t?/a/ -/4t1
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