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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER DEI.CARATION <br />I n<.6, arm undd p6all, of pdjury lhat I m .rcmpl from th. Conhaclos Lic€N l-3w for thc followinB r6on (s6.703 L5 <br />Businss and Proasion Cod.): Any Cily or County which r.qun6 a pcmit Io coNlrud. allq, inprorc, d@oli.h or t pdn M.- <br />slru.luc prior to hs isue.. aLso Equic lh€ aprlicdl for such pdni lo nlc a s(..rt 3rnod rhd h. o. sh. b licd.d pulMr <br />ro rh. pmvisioN of th. Contr.clois Liccnsoj t w (Chapl6 9. CommocinB wirh S*rio. 7000 of Div6ion I of lh. Busi.6s nnd <br />Pof*ioN Cod.) or fiar hc or lbc i!.r.mpr th@io6 dd rhc bari! aor lhc a1l.8.d .$nptio.. Ary viololionotsc.lion 7031 5 by any <br />applicant for 0 p€mn sub.jdrs lt applicafll to acivilpmhyotnot morclhan fivc hundr€d dolles {$500). <br />I, 6 o$ro oilhe proFnr. or ny .nploy6 * ilh walB c th.ir Flc comFnslion. will do th. sort ud th€ ffulr is m! <br />intdd.d or olldal aor sl. (Sa.7044. Busi6 md ProfesioB Cod. Th. Cofltr.clois l,iccN tiu &6 lor @ply ro @ oMn ol <br />lhc plorFty who hril& o, inFo6 th@l! &d who dc.uch sll( him.lf or h@lf or lhsugh his or hB oM mploy6, <br />provid€d lhal such imprcvo ls e nol hrotlcd or ofiqql lo, erc I[ ho*da. th. hiildins or nnFolml is sld wilhin o.c )Er <br />ofcompl.lbn. rh. O$rd Auikld vill h.w th. budrn of pmvins thd hc or shc did nor build or inpo!. $. pmpcl, lor rh€ purpos ol <br />I, s oqs oarhc prolgly, eqcluiv.lycontrerint *irh lic.6.d contrdoBro coisDd lh€ Folcl (Se. 7041, BEins <br />d PD,ission Code: Thc Conhclois Lic.nse L.rv d.6 oor apply to an owns o I propcny sho huilds or inpro!6 rhdon. <br />&d rho conrdds lU slch p(j.ck *ilh a ConLa.lo(s) lic4.d ptrEuei lo th.Conlraclor's LiccBc Iiw). <br />I @.r.mfl uda Sdtion , B. & P.C. forlhis t6on. <br />Drt. Orrcr: <br />woRxERs conr-iFNsi-roN <br />oEctdSalro! <br />I hd.by arm urds poally oaFjury onc oflh. fouowin8 dEl&.lioB: <br />I n.vc dd sill mrinr.in a Cslificarc of Congt lo SclllBuc for worl6 compdaario.. a povidcd fo, by s-tion 1700 of rh. <br />tjbr ( bde lor ln. pdfomdc. o t lh. "slt Ior which thc pmil is issu.d <br />K:hav. 0nd sill nainlain work6 conp.Bation iNuranc.. 6 r.quncd by Salion :1700 of lhc kbor Cod.. for lh. pdaoroc. of <br />iEurec. crir dd Flicynrmbd a.l <br />CD 6n <br />l.dify$d in rh. FforMc. otth. wort for which this pdmn is i$u.d. I sh.ll nol onploy dy <br />$ 6 10 b.cone subjEt lo the wo&6 Nrnposrion ld*s orcdtironia. and agrd rhar if I should b..om. subjrt to lh. <br />*orkda corp@rion lrovisions ols.d ion ll700 o I rh. rjbor cod., I sfull fonns i'h co'nply wilh lhos. pDlisions <br />WARNINC: !ailu,. to sui€ wort6' comp€elnra .o!@sc n unh$ful, dd 3h e mDloy6 ro nimi.al DqBltts md <br />rhousand dollds ($ll)(J.lr0o). <br />'n addiiNr to rhc..s <br />ult!!ts !a! <br />I heb, afli,m undd p.f,.lty of pdjury lhat I m lic6s.n !nd6 Fovisio! oi with Sdlion 7000) oa Divkion I <br />b 93f*"N <br />J-c""-ry <br />I hseby amm un,l. FaaliyorFjury rhar rhse is a.oBrrucrin lddii psfonnec. oflh€ srrk lor which tha tsn( is <br />issu.d (56. 1097, Civ. C ). <br />Lcndd s Nam€: <br />AITIIIANLDICTASAI,IQ! <br />I hdrbyrrnnuido poalry ofpdjuryon ofrn followin8 ddl,rarioNl <br />D.molilion Pmns-Asb6los Norilicrr ioo Falfal R.sularions OnE 40. Pfi6) <br />_Rcq!icd Latd otNoli6cdkn <br />I cdiry that lhe ledoal rcsulations rcssdi.s asbBlos ranoral trc nol opplicable lo lhis projcct <br />I .diay thar I Mv. Md lht .pplic.rion ud sral€ lhor lnc <br />ordinan.6 and Srar. ljws El,tin3 lo buildins cornNcrion, <br />abole mdrion.d popdly fo. <br />( <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Siqns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER 1,1/1, \'t l)r9*rr{t") <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 Rouqh <br />Ceilings (T-Bar Rough) <br />It4eter Release /t <br />Rough I (1 c.Jo <br />o ()c ,^t <br />FINAL l/)-lv <br />Notes, Remarks, Etc <br />Communications Cable <br />Transformers <br />Service Meter lnV <br />oa th. Bosins ed ProLssiod Codq o my liccE. b in full forc ed eiI4l <br />: