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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OM.rBdld.r Dcledd
<br />I h.r.by ailm und.r pcuhy of p.riury lhll I m .xnpt fom fi. Contracba' Licosc I-3w fo. thc followins rc6on (sa. r03 I 5 auin.$
<br />aid Profsio. Cod.I Aiy City d Cenry which GquiG a pmil to cohshcr, alt r, improv!, d.moliih or r.p.ir dy 3tacr@, #or ro iL!
<br />issuec., aho r.quir6 t. agplicDt for ruch pcmi! to fi1. a si8ncd slar@.or lhdn.or shc is lic.ns.d puEu-rtol]lc Fovisron5 of thc
<br />Conh4oas Licorcd lrw {Ch.pt?r 9, Conmmcin8 vnh S..tion ?00o of Oivision 3 oa rh. Buin6s sd lrof6sioni Cod.) or rhdr h. tr
<br />shciscrm $crcfM od $c bais f6 $c allcgcd crcmprioi Any ,iohtion oa Scction 701I 5 b, ary applicdt for a p.mrr iubj@6 $.
<br />applicul lo acivil Fnalty of no{ moE $d fivc hundrd dollm (1500).
<br />_I, a own.r oifi. p.opsry, orny cmploy.6 witn was6 a lh.nsol. compcnsalion, will do thc *ork Md tnc structuc h nor int.nd.d
<br />or o(f6d as sdr ( Sa ?04,1, Bu5i.s ud Proa6iotu Cod.: Thc ConE&roi's Licisc Lav d6 nor apply ro r osncr of $c prcP.n,
<br />whobuilds or ihprcvBlh.r@n, andvho do6 such work hiru.laor h6clior ihrouSh his or h.r own.mployc6, provid.n $al such
<br />ihproe.n.n6 e nor i.rod.d d offrcd for salc If, hos.vr, thc buildiiS or imprcv.mcit is sold vithii on. y* of corpl.lo, rh.
<br />OwncrBuildcr willhav. th. burdcn of provins that hc or sh. nol build o! improv. aor dc purpcc ofs.l.)
<br />_1,6 o*nd of$c propdryi m dcluivcly conlrutins wnh licdscd contacroG !o consrrud rh. proj.d ( Scc.7044, BNincs ud
<br />Prof6sion Co<tq Th. Con!&rort Limc kw do6 rol apply lo m oMd ofpropsry who buil.ls tr improvcs thrcon , bd eho
<br />coire6 fo' such proj4ts wnh a CoDrr&to(, li6s.i pdslar ro rh. coniracro.e Licosc Llw )
<br />_l m .xtrpl uild S@rie
<br />WONXERS COMPENSATION DECLARAf ION
<br />I hdcby affim und( p.nalty of pul ury on. of fic aollowing .L.lm oNl
<br />_l hrvc dd will hainttin ! Cc licar. of Conscnt to Sel .sur. for wdk.6 omp.nsaii@, s prcvidcd for by S@tid l Too ol $!
<br />ribor Cod." fo th. p.rf@c. ol(hc wort for which !h. p.mn i! isucd.
<br />_l halc &d will mainrain workcB! cohp€ns.lion isutu@i s r.qriEd by S@tion 1700 ol Oc kbor Codc, ld th. p.rfom{c. of lhc
<br />work ftr which thh pmit ii i$u.d My work.R @mp.Baio. iB!tue trid ed policy nunbq e
<br />(This s..don n..d nol b. .onplct.d if thc pdir t fo Otrc hundr.d dollds ll l0O ) or 16)
<br />,4,,^,,rl*. ',6..r
<br />in rhc p.rfomd.. of lnc work ad wbich rhis l
<br />(1100,000),in
<br />l
<br />tle.as6 6 provid.d for U? S.clid 3076 of
<br />lh.I-abor Cod., inlcrar od inoh.y's fc6.
<br />LICf, NSf, D CONTAACTORS DECLARATION
<br />I hdlby.tEm und.r po.lty
<br />th. Blsin6r od Prcfosions t in full forc. and cfi.cr
<br />pdjury th3r rh@ k . @stucrion lLdin8 .8.ncy
<br />, Civ. C
<br />APILICANT'S DECLr'{&{TION
<br />Dmdnioi Pmill-Albdd Notilicaio F.dml R.8ql.ti@r (Tid. r0, l.n 6)
<br />_ R.quiEd knc. of Nodficrid
<br />1-,,,
<br />Ihar rhc f.d.ral r.gulatioN r.gdding 6bGros
<br />rhar I hav. sd rhh .ppli..rio. ud rrdt.
<br />ordin&c6 &d Shr. L&s rcldin8 ro buildin8
<br />$ovc d.ntioncd pmp.ny f6 inspc.rio
<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 />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release Errrt ln Frt
<br />Rough Rrtr -I ?nm
<br />Service Meter
<br />FINAL SAMC 8.43,290, 550, tit
<br />Notes, Remarks, Etc.
<br />Communications Cable
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