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ELECTRICALNNSPECTOR RECORD APPROVALS DATE ID/SIG.O*ra-Builda Dccldadon I hd.by alfim undd pcDally ofFrjury dEr I m cxdF fom rhc Conftcto6 Licnsc kw for $c follo*in8 rc6o. Gcc 701L5 B6incss d PrcfNid cod.): Any City 6 Couty *hich Equt6 3 Fmir ro @.trud, al6, ihprov.. dmoli5h s Eplir ay ihct@. Fid !o its isuscc, aho rcqutB th. appli.mi ad such !.mn ro fi1. . rigncd lhh.nt fial h. or sh. h li...sd puRuet lo th. povirioE ol $c Coilr&rols L,casd t w (Ch.prd 9, ComDmcing with Scclior 7000 of Division I of0!. Buincss dd Profc$iois Codc) or that hc B shc is cxmp! (hd.ar6m d lll. bai! aG tn. rlhe.d .x.mprio. A.y violdion of Sstim ?0r I J by ey appli@l fd a p.mn subj.ct tn. appli@r lo a civil p.nalty of nor mom iha fit. h!nd..d don6 ($00). _1,6 ownc! oarhc prop.rty, d dy chploy.6 with *.g6 d rhcn rcI. .omp.nsation, will do tn. wort dd rh. rucru. E nor intddcd or oaf@d 16 salc ( S4 ?044. B6in6s dd Prcf*io.s Cod.: Th. Conhctors Li.as. Law dG nd apply to d wn.r of thc prcpcity wno builds or imprcvB thdcon, ad who dc such *st hirucla or h6clf or rhrou8h hn or hd own .nployG, provi.lcd thar such iopro!.m.n6 ec .or intndcd or of.!.d aor sal.. If, hd.rd, th. buildjnS 6 improv.mmt is sold wilhin on. y@ .f 6mpl.!o, dc O*n6-Buildd will havc the burda oa proing thrt hc r sh. nor build or inprcv. fo $. puQ6. ofs,l.) _1, a own.rof$. pm?..ry, s cxclsiv.ly onractina *nh licms.d anlr.cl s lo coBtBct th. prcjcd ( 56 7044, BBine ed Proa6ion Cod. Th. CoE&tols Licds. Llw &6 .ot apply ro m ownd oa propdry wno builds d improvs rh.lls . dd who @nreE for such projds wilh a Colrelo(s) liEned puBuot to thc CoE&lor's Lihs. Liw ) I o cx.mpt und.r S.d,dn ,B &PC for thir rcaon IIOIXEsI-COI4EINSATO!.D.&CIABAIrctr I n r.by amm undd p.nalty of Fjury oD. oi th. iollowi.8 ddlaarioN: _l hsvc ud will rainlrin aC.nifi€6& olcmat to Scl nsurc ftr uorL6' Mpcns3lid. a povidcd for by Setion 3?00 of$c tlbor Codc for th. p.rf(mucr of lhc vort for which ln. Fmn is h$.d. I havc Md wiu maintah sot6' @p.$atio. ituufue, a rcqui.cd b, S<don 3?00 of rhc L.bo. Codc. fo $c pdfotrruc. of $. wdk fd *iich $is pqon ii is3u.d My wo&6 @hp.nsario insutucc 6ia &d policy nuhbcr dc PolicyNumb.r: ExpiG'x;: *-*,,tu-,," not bc cnpld.d il$c pmn is ld On. hun&cd dou6 {1100, ot th. pdfomoc. of th. work f( whicn $h pann it isu.d. I $. wdrft ' c@p.i5ati@ las ofcaliaonil, ed ag@ 3700o1$. t bor Codc. I shall WARNING Failxc to sccrE work.6' comp.nsatio d €mploycr lo c.iniral polalri.s dcivil firq up lo m. hundr.d IiNad dolla (l100,0m).ii lddidoi & the cct of conposaion, d.mag6 a provid.d for lhc Sation 3076 of thc bborCod., inrcr6l Md mcyef.6 I h6.by affim un.ler p.nalty of p.rjury thal I m lichscd unda prcvisim of Cnartd 9 ( $c Blsinds d Pmfcssions Codc, ed my licdsc is in aull forc. ed.af.cr -o I n@by .fiim ud.. pcn.lry of pqjlry thar U@ i! r @rrruclion lddins ,gdcf fc rh. Ffl,ru@ of tn. wdk f6 which lni5 p.mir k is@d (sc. 30e7. Cii. c.). ATIUCAILIDECIIA{IION Dnolnion Pmils-Asb6r6 Nolifiodon F.dcr.l Rcgulatons (Titlc 40, Parl6) Rcqutcd L.uq olNoifi caion I ccniry $ai d. r.dc'al EEoladoos nsrdirE 6b6ls 44 thattn*.rca thi.s apprianio. Md sd. rhar cmply wnh allCiry dd Cdnry 6dinec6 ed Slatc kqs El inS to buildinS abovc mcnlioncd prcp.ny for in3p€lion pu'!G6 4-rt- Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough)trYI,IQtr n Meter Release trtrD I ')ltq Rough Service Meter SAI ru 6-43, ZgU, t 56, 667 FINAL Notes, Remarks, Etc COMMENTS Ird., OMd' I f --T------ I