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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Oqd-Buildd Dccletioi <br />I h4by affim und.. p.nalty of prjury that I d *cmpt fom thc C.nlt&rots' Licos. La* for rhc follovin8 160 (sa.703 1.5 Bulins <br />ud Profesion Codc) Ai, Cit, q Couir, vhich tqlirB . Fmir to con!!tuc! 6hcr. imp@c. dmolish or Epair &y structur.. prid ro ir <br />irs@c., also r.quirs thc .ppliqnt for such p.mn ro fiI. . iig..d rGt mat rh.( h? o sh. is liccns.d pusumt o d. provisions of th. <br />contractor's Lic.ns.d Ltw (Ch.ptcr e, Cmmcncins *ith scctioi 7000 of Divkio. I of $c Bsiies ed Prol6sions cod.) or rhar hc d <br />rh. is .xcmpl lhRfrm d th. b6is fm thc rll.g.d .x.mplior Any violalio of S.clion 703 I J by e, .ppli@l aor . p.mil !ubj6l! thc <br />app,i@r lo acivilpc..lty of not m@ the fiv. huid..d dolls (t500). <br />_1. 6 ownd ol lhc Fopaty, s my mployd wirh w.g6 s ihcir sk conpas.rion. will do lh. wod ud lh. lrucrEc is not inBdcd <br />or oltdd fm s.l. ( Sa ?044, Buin6 ud Prof6io.. Cod. Tn. Cotreror'! Licffi t2w do6 not.gply b s oMo of thl prcFny <br />vto buil& or inprcv6 lt.en, ud who d.B luct work timclf d h6clf or tfiroush his tr hcr M cmploycB, providld th.l sucl <br />imp'ov.mob B nor inldd.d o' offd.d rn r.l. l( howcva, t. buildins or imprcvmor t 3old wi$ii onc rdof cohrlai@, $. <br />o{.6-B!ilds will h.vc rh. burdm of prcvin8 lhar hc o, th. nor build or improvc for th. purposc oa !al.). <br />_1, s ovndof$. prop.rry, m qcluivcly cont.clin8 with lic.ns.d @nr*r6 to @.rrru.t rh. proj.d ( Sa.70aa, Bsinqs d <br />Prof65io Cod.: Th. cont&1ors Lt.Bc liw dG nor .pply ro e oena oi prop€ly who buil& d inprovB thad , ed who <br />conracE for such proj.cls wnn a Conreb(, limcd puB! r ro rhc Cont.crofr Li.nsc trw ) <br />_l m.x.mfl uda Satim _,8 & P.C. ld this Ead <br />WORT(ERS COM}ENSATION DECLARATION <br />I hacby af6m undd pcDaliy oi p.rjury on. of lhc following d..l@lion! <br />_l fi.v. ad will m.iouin . Cqdfist! of C@ot to Sclf-lorurc for wo*6' comp65.tid. a povid.d for by S@ti6l?00 of rh! <br />Lald c.dc, fd thc pdfdlM@ of thc *dl for which thc pcDit is islu.d <br />*l h.v. md will minhir wdkcs cmpa$ldon ituur&@, a rcquircd by S.ction 3700 olrhc Labo. Codc, fd thc pcrf@-.. of r'. <br />wol for vhich thii p6mir ir iss!.d- My eo*6' @nFmarioi insuaa @i!r ed policy nu6b.r ac <br />PolicyNumba ExpiG <br />ifthc Fnn i! ror O.c hun&cd doll6 {t100} or 16, <br />f6 which rhis lmil is i$u.d, I <br />.ws of c!lil@i\ Dd asE dr.r. <br />cmploy e, pcEon in any <br />work.R comp.nsarion covcragc <br />d doll4 (1100.000),ii addnioi damas6 6 provid.d for lh. S.clrd <br />LICENSED CONTRACTORS Df, CLARATION <br />I hq.by a8im und( p.nahy of pdjury fial I u li.as.d u.d!. prcvisi@ ol ChlpiB 9 i <br />ficBusin.$ ud Profc$ions Codc, and lic.nr k ii full for@ and cffccr <br />ofpdjury thd lh@ is . @n5rrudion lodinS !3ocy <br />, Civ C.) <br />APPLICANT'S DECLARATION <br />D.frohion P@ir!.Arb6rd Nodll@nd F.d.nl Rlsutlridr (Tid. 4q Pd 6) <br />_ Rcquircd Ldr.r ofNodficado <br />'asrd ro comply wnh all Cny Md <br />abov. m.n1ion.d prop.dy ltr i.rpcciion <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 <br />E;',(i IiRED <br />Rough <br />Service Meter FEH I ZUIS <br />FINAL SAMC 8-43 200 55A F <br />Notes, Remarks, Etc. <br />L-d* s N*. <br />- <br />Site-Work <br />Communications Cable