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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS O1!NUII BUILDER DEI,CARATION <br />I n6eby amrm u.dd p.nalry ol p.rju.y rhar I m €xcmpt lilm lhc Co raclo6' Licm. Law for the tollouiry rcNn (56.703 1.5 <br />Dusin6s ad Profsion Codc): A.y Cily or Counry whEh rquira a p€mn lo coNtruct. ahs. inpovc. donolah or r€p.tr y <br />shcrs.i Fior ro irs isueq atso rcqune lhl applicd for such p.mir ro ,il. a siSned staland rnal h. or 3hc b licoscd pGuMr <br />lo lh€ p,olnions ot $e Co.racbi! Liccnscd kw (Ch,q( 9. Comm.ncins wilh S{lion 7000 of Di,ision I ol fi. BBin.s dd <br />Pol6sions Cod.) or lhat h. or sh. is .x.mpl lh6.nom &d lh. bsis ior lhc all.scd .x@pion. Any lioldionof Sdion 7011.5 by oy <br />aprlicanr for a pqnil subjds rhe aprlicant ro acivil rcda[toanor norc thm fivc hu.d,cd dollds (St00) <br />l. d o*n( otrhc prop.ny. or ny cDploy6 wnh * ar6 a lh.t el. .onpdelion, will do fis woll ad lhc nu1ft 5 nol <br />inloded or ollged tor el. (Se,'7044, Busi.s ed Prelsio6 codc In. Corfiaclor's l-iccrc l5p do6 .ol arply 10 e oMd of <br />rh. Fsp.rty who boilds or nn|xolE lh@n, ud who do6 sch wrt hinscllor hficllor thrcogh hir or hE own mploy.6. <br />plovidcd ih.I such improvmts m ml inlod.d oroflf d forsk.l[ how46, ir building or inpmlqMt is sld within onc ]r <br />olco,npldion. th. ol,no Boitld will h,!. ih. bun6 6f proving $d hc or sn. did ml hrild or imprcvc th. p,opqly for thc pu,Doe ol <br />l. aso$,.soalhcprotEly. m.xclusivcly contracling wirh li.mcd co.traclosio codncl lhe Fojccl (Se 704,1, L6ins <br />tu PFfBiotr Codc: Thc Contracrois Liccnsc LaN do6 nol aptly lo eom6 otpropslywho boil& or inprores thd@n. <br />&d *ho cortdds for such ptujds wnh a conrado(,licmed pm@r ro $cConlraclois Lictu. ks) <br />I d crempt undo setio. . B. & P.C. for thisrwn <br />l) .r Owner: <br />]toBKlEStCOMtEnlr4rl()Npf,ct aSartor <br />I hscby ammundd poaltyolpdjurlon.olth. lollowins drlaaliod: <br />-l hlv€ sd {ill naiorain a C.nificatc olco6@l ro s.la-ln$E for work6 ornpmslior, 6 provided aor by Sclion 1700 ofrh. <br />Labor codc lor lh. pafom@. oalh. ert for *hi.h th. pmn ir isucd <br />9ft'"*and vill mainlain *ortm compcNation insurrnce, a rcquircd h, setion l?00 oarhe L.bor Cod.. for lh. r,clomancc ol <br />lhls D€mir n Gu.d. My {orln .ooFE lion i6umc. cmid dd policy nu'nbd oe: <br />O/V a _ _Erpn.s <br />I cdi! th.l i. th. paaonneccollhc wort lor which lhis ponn a istlc( I shall not dploy ey p6on in y mmd <br />s 6 to bccome subjdr Io rI. worL6'conpoEtion las olcrlitomia ed aar th,t il I should b{onc subjcl lo lhe <br />worln' @npc.tiod prcvirioN of Sdio. 1700 oathc t bor Code I slEll, lonhwith comply wnh thos tmvisions.. <br />WARNING F.ilur. to suc vork6' snDsalion cov6.sc is unlawful, dd slBll subjd' m dplot€r ro Eiminal pqEltis ed <br />civil nbduptoon tundr€d thosud doll6 (1100,000). in addil$n ro rh. con of compcnsation, dms.s 6 provid.d for lhc <br />e <br />DES/AdIIO! <br />I h@by allm undd penrlly ol pojury lhal I er li.6!.d undd Fovision of Chafl6 9 (co@cing vifi sdion 7000) ol Divisiod l <br />of rh. BcirB &d rYof6ioE Codc, and my lic@ is in tull aorE &d clf<1. <br />C-zc. <br />---Licc.s. <br />N!mbdl dr;7?g= <br />€ <br />corsrBucuoll.EtDuciclNcy <br />I hd€by aflim udq p.nalty of pdjur, firl thq. a r o.slddion Lndins .stry for lh. polomucc ol$. wort for which rht pdmit i5 <br />issu.d (Sa.1097, Civ C.) <br />ATII.ICANI.DECI,A8AIIA! <br />I hElby anim u.d6 poEly or pcjury on. oatn. aollowios dalsal iors: <br />D.mohion Pdns-Asb6ros Nor'fication Fqlqal R.aulario$ Onk 40, Pan6) <br />R.qun.d L.irs of Nolilicatbn <br />I c61iiy rhal rh. l€dsal rcsulal ions r€strdiis abcsros rmovd ac nor .pplicabl€ lo lhis prorerl. <br />I cdify rhd I h3v. r6d rhis applicoiion od stare tha! tt abo( inlomation b cond. I !8rE to compry {nh all Cny and County <br />oidina.cs ed shle tiws Elatibg ro buildins codllruction. ud hqcby adhorn. icrr6drdiv6 ofthis Cilymd Counlylo fl16 upon tfic <br />z <br />Site-Work <br />Underoround <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouqh) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter al <br />FINAL b/7/tt2 2 ;MZ <br />Notes, Remarks, Elc v <br />Rev.08-07'2015 <br />o,To <br />"*-u** "ro,t*t, .Z.r.r *HL