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APPROVALS DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underground
<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 (Rough)I 'tkz)
<br />Ceilings (Hard & Soffit Rouqh ul
<br />Ceilings (T-Bar Rouoh)
<br />lr4eter Release
<br />Rough il_4)
<br />Service Meter UI
<br />FINAL I {4lc d1r\)
<br />Notes, Remarks, Etc VT VrT-
<br />ELECTRICAL-INSPECTOR RECORD
<br />OWNER AUILDER DET,(ARATION
<br />I h6.b) altum und6 ,€.alry of psjury rhd I e .rcmpt fiom rh. Conr6.ron- Lic@ riw aor ih. followiu r€Nn (S( 70] I 5
<br />B8in6s dd hofeion Codc): Any Cn, or Counry \ni.h rcqunB . Fnil lo snslrucl, alrd, imtrcvq d@olish Dr c?at ey
<br />sttudue prioi ro hs isu cc, also rcquic lhe applicant for such p6nn lo filc a sisnol staldor rhd h. or she ie lic6.d puBuml
<br />to rhc lrotsions olrhc Conrador's Lic.n*d La$ {Chapid 9. com€ncin8 wiih Sdlion ?000 ofDilisto I oflh. BEin6s Md
<br />P(l€$ions Cod.) oi rhar hc or shc is .xmpl tnE€fto,n ed rh€ bdsis aor the aucBed cxdplion. Any violalion ofSetion 70115 by any
<br />applicantlorapmilstrbjcdsrhc.pplicanttoacivilpenahyolnolnonrh&nvehundredd.lds($500)
<br />I, d o*n6 ol rh. pr.p.rty. or my dnplorc wilh NaB6 s rficir ele composlion, sill do rh. work ald lhe $tude is not
<br />inlurded or ord.d fo! slc (Sc.7044. Busiod and llrolNiod Code Thc Conrradors Lic.e k* doe nol apply lo m owno of
<br />rh. popdy who blilds or inprovB rh@n, d tr'ho dcsucn m hin*lf or h6clf or rh(n'sh hi! or hd om .nployc.
<br />fovidcd rhat su.h inprcvand6 e mr i a .d o. ofiisi for $L ll ho\v6's. $. ttrildi"s o. impmtmdl is pld rirh'. o.. ]a
<br />ofomplcrion. thc olrnq Build6 will havc lh. hrdo oiForins thd h. or sie did d hiild or inFo!. lh. popsfr lor lh€ purpos of
<br />I. s o$na ofrh. ropsly. m .rclusi!.ly .ontr.crin8 lvnh li.m.n conrrrroc ro consrrucl tl"{ Fojd (Sc 7044. Bds'n6
<br />and ft.r*ion Cod. 'rhl Conkadoi3 Li.cns. Law do6 nor aapl, ro d os.s o f prop.ny pho builds or inprov6 lhrmn.
<br />and who conrrads lor such projccrs wirh a Conn?do(, liccmcd pus@l ro rhc Contador's Lics. bw).
<br />I m exenpl und6 Sdion
<br />Drr.: Onmr:
<br />WORKERS' (IIIPENSATION
<br />DrclAxarlo!
<br />I h6cby amrm r.dd p6.h, oapcrlo4 oneoalhc follo\in8 d(ldalio6:
<br />I lD'c and * ill ,minhin a cdifi..t. of ( oN.nr ro s.lalmorc for trvk6 comptral ioa. 6 pror idcd for by S{lion :i700 . alhc
<br />l,abor Code. for lhc p€rrommcc of lhc $oa for *hich lhc t6nil ie i*ucd
<br />Ihaveandwill,non sin workcu compens.tion insur.ncc.6 rcquned byS(rionlTo0ofrh. t.aborcode. aor nrc F6fonnm.. ol
<br />thc work for shich lhn pennit is issued. Myvorksi conrpens.lion iGurdce !ei6 dd Ix,licy numbo de
<br />PolicyNu,nbcrl
<br />I cen,ry lhar in r& psnrmanceoalhl sork lor rvhi.h rhh prnrir is iss$n, I shall.or mploy er D€son in ony mann(
<br />$ 6 ro b..o,n€ subjar ro
<br />'h€
<br />\orls' co,npffirion laN of calitomio. and a{re thar ir I should b..om. subjer '. 'h.wor k6' comp€netion provisn,m of S.clion 1700 oh h. l,fltrr Codc. I shalt. ronhsi(h c.mpl, snh rho* prolisioB..
<br />WARNINCT [ailurc to surc rork6 mnrpmaxoD covsasc is unla*ful, and slrall subj(t an dntloy.r ro dimirol p6.lli6 atrd
<br />cnil fines up lo onc hundred thousand dollaB ($100.000), in addnrcn b thc cos ol.omp.nsdtion. danaScs 6 providcd for Ihe
<br />Strri.n l(176ofrh.l f,t-r a.dc inrd6randdiomcv s fasttn/tg
<br />PECI.ASAIIO!
<br />I h6cby .Itm undo !..rlry ol pojury rnar I m licaE d uda Fnlision of Ch.pt6 9 (co'n'Mcins wnh SElion 7000) oi Division l
<br />oa rh€ Bui.6 and Phf*ionr Codc, od my licds. is in tull forcc dd .flcr
<br />,"*."**, ( lo 1il)11)
<br />""," ll/7/ l1 .,",,",y=W
<br />A.TIUIANfDICIASAIII)!
<br />I hedy amm und6 pdalry of pojury onc of lh. aollo*iog ddldarioN:
<br />D.molition Pdmils-Asbeios Nolilication rcdfial R.aulalions (Tilb,r0, Pa,l6)
<br />Rcqun.d krt6 of Norificarion
<br />I cqlily lhol Ih. Lddal r€sol.tions Essdins 6b6tos rdolaluc lor lpplicablc ro rhis pojd
<br />I cfiray Oal I havc reail rhis application dd sar.rhd rlE above inaomaliof, is conal I asrE to conplywiln allCily ud Counry
<br />odinanc6 ud Slalc LlM r.l,lins ro buildine comtrucrion. r.d lftby aurhorize lcprBdltrl iv6 oflhis Cny dd Cou.tyto old tpo. fi.
<br />ab.!e
<br />'nenrioned
<br />propeny fir insp.dion purlris*
<br />Applicanl or Eonl Signlluc ttl k,+,4/tc(^",Lut/tq
<br />Pole Bases
<br />lltttvtel,'lb
<br />'t6 lP,'N',E
<br />'Tl.,g...ut<
<br />.lr. & l, C. i)rlhis re$n
<br />CONSTRUCTION I .INDINC AGENCY
<br />I hmby ,IIm ud6 Fahy of pdjury rt,t th6. ie s snnru.1ion koditrs .sfty hr Oc p6foill@. of rnc ert for s,hich thi! Fnn is
<br />i$!.d (Sc. 3097. Civ. C.).
<br />L.nd6 s Nmc
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