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ELECTRICAL.INSPECTOR RECORD
<br />DATE rD/stG.COMMENTS (}1! N ER AU I LDER DEL('AR 'IION
<br />I h6.by a,Im unds pdahy ol pojury lhal I m etmpl fmo rhe Contradou Licd* Iiw tor rh. follovinl r.M. (Sd 701 I 5
<br />Busins and Prof6sion Cod.): Any Cily or Cou.ly $hich equi,B a Fnil lo <oEhrl. slld nnProc, dftolish or r.Pat mv
<br />slru.r@, rior Io irs isuaocc. also Equn6 rh. appli..nl lor srch p€mi kJ 61. a siSn d stat rol lhal h. or she t licm.d puN&r
<br />to rh. proris,oos ofth. codrraclois Lic.nsed t,aw (Chafl- 9, Commcrcins silh seri.n 7000 ofDivision I oarh. Ru(in^t md
<br />Prcf.sioN Cod.) o. rh.l he or she t dcmfl rhd.lion md th. b6is for tlE alle-lcd €ronption. Any violationoasectirn ?011.5 bv an)
<br />applicanlforapmrilsubj*hrh.0pplicanlloacivilp€nallyorlornorerhmfilchundrcddolles($500)
<br />t. 6 ow6 ollhc prepeny. oi ry e,nPloye rilh s ass 6 rhcn sh comp.flsation. vill do rh. qorl trd lh€ drudu. b mr
<br />inloded o! of.rcd lor sl. (Sc.?044. Dusin6s dd PiotusnJns ( odc I h. Conlraclor's Licw t w do6 nol applv b d o"rr ol
<br />rhcpspeny who toil& or ilwoG lhq@n, Md who drE such \ oli hinlcla or h6ell or limush his or hd own .mPlov.6.
<br />p'ovid.d rhar strch inproldndrs N nol inl (H o,.ITsed fbr eL ll ho16q, rh€ buildins or iftproltmdn iseld wilhhorc )@
<br />oicompl€lion, lhe Osnd Buildd "ill h.v€ tic hrkn ol pBvins lh, hc or sh. dil trol hiB or idpro\! th. FbPdv ao. 6e porl.e of
<br />l. s oMo oflh. prop.nr. n cxclusivcly co.rracrinr *nh licots.d conlrrcto6 kr oisrtud th€ Fojd (SE 7044, Bains
<br />and Poiision Cod. 'rn€Contador'3 Li..ns.l-oq do6 nor apDlyto an oNdd ofprop.ny$ho builds or nnpro vs lh6(n.
<br />and $ho co.rids aor such Drojds wilh a Conttulo(3) li.m.d prrsusl lo lhcContador's Licdsc t w).
<br />I @ cxdfl undd S..lion , B & P(-. forrhs 'Bs.n
<br />wotu(Exs'coMPENsa tIoN
<br />DEEI,AEAIP!
<br />I hdcby alfim undd porry ofp6ju.y oE oflh. followiiS dclmtioBl
<br />I har. dd*ill minrain a Ccnili.al. ofcoMt to s.lf-lmur.lor w 6 conp.Nalion. s Fovid.d h, bySdion 1?00 ollh.
<br />L2bor Codc, for rnc pcfoffie oI thc Bo,l lo. which fi. P@nn is isu.d.
<br />Ylh c and wrll nm'nk'. u 0116 comFMr ror iNurancc. s r.quiEd by S.clion l?00 of th. tabor Codc. aor th. pafor@.. of
<br />the wolk lor Nhich lhis pmit i3 if,$.d. My vork6 coopeelioi iNu@c. cei6 dd poli.y tunbs ei
<br />las"tl\co-
<br />'*,."futo 3/r1ziTtLn
<br />I cenifyrhd inrh.pdanroan.cofrhe $ork foruhich th'rpcfrir k lssucd.l snsllnol @ployanypdsn i.anvmoncr
<br />vr 6 ro bdoftc subjd b lh. so*61 cofrF€rerion l.ws of ( 0liaomia. and asrce rhar if I should bccomc sbjd ro lhe
<br />vork6 co,npmsrtion prcvisiolsorse.rion lTooofrhe kbor Codt.I stdll.fndh$nh comply Lvithlh.Epmvisio6
<br />*ARNING Failur. ro sue so!ke6' compcdsrnJn .ovenrc is unla\elul. dd sh,ll subjar an mplorcr lo dininal pduhi6 dd
<br />civil fin€s up ro onc hundrcd rhousand dolltrs (S|O0,00O), in addnion loth€co( of conpcNtion d.maB6 a poidrtl ro! rh'
<br />Sedion l0?( orrh.l aLr(od.. inlE6l and
<br />LICENIELCONIIAqTAB
<br />DECIaAAIIO!
<br />I hort y .flirm undr pcnalty ol pdjury lh.t I an licos.d undd prolisDn oachapl6 9 (conmdci.s *ith s{tion ?000) ol Division :l
<br />ot lh. BuinBs dd Pot6sioBCod..od nylicmei. in tull fotcc dEficl
<br />q, q e,7-
<br />CONSTRUCTION LONDING ACEN(]Y
<br />I hq€hy amrm undd Fnallyofpeiurylhal rh6€ is e connru.rio. Lndi.8 asqcy ror thcFaom ce ollnc sort l6i \rhi.h rhis pqnril is
<br />ksocd (S(.1097. Civ. C.)
<br />AT8IICATLDECI.ABAIION
<br />I hddy arm und6 paalty of prju., oN ofrh. follo*its dccl{at io6:
<br />Deoolilion Pmirs-Asb€tos Norifi.arion Fcddal R.gulolio.s (Tille 40. Pan6)
<br />R.qund Lc d oiNotifi cario.
<br />-l
<br />cdri lhal rhe ledoal Flulari.N Eaedm3 6b6los rdo'ald. nor tpplrclbl. ro lh's frcJd
<br />)al (cn,6 rhd I h,r. rc.d rhts rpplmnnn ed nal.lhar rh..lir. infomalion iscotr&:l.I sgd ro condv wnh.llcnvtnd aountv
<br />ordinanc6 and Stsr€ lr\s Elarins lo huildins connrudion. 4l hdtbratrlnorize iv€ olthis Cii, and Cou.tyro ota trIx)n
<br />abvc nEnioned [openy ntr .=:z
<br />id 14 ilo<.L
<br />,,,. lhl*a
<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 />Communications Cable
<br />Building
<br />Under Slab / Floor lt It ,,SA
<br />Bonding / Grounding / UFER t r5r/0/0 !wnhk 6W
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Roush
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />.hl"^-t ^/z
<br />Rouqh rurlv v wqr N6'
<br />Service Meter FIWT? (w1nb/e w.
<br />FINAL tLTVritt ,ly-t/bA &t
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Air Conditioners
<br />"".., / /z /z-t:
<br />,.".*.r**, C-l O
<br />*" //L/4)..",."",., 1eu Ek<+t Le 14<-
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