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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER DEri^ARATION <br />I fi*by allm undq p.ralry of pdjury rr'.,1 , d crcmpt ton rne Conhcro4 Lic.ns. La{ aor rh. followins r.Nn (s&.70115 <br />Busin6s and Proiesi.n Cod.): Ant Cily or Counly stich rcquir6 . psEn lo conslrud. alt(, imptov€. d@olish or rcpat , <br />smduq ltior ro iis isud&, also rcqunB thc tppli@l for such FEil ro 61. , siSn d slalmol lhal lt or sh. is lic.nsed pu6u l <br />ro rh. provisioN ol6e Conlr.cro.s Lic.nsd Llw (Chafld 9, Comm.ncins wilh S*lion ?000 ol Dnision I of rhc BGinB ed <br />Profsions Cod.) or rh.t h. oi sh. ir .r.mpl thg.from sd th. bsis for lhc all.led .rdptiof,. Any viohlion oasdrion 701 L5 bv uv <br />.ppli.d for r pmril subjals lhc applica lo acivilpc.alyofnor mor.de fivc hun&€d dolls (Ssoo). <br />l. as osnd ofrhc prcp.ny. or ny cmploye6 wilh saB6 s lheir elc compcBalion, will do thc wo* dd lh. strud@ is tur <br />i odcd oroird.{ aor elc (Sa.7o14. Busin6 ed PrcfsionsCod€: ThcConlEcroir Lic.M La$ do6 .ol ,9plv to e ovnd ol <br />the pmpdy who boilds or imFoc thson, dkl who do6 such Klt hios.lror ha*ll or rhouBh hb ot ho oM .ttprova. <br />provid.d thd such imlrovoal! em( inrdd.d orofidal for sk.I[ nowd6.llE hildina or impmvdal i5 $Usthinom rd <br />oacongkiotr rh. Ownd Buitlg will halc lh€ hrdd oaprovidg iha hc ot she dil nol hild or inFo!. $. popqly for lh€ tl!4rs or <br />-1. <br />doMsoaihcprop6ly, dn ciclusiv€lyconra.lins wnh licsrd .ontraclots io snslruct lh€ Foj.d (s(. 7014. BGins <br />md frDlision Cod€: 'l h. contr.dol s Lic.ns. Law do6 f,ol apply lo e ownd oaPropcny Nho builds or ifrprovd rhdon <br />and who comacls for such F!j.r1s Bnh a Condado(r l,c@4d pu6@t lo th. conta.lols l-icm tiv) <br />I anercm unddsNto. . B & PC f.' rhis!6on <br />WORI{ERS' COM PFIISATION <br />DECIJSAIIO! <br />I h@by srm rrid p<Elly olrrqjury oc oflhc fouoving d..lE tioBl <br />-I <br />ha!. sd will minraiD a C.difical. otcoMt ro S.ll-lBu. lor sortm @hp.nlttion, I Fovid.d for hy Sclion 3700 of lhc <br />Labor Codo forrh.,sfonn&c. oflt wod( aorvhich lh. p6,nil is isucd. <br />>lfilvc and will naiitain wort.rs comFsario. i6ufu.q 6 r.qui(d by scrion lToo or rhc L.bor cod.. for rh. pqrotl@c. or <br />rh. worL lor wnich tht pdm b i$.d My wql6a onpas{ion icumc. csi6 std Flicy n@ba e: <br />lo .< 9er ttt e AJr\^ <br />Qo <br />I c€.lirylhal in lt€ p€.fomec. of the work for whi.h lhis p€mn is isucd. I shtll nor mploy Eny pd$n in my m&n6 <br />$ s lo !..om. strbl€d lo ltc worl6' omFMlion lass oacaliaomid. trd aAE ln.| il I should b..oft 3ublct to th. <br />woA6'conpdalionprovisioNofSElion3?00ollhcbborCodqlshall.fonhvniconply{irhrk)*PmvisioN.. <br />WARNIN(; F ilure lo sNurc Nort6' co6!..sdlion colcds. s onl0lvful. d shall subje.t D onplols lo simi.al IEEli6 ed <br />civil nncs rp to on. hund..d thoMd doll6 ($100,000 <br />S€lion 1076 olth€ tihor Codq inls6l ud tdoh.y s 16. <br />l, in addirion ro the cosr of.io.. dma!6 6 !tr'vid.n 6r rhe <br />It-zo-1 5 <br />T)DCLARATION <br />I hdeby amm undd Fnah, of p<jury lhar I d lictu d undd Fovision oachaptd 9 (conmflcins *ith Sdiion 7000) of Division l <br />ot rhc SNiB a.d Proreioc Cod.. a.d my licd. is in tull lorc. ,ul tfl€t <br />k 0tZ il <br />o \-o1 :?a 2o c.""*". <br />CO! AICIIONIIIDIICIGEICI <br />I heby am rndd Faalry ol Fjury lha th6. is . oisltudion lmding a86cy for lhc pdfo'lm.. ol lh. vo* for $hi.h rhis pdmn is <br />isucd (s4. 1097. ci!, c.). <br />AITII{:AILDES,AAAUO! <br />I he.by a1lrn r.dd F.ally of psjlry on€ of lhc following d.cl&rrio.s <br />D.mol'r ion Pmits-Asb€ros Norifi.arion Fcddsl R.xuhtions {'I itlc 40. P416) <br />-Rcquir.d <br />lilloorNorific.lion <br />I rr.rc lo conply wilh a Cnymdaoutrty <br />rtiv6 ofrhis City ed County to orc upon the <br />abore mstion€d prcpsly for inrpdion purpos. <br />\pnlti or l[u't Sig m <br />ncrn,ireen n€(prn,rr. F{f< <br />*,"16*2"-19 <br />Site-Work <br />Underqround <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 / Grounding / UFER <br />Torqueino <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 ltrleter <br />FINAL q///b arMr,) <br />Notes, Remarks, Etc '/ 't /--'U <br />Transformers <br />Pr,l-or^(c <br />i{ r( n