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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS DATE OWNER BUILDER DELCAILATION
<br />I hd.by arm u.dr ixnalt, of pslory lhol I m .xcmF tom lh. Conta.rort' Lic.Ne Lrw fo. rh. follosinS rwn (58.703 L5
<br />BBi.6s ard Prolsion Code): Any Ciry or Counly shich ,.!ui.6 a pcni ro mBrruc( aho. imprcv., da.olish or Blan e,
<br />nrudu€. prior to ns Guec. a,1$ rcqnt6 rhc @plicdl for srch p.mil to lilc a siSncd stalmot lhal h. or shc n Ic6s.d P6uml
<br />ro rh. provisioB of ih. Conrracror's Liccnsed tiw (ChaflE 9. CommdcinB {ilh Sdlion 7000 ol Dilision I otth. Busind dd
<br />Prcfdsioos Cod.) or thar h. or shc i5 crdpr lho.&on dd lhc bsis aor rh. ill.8.d .rdplion. Any violAlion of Selbn ?01 I 5 by &t
<br />.ppli.ad ror a pmi sobtec rh. applicmr to acivilp.nahyotnot mor€ thu fiv. hu.di.rl dollds ($500)
<br />4'li!4. 6 oM€r orrhc prcp€ny, or ny dplorG wlh wag6 s rhcir $lc .omp.Mrion. will do Ihc lvort and rhc amcrdc b mi
<br />iflaxkl or oue.d aor el. (Sd 7044, Busin6s Md Prcfsioft aodc: Th. Co r&lors t,i.@ Llw do6 nol lpply ro m ownq of
<br />It DilpEly who tuil& or imp.or6 $6e'i. a.d who do6 such *o* him.lfor h.elaor ltmugh tus or td ow cnployc.
<br />prolidai rh.r $ch nnpro@rs e
<br />"or
<br />inrqd.d or of,o.d lor eL ll howdd. th€ btrildins or imPIow"E is $ld wilhi. on. ,a
<br />ofco,n ldion. rh. Oqrr Builds will harc rh. tudd of ptroving rht he or shc dd mr hrild or iqrov. thc tropdy fo, th. purros of
<br />l. sowndofrh.rrololy, m€xclusiv.lycontBclins wilh licoscd c.nlBdon lo cosrtu.l lhc Fojd (Sa. 7044. BG'iN
<br />a.d l,roftsiotr Codc: Thc cont,.ror's l-i..!sc l.aw do6 not applyto & dsn6 olp.opdy who buil& or imprcvd Onsn,
<br />d trho .om6ds aor suh projds wnha conr6cro(s) lic.ns.d pu6mt to th€ Conta.rof s l,icd* lz$J
<br />_l m.rmpl mds sction
<br />Q,nuLr-tJ^'",. ,//-L, -)Ol P
<br />DICIATAIIq!
<br />I h.r.by amfln undd pmalryolpdjuryon€ ofrfi. follorinS d.clualioN
<br />-l
<br />hsvc rnn will mai.rain s Ccniarc .oaco.sr ro sdfisur€ aor vorlst .on9.n3,rion,6 p(vidal for byScion:1700 ollhc
<br />L,bor codq lirr rhc pqhdan<. o arh. wo.r aor whi.h lhc p6mn ir isu.d.
<br />I hav€ md rvill maintain workcB comp.nsalioo isu' anc€- 6 r(tuncd by Ser ion 1700 of thc Labot Codc. tor lhc pdromdc. ol
<br />Ihc Nort tor shich lhis p€mil t is.4 My workdi conpslsarion iGa&c. ori6 md policy numbq rcl
<br />Policy Nmb6: Expi6l
<br />htq-/tr*,',"rhar i.rb. psiormanccofth€{o.k 6r{hrchthisp€rmir n usr.d,I sh.llnor anployanyp6on in an} ndns
<br />e 3lo b@,n. subjdr o rh. worl6' comFsaiion h*s oa(:aliaomir. d agreltal if| siould b..6n subjdl Io d.
<br />{od{d conlpdsrion pmvisios ol S.€lion 1700 oflhe kbor Cod.. I slull. fonhNnh codrly *irh rhoc pr.vbio6
<br />WARNING: F iluB ro sw. $o.t6' comp.ffario. ovm8€ is unhvtul. and shall subj*l o mployd Io dniml pdEhi6 md
<br />civil nn.s up to onc h@dr.d thousd dol6 {1100,000), in addilion lo lhc cosl of conp.@rio.. d,mg* a provided for thc
<br />Sdion 3076oarh€ libor Codc, inr-*r edolrormy's a6
<br />LIS'NIDIA.NT&|CIOBi2[(rlBAl&!
<br />I hd.by .mm und6 p.natt ol psjury lhot I dn liccnsd und6 provision ofchoprq 9 (com,nm.ing wilh S6tion 7000) of Dirision l
<br />ol rh. B6F6 ed Pol6ioG Code. ad my licft. i. in full fora and.ild.
<br />CANiIAJJCIIOII.ENDIAC.ACDICI
<br />I hcby artrm unds poalry of Fjury that lh6c i! a connrudion bndine aedcy aor lnc pcaolruc. oilhc wr hr wtuch ln. Fmn i6
<br />issxcd (Sa 3097, Civ C.)
<br />AIIIICAILDECIAIAIIO!
<br />I Hy afim undd Fmlry of p.rju.y on. of lh. folloqins d*l*alions:
<br />D.molition Pdmiis-Asbdtos Notiication Fcdml ReulatioN ('rnL 40. Pan6)
<br />-R.qoirqi
<br />L.ttr ot Notituolion
<br />-l
<br />cdiB that $e ledoal rcxllarioc r.s&dins abcos rdnov.l &c not .pplicablc lo lhG tmjcd.
<br />ft4&d,L r hd I h.,. rcad r his applic0r ion ed nar. rhd rh. above inromar ion is cordr. I as@ ro .omply srth 'll c y and (-ounty
<br />odiEn 6 md Sral. laws r.ldtrB ro boilding .oNi dio,L d hdbyaulhona rcprBdtdiv6 oaoi! CiryedComlylo 016 upotrth€
<br />d{vt inenrn,ncd pmFn) ntr insp(rn,n
<br />.^pplicsn( or ng€n( Sknalurc:
<br />A
<br />D.',' //-lo-2OtE
<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
<br />Bonding / Grounding / 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 />Rough )
<br />Service lvleter /L"
<br />FINAL z)bl/,",'ia W,A/",r20
<br />Notes, Remarks, Etc u l
<br />-b
<br />tD/stG.COMMENTS
<br />Meter Release
<br />,'",.,'//'/,t-)Ct I
<br />LiclM clN:-Licmc Nunb..
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