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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE rD/stG.COMMENTS o1,6-Buildd D..le ion <br />Ih.,.6yliirmlndsp.mhyotp.rjuryth.tIao.xemptfo.mth.ConrtdoRLE.L.*forrh.rouowrne160r(w.7olI5BEin6. <br />ind Prcf.ssion Cod.): Any Cn, or coury !hi.h rcqunc ! p.rmit to .oBtrud. rlld. improv., dcmlih or Ep.n 6y slrucls., prior to n! <br />issuanc.. d$ r.qun6 th. rpplica forsuch pmil to,il.r sr8..d sllr.n thar hc or shc ir liccc.d puBunr ro rh. povisioB offt. <br />Cont,rctols Lic.G.d Law (Ch.prd 9, comh..ci.a with SclDn 70oo ofDivuon, ofrh. BNin6s.nd Prof6sio.! C6d.)or thar h. or <br />shc i! .x.nfl o.r.fton and lhc basis aor th. all.s.d d.nprion .A!y viohtioi of S.ctiotr 701 L5 by &y sppliqnt lot a p.mn subjers rh. <br />lpplicel b..irilp...lty oa.ol @rc the nvc huodrcd douaB($500). <br />_I.a osn..ofrh.prop.nr,ornycBployc6wirhw!g.!!srh.irsol..omp.nsrion.villdorh.vork.ndft.structu.isnori ..d.d <br />or olt r.d fo. $1.( Src 7044, BurHsind Prof6nonsCode 'rh.Co,tacrors Lic.6. tiu do6rcr.pplyrornown.roarh.prop.ny <br />who buil& or inprov6 rtd@n. afld who do6 such eo.t hitu.lforh.6.lrorrhroush his or hr own.nploy.6. p.oyid.d rhrl such <br />ihp,oEm. sq. nol inl.nd.d or of,d.d forslc Ir, howcvcr. thc buildins or imprcv.d.nl is sld wilhin onc y.ar ol.o,npl.tio., rhc <br />O*nd-Build.r will h,!. th. burd.n or prolirg lh.l hc or shc rcl blild or inprov. fo. rh. pu.pos. oa !.1.) <br />l. eoreroath. proD.ny. m.rclusivclycontadin3Bnh [c.B.d cohk cto^ ro c.dttuct rh. proj.cr ( scc 7044. A6i.*iand <br />Pmf.ssion Cod.r'Ih. Conmcrois Lc.ns. Llu do6 nor.pplr ro an o*..r olDrop.iy who bu,lds or dpro!.s th.r@n, lnd who <br />conticrsfor r(h pojcls wiifi a Coiracto(r) lic.nred p!.sunr torh.contidoi. LE.nsc Lau ) <br />I m cx.opl undcr S(tiofl <br />WORKERS COtrIPENSATION DECLAIIATION <br />I h.r.by !fiin r.dcr p.nrlry of pcr.lury on. ollhc rolbwirs d(letio$: <br />I hrv.andwillnainrai..C.nifi.rrcofCoN.nrroSclf-lBur for wo*.6 comp.nslion.s prold.d lo, by Sdon 37ooolrh. <br />t bor Cod.. forrh. p.rfom.ft. ofrh. wo.k ror which th. p.mil B tsu.d. <br />I hav.lnd willm!rtrrain wor[.ri comp.nsrion insur.nc.. as r.qur.dbyS.crion]700olrhetiborCod.,lorth.p€rlormnccofrh. <br />*o* aor phicn lhis pdmn is ku.d My !o.ke* comp.nsnon,nsu,rnce 6tris.nd poncy nun$er.rel <br />I c.nify lnll in th. p..fom.nc. ofrh. qorr tor which rhis pmi is i$ucd, I sh.U et cmploy.ny pcuon ifl rtry n.nn.rso 6 ro <br />b.clme 3ubrdt to rh. mrkds'onpen$rbn bws of Crl'rorh'd. snd lsre rh.r I should b..ome bJdrorheworl€c' <br />co,np.nsarion prcli.ion! oaSccrion 1700 of th€ L{bor aodc. l,hrll. fonheirh comply *nh <br />rYl <br />*ARNINC F r,urero s*oreworl.ts .o mp.nslr io n colcdsc u unla{aul,.nd shlll subjd !o cmployglo ftinif,.lp.nsfiid rndcitil <br />ao* up lo onc h!.dr.d rhor$.d doll6 ( $ 100-000).ifl ddirion to rh. .osr of comrlNllion. darug.s s ,rovidcd ror th. S.ctio. 1076 oa <br />lhc Lrb.r Cod.. i .16l and allom.yi lc <br />LICENSf, D CONTRACTORS DECLATTAIION <br />I h6cby.rrm unds p.ntrhy of pdj'ry lhrt I d li..ns.d ud.r prolilion otCh.ptd9 (dnmcncins with S€clion 7000) ofDivision I oa <br />lh. Busin.s ud Proldrioc Cod.. ed my li.cM ir in 6ll forc..nd.trdr. <br />CONSTRT'CTION LENDINC ACENCY <br />I h.Eby lffim und6 FElty oaFjury thlt thc i! ! coanNdion kndiq .sc.cy aor th. pcrforonc. offi. uo* for {hich rhi! pmi & <br />i$u.d {S* 3097. Civ. C.). <br />a!E!!.4!NrlpEe! BAr!l)! <br />D.molnion Pc.mih-Asbcrn Notili.llion F.ddal R.sulalions (Till. 40. Prn 6) <br />Rcqut d lrrr.rof Nolificltion <br />I ..niry $a lh. f.doll r.sll.lions r.sffdins 6b6los rmovrl rr. .o[pplicrbl. lo rhi. pNjdr <br />l..niry lhar I ha!. r.!d rhis rpplicarion rnd srar. thlI rhc.tor. infomalion is corar. I 18@ to comply wi(h all Cit, a.d Cou.ry <br />ordinrnc6a.dSrai.ti*sr.lrrin8rohtrildins.oEtrucrion.h.rsby rulnoriz r.prerntat iv. s o a r his Cily a.d Cou.ty to.nt.r upon thc <br />.bovr m.ntion.d proFn, ror icpd <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communicalions Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />lvleter Release <br />Rough <br />Service lvleter <br />FINAL o"llL/ts -;{l4t\Aq"hl <br />Notes, Remarks, Etc ll \.,,U |- <br />M:\WP51\Pe.mrt.hspectlon Foms\Eleclrca -lnsp€cton Record.doc 03.31.06 <br />Air Conditioners <br />PolicyNunh..: __ _ _Errtcs:(Ttu set ion nc.d f,or b. compl.t.d ilrh. !.mii i! fo. Orc hundrd doUd l$l0o) or Ls) <br />Lic.N. Chss ___ <br />Dit.: Conlracloi