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ELECTRICAL.INSPECTOR RECORD <br />ID/SIG,COMMENTSDATE <br />Site-Work <br />Under round <br />Pole Bases <br />Li ht Standards <br />Pool Founlains <br />Si NS monument <br />Life /Low Vol e <br />Fire Alarm / Dam ers <br />Communications Cable <br />Under Slab / Floor <br />Bondin / Groundin / UFER <br />Transformers <br />To uetn <br />Sub-Panels <br />Air Conditioners <br />Roof To ui ment <br />Facto Wired Unit <br />Walls Conduit <br />Walls Rou h <br />Ceilin hsT-Bar Rou <br />l\,4eter Release <br />sRouh <br />Service Meter <br />(rbFINAL <br />Noles Remarks, Etc <br />WOR(FTS' (:(TMPENSATION <br />OECI.AI{IION <br />I k.eby aflnn undcr p.oah, of lEjury one ol the n bwing dcchationsr <br />-t <br />hat od will nrinrlin ! Ccnifi.stc of Conscnr lo Sclr lnsurc lot workc^ onllcnerion as nmvidcd for b, s"rion ]7(D or rh' <br />ljtor Codc. for rh. p.{orNtrcc ot rhc worl for *hich rhc p.,mir h issucd <br />l hav. and sill roinrrin so.kcrs coq).nr6rion nru!!rce.0s ,cq ied $y Sal ion lTln ol th. libor Cod' for lhe pdromN'of <br />$. mrt lor rhicn rhie F.mn is issu.n My workds onlcnslrion insurmc csicrund policv nudlxr d': <br />c <br />DNUv.l 0 <br />-l <br />anirr rh{ in rh. lErlor@tc of rhc w.rt lor which rhh p.irnn i\ i\sued. t sholl <br />"ot <br />cnllov,nv,Erson in 'ivnunNs, Nlo b.com $bjccib rhc workeB odp.nsrion lo*s ofcclinmid. rnd lsrec rhd ifl \lmuld bccoit subFcl kt lhc <br />w.*$s.onD.nsrionPmvhionsofssrion:lTmofficLaborCod..lshnll.lonhwirh.onllvwilhllmsrmtisions <br />W RNTNG: F ilurc lo sw workcs' codpeosdio. covemsc i\ unhwrul. md shall srbicr an.mploFr r' niminal FMhi.s snd <br />civilfi.csUploomhundrcdlhouqnddollan(JIo0.ux)J,inoddilionhrhccoslof.ompcnsation-danEgcssspr.viri.lif.rlh. <br />s(rt 1076 !l rhc lihn(1d.. inlurc{ rnd t.nty s lac\a.z-t8 <br />DECI,${ITQN <br />lh.nhyafii,mundctFn,llrotncrlryrhdl0mliens{undcrF(,visionotChnpr€r9(.ommminswirhSElionT0o0l'rDivirionl <br />or rhc Busirc$ !.d Pft,rc$ions Codc. lnd nly licctr* h in luU t,rcc and cfccl <br />B I 0 0 41(1 <br />+.z.to (d+orvq <br />CONSTRT]C'TION I FNDING AG}'NCY <br />Ihcrchyuft'nxndllF-trlllyotF',Uryrhlrllrcrcha.ondru.liotrlcndilgsgc..yr.flhcpcrt.nnan.colthewoforwhichlhnpcnnilis <br />t$rcd iscc 109?, Ci!. c.r. <br />k.dcis Nom <br />- <br />APILICANLAECIABAIIS! <br />I hoEt y diim under pcmllyofperjuryonc oi lhc followhg &.lmrions: <br />D.mlilion Pcnnirr Asb.sos Notilicariod F.dcrrl RcBulariool (Tillc 40. Pan6) <br />-Rcquird <br />likr of Nolifi .alho <br />-l <br />cdiry rhor lhc lcdcBl agrlalio.s rcaffding ash.eos r.mv0l a,c oor 4plicahlc ro $ir ln)irt <br />I c.nifylh6r I tuv. rcdd r[hlPplic nr md sorcrhr lhc rbvc infonmrion i\.ortcr l rare h conlny wirh lll Cty rnd CotrnrY <br />flhis Cny rnd Cou ry ro cnrcr uIY,nrhc.rdituo.cs rd Srrr. I-r*\ rcl$i.A h h0ildihgcotr!ruc(ion. r hcrchyNl <br />atx,vc nrdiorcd F)pcny lar imF<rion <br />Appli.!nl or AH.rl signolurl <br />Danicl Mrs <br />APPROVALS <br />Buildinq <br />Ceilinos (Hard & Solfit Rouoh <br />{1'4/ <br />>o&x <br />-EnDELclRArIoN <br />I hcrchy amrn nnd.r I'cmh, of F jury rhnr I m crcryr fr.m lh€ Conrmdor' Licc.s. Laq for rhc following rc&ron (S* ?0:11.5 <br />Bulincs dnd Profcssion Code): Any Ciry or Counry whhh rcquncs a Fmir ro o.slruct, al!.r. imrovc. .kmlhh or rcr'n anv <br />iflcluro, nior lo ils irruft.. dso rcllircs lhc lpplaanl ror such Ilemar tc fiLa sisftd nlktrd rnd h. or 5h' is lianEn t'!N'd <br />lolhepovisionsoilhcconll&loisLic.n*dtjg(chaplc'g.commeinswilhs.ctiotrT(joo.lDivi3ion]oflh.Busiltcsmd <br />Polcasions Codc) or lh{ Ir or shc is excmpl rh.crron.rd lnc basis for ih. sllc8.n ercnltrion Anv violationorsction70:ll5 bvdn, <br />aplliconr foraFrn subj(ls lhc aruli.!.tro acivilpenallyoa.or morclhan nve hundrcd dotlaB ($too) <br />l. ss owrer ot lhe tftFny. or my cq,loFes *irh ws8.s as rhct $lc .o.{Etr$tion, *ill do lh. worl ajd r}E slrxrw is mr <br />inhntu or ofl.r.d Itr s;c (48.7044. Busincs md Prlfcsrions Codcr Thc Conrra.rors Liccnsc Llw d..s nol apnlv r' an owrcr of <br />rh. plstEny who hoildi.r nr{re\6lhcEn, ,nd who dEs uh M* hinscli or tcrulf or rhrus:h ti or h'r o*n ctrll)lott*' <br />p,n'ia.a Lrrot ,*r' impotE s G ml i cnd.d d ofrenn ror eL. lt hoME. rr* trildins or rlmEm ir $ld wilhin otu tt& <br />;f complcrion, $c Own; Buikis will h.h rrE hlfllcn of lovins Uil tr or she dil nor btrild or tr{'mw rh. PDPcnv fo, rh' l,uqre oi <br />-1. <br />as o*.er of rh. pbPeny. si cx.lusivcl, contrrcrine wirh lic.n*d .onrtacbs to conslrucr rhe a/oid (Scc 7044' susirE$ <br />a.n Plohsixr Codcr ih; Conlracrols Liccos. L,q does ml!rl,lv ld,nowncr oflmp.nv qho buil& or imrmlcs rhcr'on' <br />anl wh6 drntmcls for such prclrc wilh a ConlBclo(.) li.cn$d punudi t fi. Gntrerois Lk.ns L!w). <br />-t <br />dm.xcnrpt undersdn,n- B &P.C forrhiricd$t. <br />Dol. ovn.r <br />I t.il.l.l <br />t ldcis Ad.lcs' <br />+,L46