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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Own6'Buildcr D.cldari@
<br />I hacby a,fim udcr p..alry ofr.rju') $ar I M qchfl fom l.hc ContracbE Licisc La{ fr lhc followin8 r.ao. Ge 7031.5 BBin6
<br />ed Prcf6lioo Cod!): Any Ciry o C.ary which EquiB r p.mir ro @nitrEt. drcr, improv., d.molish tr Epair ey structw, Fior to ir
<br />issuec., ako rcqutd lh. applimr for such Fmit to filc i sisn.d rLlffil thal hc or sh. is lic@d purs@l ro rhc Fovisions oi rh.
<br />ColBltr\ Licasd Law (Ch,Pld 9, Conodciig with S.ctid 7000 ol Dvision I of thc BNio6r 6d Prcf6ioos Codc) or $at hc d
<br />3h. i .x.mpr thdftom ed tt. bsG fc tn. .ll.g.d .xdprioD .Any violation of S€tim 701 I 5 by ey applicot fq a pmn subjccE rh.
<br />alpli@r ro n civil Fn.lty of nol mm th6 fiv€ hundrd dolla (1500).
<br />_I, a omd of $c irop.n , or my 6plor.B wid! *ag6 d $cir sol. comFnrdion. pill do thc work ed thc rhctw 6 nol inrad.d
<br />or oftcr.d fd s.lc ( S.c.7o44, BEica od PrcfdiMi Cod.: Tl'c Cmhctor's Li6r La* dc nd .pply to d (M.r of tlc prcpc.ry
<br />wlD hoil.t! o. imprcv6 tn@, ud who d6 such pork hiG.ll or n6.lf tr thrcu8h his d hd @n mploys, p,oyidcd lhd such
<br />inprcvmd|s @ nor iokndcd or oft@d for d. rf, ho*a.r, rh. bul.!rn8 or imFov.mar it sld wirhin on. ys of @mpl.uo, tt.
<br />OwncFBuildd will hav. lhc burdm of prcving lhd h. d rhc nol build or improvc for th. purp6. of!alc).
<br />_1, a ownd of lh. proFiy, h .xclBiv.ly cont&ring wirh lic.ns.d @tacroE to @rdct rJr proj.d ( 56 70,..1, Buin6 sd
<br />Proasion Codc Th. Contr&tors Licdsc k* d.6 not +ply ro m ownd ofpr.p.n, who build5 s improve th@n , dd eho
<br />mnhcs for sucfi proj6lt wnh s CdtrBclo(, Ii6s.d puEuet ro lhc Conrets s Li@nsc L.w )
<br />_l m.xmpl un&r Sati6
<br />EABKEIS-CO!{TEISAIIQN.DECIdBAIIA!
<br />I hdcby amm und.r !.nalry of pfjury onc of lh. fotl@irs d..lmrions
<br />I havc dd Bill nainlain . Ccni,ialc of Co.shl ro ScllJnruE f6 wdt6 comF.sari@. 6 !rcvid.d ao by Scrid l 70O ol thc
<br />Lalor Cod., ftr thc Frfomde of thc wdl fd which thc pdnit is isucd
<br />I h.v. ud will m.iniain wdta cmFc.dd iBufucc, d ,.quEd by Sction l?00 oath.l$or Cod., for $. pcrfmae of $c
<br />worl for ehich thir pemn is i$u.d. My wo{6' c6p.ns.rio ituu@e 6id ed policy f,umb.r e.:
<br />Polic, Nufrba Expi6l
<br />(This sdim n..d .o1 b. €mpla.d if th. p.nnn i. ad On. h{nd,cd dolls It l00l or lB,
<br />_l ccnify thar in $c pdf{fucc of thc wd* fB which lhis pcmi G isu.d, I shsll rot mploy uy Fss in ey herr ro 6 !o
<br />b.cm. subjet b tn. worr.s cmF.sltim las of C5lif@it, dd.gFc th,r ifI rhould b.@mc subjet lo lh. wolc6'
<br />compasalion plorisims ofS4tion 1700 oalhc
<br />""" ..{-,ta/a/
<br />l. fonhwnh omdy qnh tfic. rovisiom.
<br />VARNING FailuE ro lcurc vnt6 @mF.$rio cov6.sc is ula*f,n, dd lhall 3ubj6r a @ployc. ro cininal F.alri6 md civil
<br />fii6 up ro oc hurlr.d rhoced .lolla (l I00.000),in addidd ro thc c6r ofcmpa8atid, dan g6 d prcvid.d for dr sdtion 1076 of
<br />lh. t$d Cod., inrdd &d rtlom.y't f6.
<br />IICDNSELCOTIBACIOBiDECIABAITON
<br />I ha.by afiim undd p.nrlty of pdju.y .nd I m li.os.d oidr prcvisi@ of Cnaptd 9 (comm@cing *i$ S..rid 70OO) of DivLion 3 of
<br />lnc asiis! ed rrofsim Cod.. dd my licosc i. in flu forc. &d cn@t
<br />CA!$BIICIIAN-tEXDITGICEICT
<br />I h6by lilim ud.r p.nahy of Frjury $d fift h . conirudion lddii8 agdcy fd lhc pdfmMc of thc w6k fd which drh Fmn ii
<br />i$ocd (56. 1017. civ. c).
<br />AIIUCAXI]T-ODCIIBArION
<br />D.noltim Pmin-Arb6r6 Noiifiqli@ F.dcral R.guldos (Tirlc,l0. Pan 6)
<br />RcquiEd Lcno of Notfi @ton
<br />I ccnify thal $c fcddal rcgulaaons rcgdding 6b6r6 rcmovol e nol applicablc lo rhis pIojct
<br />_ I @'dfy th.l I havc r.ad lhis appliqtio ad si. thar $. abov! ihaomrtion i5 coret I a8,e lo conply *nh dl City od C@nry
<br />rdii&c6 &d Sl.rc t ws rclaling lo building @slrlclion, ed hmby authoriz. r.pcotativ6 of rhir Ciry dd Cou.V ro 6rE upon rtc
<br />alovc mdtion.d p.op6ry ad inspelid purposB
<br />QZ-.cz ,/z->/-
<br />.<-/v4 {
<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 />Torquing
<br />Sub-Panels
<br />Air Conditioners
<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 />Meter Release
<br />trAPtl{EIJ
<br />Rough
<br />( UIJ
<br />FINAL AMC 843, 29(, 556, 667
<br />Notes, Remarks, Etc.
<br />Licd. ClBi_ Licd. N6ba_
<br />Service Meter
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