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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS Ow.d-Build.r D.cldalion <br />I h.rcby amm un&r pdally otp.dury lll.1I m dcmpt f(m t. Cmtretou Limc L!* ftr rh. followin8 r.Eon Ge 701L5 Buin6s <br />and kof6sioi Codc) Any City or Cooty vhich EquirB a p.mit to conslrucl, rlt r, imprcv., dcmolish s r.p.ir my sthcte. Fior lo itt <br />issudc.. rlro EqlaB th. lpplioi for such pdnit ro filc . siF.d slaldar dar hc or shc is licoscd puBuet to ttu FDvirift of $c <br />Cohlrulor'r Liens.d Law (Chaptd 9, Co,mocinS witn S.ciio. ,00o of Division 3 of ih. BGi.es dd Profssi@s Cod.) or rh.l h. d <br />!n. is .xd/ ln@fm md $! b..ir a( $. rll.g.d cxdprion Any violatio oa Scc1i6 701 I 5 by dy ap?li6r lor . Fmn subjcds thc <br />apdicdr lo . civil pcn.lty of oo{ noc de fivc hun&cd dollds (1500) <br />_1, 6 ow.d or rhc Fop.ny, or ny coploy.6 virh waa6 s th.t rcI. mp.nsario, will do tnc wor* dd lh. shcru. is nor intmd.d <br />or otf.rcd fd 3al. ( S.c ,044, BBin6 {.1 P.of.srions Cod. Tt. Csturor'! Li@!c Law dc nor apply lo u own6 of iI. proD.ny <br />who buil& or imFot6 $o@n, ed who dc slch work hiG.lf or h6cll or lnrcuel his or ho oM mployc6, prcvid.d $ai slch <br />ifrprcvmcnis r. not imcndcd d ofl.Ed for slk Il, howcvd,lhc buildingor iftprovcmcnl is sold *ittin onc ycsofcomll.non, thc <br />Ownd-Buildq will hav. thc butdcn of provins thal h. u sh. not build tr inFov. am d. plrpo* of ral.) <br />_1. 6 own6 oi th. pDp.riy, @ cxclBircly co r&tire wilh liccnscd conlracroE ro cwdd rh. Drojd ( Sa. 704!. BsiD6 ud <br />Pmldsion Cod. Th. Contactors Li@.F ta* docs not apply to a oMs of propdty who builds c imprcvB rh@on . ed who <br />conr@rs fq such prcjEts *ith a contr&b(s) li6s.d poBmr ro th. Co.hcrd i Lie.s ky ) <br />_l m .rcmpr undd Sccrion <br />-8. <br />& P.C. ad fiis ,t@n <br />YABXEBS-CAM&ISAIIAN-DECIdBAIIOX <br />I h.rb, affm mdr F.alty 6f pqjury on. of di. followins d.claralions: <br />_l h.v. sd will rujf,t jn a Cdjfidc of Conror ro SclfJnsur. ld ,0(6' @opcnsati@, a povi.Ld ld by Setim 3700 ol th. <br />L.bor Cod., ao tt. pafd1Mc. of th. *dl ls which th. pmit h issu€d <br />_l havc ad will mainrain wort.u' cmp.nsation inutre, 6 rcquiEd b, Setion l70o oa &. Labor Codc. for lhc p.rfmMc. of lh. <br />work for which rhis p6hil h kud My wtrt.rs compdsalio insuree @i!r dd policy iumba e <br />I c.niar rh.t in rhc p6fmd.. ollhc qo* fr which fiis p.mt is issu.d,I sh.ll nor.mploy dy p.6o i. dy nun€r so 6 ro <br />b.ffic subj.d ro rh. wdk6 ' cmp.Nlio IrE of C.liromi4 dd r8ra $ar il I should beom. subj.cr ro rhc wnkc6 <br />comp.nsadon provilions ol Scclion 3700 of lhc kbor Cod., I shall. fnhwnh cmply witn lhN. prcvision! . <br />WARNING: Failu.. ro !.cu.. *qt.R @opoEado covo!9. is ulasful, ed shrll subjccr & chployd ro Eimiml poalriB ed civil <br />fin6 up to @. hu.dEd 0D6dd dolld (l loo,000),in &ldirio ro rhc 6r of @frp.ns.rim, dm.a6 s pmvid.d fq th! Seti6 3076 ol <br />thc L6or Codc, i .r6t ud artm.yk f6 <br />/ <br />caNsrBrcua!_&ElDrclcflcr <br />I h@by aitm udd p..6lry of pdrury th.t tha is . @nrrucdd lddiag .gdcy fd rhc pqftu of ln. wdk fd ,hich this p.mn ii <br />i$u.d (Sft. 309?, Civ. C) <br />AEIIICATI]IDDEIdA{IION <br />D.molidon P.mils-Asb6tc Norification F.d.ral R.8ul&ios (Tirlc 40, Pan 5) <br />_ R.quiEd lrna orNodllcalion <br />_l ccnif, lnd lh. f.daal rcguhlions rcgarding Bbstos rcoov.l dc nol appli@bl€ lo lhis prcjat. <br />I ccdfy $al I hav. r.ad rhis applicatio Md sl,. thar fi. abo!. infomarion t concct I aerc lo cohply wirh lll Ciry dd Counry <br />6dioec6 md Slal. l- ws Elaling ro buildinB onsrucriM, dd hcby aulhoriz. EprBol.ri!6 of $is City ed Counly to .nrd upd rh. <br />rbov. m.nrion.d prop.ny for ihrp.crid purpos6. <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 />lvleter Release <br />I :XPIRED <br />Rough <br />F :B U I 20tS <br />FINAL <br />Notes, Remarks, Etc. <br />Policy Number_Exlt6: _ <br />flnis sccrion ned nor b. compl.t d ifrn.pdmir is for On. hund.d doU6 ltl00]or16, <br />LICENSED CONTRACTORS DECLARATION <br />I hftby !fiim undd Fnalry of Frlry 6at I m liccis.d und6 ptuvision olChafld 9 Gonhddns wirh S.€t,on ?OO0) oaDiyisioD I of <br />dc Buinds ed P,oldsions Codc, dd ry lic.ns. is in fullidc. ud.ff@r <br />Service Meter