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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG. <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 />Rough <br />Service Meter I <br />FINAL 4/22,,/tt 2TX1 tlt ) <br />Notes, Remarks, Etc 7 l-- --r 7 <t, <br />Ovnd-Buildqr Dccl@don <br />I h.reby altirm uhderp.mlryorp.rjurythrr I am.x.mpr aorn th. ConlocloG L'..ns.ti* ao,lhe aollowrng reso.Ge Toul,5 auin.ss <br />ud Prcldio. Codc): Any Ciry or Coriy shi.n rcquir.s r pmit to coErtuc1. !h.r. improvc. d.molbh or Bp.n ey tucluc. prior lo irs <br />tsunc.. .ho r.qun6 th. .pplica.l aor !o.h p.dn lo fik I sisrcd nrM.Dt thd h. or rh. i! licc@d pGunt ro th. povirioB oath. <br />contdcror. LG.6.d Llw (Chaptr e, Conm.ncing wnh s.ct6n ?0o0 ofDivilEn I olrh. Busin63.nd Prof6sioN Cod.) or ih.r h. or <br />sh. is .r.npr rhqcnom !"d rhc balis for rhc .ll.scd cx.mprion .Any viohtion oas.dion ?01 I .5 by &y appliclnr lor . p.mn subj.ds rh. <br />applioor ro ! civil pculry oa nor mr. rh6 6v. h!ftlrcd dolld (1500). <br />I. a ownn oalh. prcpcny. or rny .mploys wirh ,a86 I th.r sol. comp.ns.l ion, w ill do rh. wor* md rh. eto.r(c is not inr.nd.d <br />or off.r.d for $1.{ S( ?o44. Busin6e.nd Prof.s36 Cod.: Th. Contucrois Lic.B. Low do6 nor ipply ro rn owm, of rh. p@p.ry <br />who blildr or improvd lh.ron. and eho d.6 skh wort fiiruclf or h6cli or rhioush his or h6 osn .hployc. povidcd $d such <br />inpror.hcnls r. nor inl.nd.d or olld.d lor 5!k. lt how.vd. lt blildin-! or improvcm..r bsold withi.o.c yaroi.onplction, rh. <br />O,ffi-Build. wiu h.vc rh. bdd.n ofpmvins rld h. or rh. mr build or imp.olc lor rhc purposc ofsalc). <br />1.6 ownd ofIh. propdy, m .xclusiv.ly conhdi.s with liccBcd conlractoBlo coBlru.l rh pmjdi ( s.c. 7044, aBin.$ and <br />Pof.ssionCod.: T1E Co.t6cio.s Licens€ tr* doe nol apply to sn ow..r ol prop.ny who burlds or inrprolca rhcreon. and who <br />co.t!* for ioch proj{B *trh r co.t6cro(, lrc.ns.d puGunr ro rh.Conlmdois Lrc..* b* ) <br />Irn, r\.nr LnJcrSrdkr) <br />gaatsEBlcaMrElt^lo!-0Ee!4larro! <br />I h.r.bt tflim undd pcn.lly o t psjury o.. oflh. aollowins del...tiotr: <br />I hrr. anl will mainltin ! Ccnificarc ofcoccm lo Sclt l osur. lo' w,le6' comp.Bar6n, I provd.d aor hy sftr <br />'on <br />1?oo of rh. <br />tab.r Codc, lor thc p.rlonna... orth. sork aor whici th. p.nit G isu.d <br />lh!!.and willmrin(.in worlers' bnpensal'on <br />'nsuance. as requredbyS€dionr70oofrhetiborcodc,aorthep.rforunc€ofrhc <br />work for qhich lhispdmn i isln d Mywort.R conD.nsrio. insuranc.s 'dand pol'cy number!E <br />Poli.y Numbdr__ErpiE!: <br />lThi! 3erio. nc.d nor bc.onplcr.d ifthc pmn k fo. On hundr.ddoll.6l$100torlcss) <br />I c.nifr lhtl i! lnc ,.rforuoc. ol thc {ork for shi.h lhis pcmi s i!su.d, I shlll not.mploy any r.rson in any nrnn.r so s lo <br />beom. tubjdr ro ih. wort.6 omp.n*ron bws olc.l,lorna,,nd.ar* thar fl should b@D. ubJer brh. eort€6' <br />comF.s.rion prcvisions ol S<rion l?00 ollh. lrtor Codi I shlll. lonhs nh conDly u nh rhos. lbviliotu . <br />Applic..t: <br />WARNING railxr.(o .eur. worleE @np.nsarion covens. rs ul.s aul. tud shallsubjel & .mploy.r ro oidinal p.n.hi6and civil <br />,iod up to on. huodr.d lho$tud dollus (t 100.000).in rddilion roth.c6lolconpc.srlion. r,!tuscs s provid.d for thc S.dion1076 or <br />th. Lnbor Cod., i.rct md rtorhey 3 16 <br />f,tt[NlELeoNr8aelQBilEe!4Bllrro.! <br />I h.r.hy .fim undq p.Ehy ol pEjurr lhll I e t i..ns.d undcr prcvb ion of Chaptd 9 (com.n.hs wirh Selio! 7000) oa Divisio. I o, <br />th. Bulin.s .nd ftolesioB Codc. dd ny liccm. is in frll rorc. ud.fT.ct. <br />Lic.ns.Nuoba <br />CONSTRUCTION LENDINC ACENCY <br />I icr.by !firm undd pcnally ofp.rjury rhil thd. is rconrmdion Lndins.Bcncy for tnc p.rfomsnc. ofth. work lorqhich rnisp.mn is <br />bsu.d (Scc.1097, Civ. C.). <br />APPLICAN'T'S DICI.ARATION <br />Dcoolirion P.mir-Asksros Norification [.d.ml R.suhtion! (Tirl.40, Pan 6) <br />R.qun.d L.lrer oaNotilicalion <br />I c.nify lh,l lhc Lddrl r.sulalioB Es&dir! Eb6ios roovrl d. ml spplicrblc to this prcjd <br />I ..niry rh8r I nav. rod rhis rpDlicalion md nar. thar lh. abo!. ilfomition is cotrc.l. I .sr.c to co,trply with all Cily .nd Coury <br />ordinarc.i 3nd Sl3rc Llws r.hrins ro buildins consrDcrion. md hc.cby .urhoriz rcpr6.nhiv.s of rhir Cily .nd Coury to ord upon rhc <br />rbovc h..tioncd oropcny lor in3perion purlos.s <br />Appli.a.r or rs.nr sis : <br />I <br />Ni P51\Permil'lnspection Foms\Elecl(cal lnspeclion Rocord doc 03.31.06 <br />COMMENTS <br />Site-Work <br />Pmnl.c imc (prinor _ <br />f------T------ <br />I