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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS O\YNER BUILDER DELCARATION <br />I tdcbt aitm undd paalty oa paluly rtur I m cxcmp' 6o,n rhe Conrado( Lic.ns. l j\v lor lhc lollowin! l.en (56 701 I 5 <br />ttusin6s and Profsion Codc) Any Cily or Counly shich r.qunB a pifrir ro coNrocr, 0lld. improvq &nolth or Epan dy <br />srrudlrq ptur to ns 6ud.q ale r.qun6 rhc appli.d aor such p.rmil b lil. a si8n.d slalmdl thal h. or shc s li.ds.d p@&l <br />ro lh. p.oviriore ot lh. Co.nd.6'. Lic..$d t.aw (Chapr6 9. Conoc.cin! {it[ sdrio. 7000 oa Divirion ] ollhc BBiB ed <br />Pofision! Cod.) or th h. o. sh. b .r.mfl lhdclion Md thc h.ris for lh. alL-!.d ddnBion Any viohlion ofscda. 701 I 5 by any <br />#ffid#ffiffi;#ffidffi*ffir1*", <br />rh. Fopaty *ho hrilds or nnprclB rh@tr !d *'h. &6 uch rK* hims.lf or h@lf or rhtou8h hk or hd oM coploy.6. <br />providc! rnat such ioFov@r. e @r inExLn oroitdsl aor sL lf. how66. lh. hlildils or idpm\cldl is eld $ihin on.,@ <br />ofcompLrion. thc O"E tJui!:16 sill have rtE hrdo otproring lhd h€ o! shc did nor build or ittjlrcr the popory for tnc pur?os oa <br />t, N owfld oirh. prcpqly. n crclusircly contra ns sith licosd.onrrto6 to.oBttud th. lrojdt (S4.7044. Bbins <br />afti hoftssion Codc: Th. cdtrkrctofs Lica. La{ do6 nol apply ro d os.s o f pmp.rly Nho builds or inprolts lh6o . <br />lnd who co.rads aor!u.h Fojds with aCo.rmdo(s) licots.d pusxdr ro Ih.Co.aacrof, Licc6c Law). <br />X r*" <br />D&C!.AIAIIO! <br />I he.by.mrfl undo p.nrlt, ofpdjury oE olrh€ follo\viflB ddlealioN <br />I hrv. snd will mainiain a Cdificarc otconst lo Sclf-lNu.c ior worl.E conpens.lion, s povid€d tor by 56l io. 1700 oalh. <br />t2bor Cod., for rhc pdaoma.c. oilhc worl aor uhich lhe p.nnil is isu.d. <br />I havc aod will mainrain sorke! .omrcBarnh ielra.cq 6 rquted by sdrion I TLjO ol lh€ ljbor Codc, aor rh. pc fonnmc. ol <br />lh. $ork tor which this pdnir is issuql My workss co'npnEaion insumnce caricr ud policy numbd ecl <br />work6 co,npsalion pDlisioN otScclion 1700 ollhe L.bor Code.I s\all, fonh*ilh .!,n pl, *ilh lhosl,mvisions.. <br />W RNINC Failurc to *u. rork6 co,npcario. .o!m8c is u.lnsful. and shall subJdt d dlployd lo ainiMl psuhiG and <br />.ivil fin6 lp b on. hddicd rhousd dol6 {1100.000), in addilion lo lhc cosl of.onpcMrio.. dana36 4 p.ovidcd aor rh. <br />sdxon 1076 ofrhclnborcod., inl.r6l ed fionry s fd <br />( ,""Al-aeJ <br />IJCf,fSIiLQ.rr&l(tA[ <br />DIETJJ]ATT9I! <br />I h@by srm undr pdahy of pojury lh.l I m licBEdl undd Folision ofchapls 9 (comnocing *ilh Sdion 7000) ol Dilision 3 <br />oI lh. Buin6 d Prol6io6 Codc, and ny lic.e is in lull lorc ,nd .fisr <br />CAISIBUqII()Ii.LIiIDI!!.ACENCI <br />I h@by amm unds poaly ol pdjuy lhd lh6. is a oislruclion ldding a8o.y tor lhc pqlomanc€ ol lhc {ork for whi(h this lEmil is <br />isru.d (Sd 1097, Civ C.). <br />AIIUCA]ILDICI.AAAIIO! <br />I halby atrm u.do poalry of Fjury or. of lh. fouowins dal,ralions: <br />D.molilion Pmns-AsberG Norincalion F.dd.l R.gdrrioB (Till. 40, P.n6) <br />-RequiEd <br />trird ol Noiiclrion <br />-, <br />cariry rhal fi. fcddst rcslhrioN Esddins 6b€sros rdroval @ nor appli.abL $ lna pojdt. <br />b,r^',,nn,**,*,nB lpplk 'on 'Id 'l!r. <br />rhrl llt. abovc i.aomdrion L corrcr. I .sc ro codply pirh all cny @d coury-iifiMnc6 md Solc Llws Ehr[u ro bu'lding .oBdudDI\ dd nacby .dhorn. EF*rna1iv6 olltir Cny ed Coumy lo dl6 upon th. <br />abovc trmrhned pop.ily for <br /><Appliconr or AC6l sig.nr <br />P.milN nane(prin0:eS; <br />."Lt/e:h <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 />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment _x <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rouoh) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />lVeter Release <br />Rough <br />Service N,4eter <br />FINAL <br />Notes, Remarks, Etc <br />I <br />.\ <br />Nudba:-Erpi6:- <br />------f--------f--