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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DIiLCARATION
<br />I hcr.by amnn u.d6 lmalr, ol pdlury rhd I @ .rnpl Eom rh. Con rclor l Lic.ns. Lrw for Oe aollowin! r.@n tS( 701 1 ,5
<br />Busin6s md Prcf6sion Codc): Any Cily or Cou y which r.qun6 a p6nn ro connflct. altd, improv., ddnolish or Epan e,
<br />.rru(uq rior to ns isudcc- atro requne thc applicdr aor such p.mlt ro frlc . sisrcd statffil thal lE or slE i5 licoed pwatu
<br />10 thc provisions ol thc (o.lrocloas t-ic.o*d Lsq (Cb0pl6 e, Com,ncncin8 vith S€lio. 700{ of Division 3 ollfic tsusin€s 3nd
<br />Polsio,s Crod.) or thal h. o. sh. b er.mpl thdcEon dd rh. b.sB aor rhc rll+cd.ronprion An, viol.lion of sdio. 70.r I s bym,
<br />applicml lor a pmit subjds thc applicant to . civil p..alty of bor mor. rhM fiv. hundrd dollrs (5500).
<br />l. a o$M oathe propery, or ft, .mp1or6 sio {as6 ar rnen $k ooopdsrion, \ill do rh. wol{ dd $. effiu. n mr
<br />ialmdel or oiIs.d lor sl. (Sc.7044, Ausins sd PslaioB Cod.: The Conrrociors Li.sc Las do4 n l ap?ly lo an os no of
<br />rh. t,spdy sho buil& or iqrovB $mn. dd who d.6 such \w* hnns.lfor hm.lf.r thrortsh his or hd om.mploycB.
<br />providcd lhat suci improvodls e mr intdxl€d or ofis.d for ek If, howa6. $. boildiu or iDpov€tml is sld wnhin onc )6
<br />ol'conl9leio., rhe Osid Builda sill havc lnc hldo or prerirs rhd h. or shc dd not hild or inqrovc Uc p{psly ao. lh. purFe ol
<br />_1. sowncrofifi€ prcp€ny. o erchEivelycoDlracriry with lic€ns.d conrrsclos to cotrnucl lhc plljd {S€. 7044, B6in6
<br />ad Plllisbn Codc: Thc Cdnlracrols Li.ensc Li* do6 nor applyro.nowna ofpropolt who build! or improlrs rhdon,
<br />and *no co @ts for such pmjels*nh. Contncto(s) lic.r*d pruuMl to lh. ConlE€lor's Lic.N tiv)
<br />_l dn.rcmp u.do Sclion_. B. & P C tulhnr@n
<br />]uoaSEElcotlfENsAIIoN
<br />DECLARATION
<br />I h6cby ailm undd poah, oapgjory on. oath. fouowing d(l rdoB:
<br />I havc dxl will ndntain a ccnincal. of CoBal ro s.lf-lcur. tbr sorkeB onlD.n$rio.,6 prc,vidcd for byS6tion I700 oarhc
<br />tihor cod., aor rh. pdfofl@cc o I rh. {o lor*hi.h rh. p6iil i{ isu.d.
<br />_l hayc and will mainlain *!*(( comp€Balion iNura"ce as rcqunedbySdionl?00otlh.l,ahorCod.,rorlhcpdfoodc.of
<br />t
<br />_l.dliirbal in rhc pqfontuncc oI rh. work lo, which this ,.mril is isucd.l shallnor dploy any pdsrn ir .rr rndB
<br />e a ro heom subjdt lo tic Mrtd' compdsion Lws of Caliaomir. Md .96
<br />'hd
<br />if I shouid bc(om. subiel to th€
<br />wo*a' .onp6Mtio. povi5ioa of Sclion l70o ofrh. tlbor Cod., I shall. aodhwith c.mply wilh rnok prolisioB..
<br />WARNINC lailurc to su. Mrk6s co,npensdion co!*8c L\ unlawful. dd shall an Gnploya ki oimmal pooh6 md
<br />.nil fi * up ro onr nu.dr.d tbousdil dollm (310o.0o0). i. .ddnio6 ro rh.p.Mliotr dm.U6 a provid.n tor thc
<br />// t//r inld6r ad lnorrert 16
<br />/o
<br />DECI.AIAIIO!
<br />I h6.by arm unds p.nalty oapdjury rhar I e lie.sqj undq Fovilion olchafle 9 {@dnocins {ih Serion 7000) of Dilision l
<br />ol rhc Busin* &d Ptuf*iotu Codc. ard sy licds. b in tull lorcs ud cfid.
<br />B o tr?z
<br />CAdiIATqUA!I.I DI!G.AG.E!(I
<br />I h€rcb, afiirm u.ds ,enalr, o f pojury rhd lhe. is d connDclion ldding alcocy for rhc psfodr&cc oarh. sor! f.r $hich db pdmir is
<br />issu.d (Str. 30q7. C'! C ).
<br />ATTIICANfDICTAAAIIA!
<br />I hs+,y amm uodcr p.nalty olpsiuryonc.lthc followina d(lsalions:
<br />D.molilion l,aDils-Asb6los Nolifi.arion f,cdeal tusularions (Tnl.,l0, P.n6)
<br />-Requn.'l
<br />l.etle. of NolinRlion
<br />-l
<br />etliry lhal the ledcral resularioN resdditrs Bbesros Kno\ al d. not applic.blc to lhis projcr
<br />-l.nifr
<br />rhal I hale rqd rnis.ppli.arion ed iatcrh.r fonn.rioniscoEd Ia8rerocoorplyNnhaUCityandCount!
<br />o inanc6 ad Starc l,Ns nLrins ro buildins coNt rurhorit r.pr66 0riv6 of rhis City md County to 616 up.n thc
<br />aborc nmrio.cd pmpdr lor inspdrion
<br />Applic t orAgeni signdurt
<br />Pe.nite nrm€ (prinl ):.*
<br />t r,/t z
<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 />f,oof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />lQeilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rouqh)
<br />I\rleter Release
<br />Rough
<br />Service Meter
<br />FINAL l.r z-rl tt z1
<br />Notes, Remarks Etc
<br />is isu€d. My*ort.rs' com!.Nlion i6urdc. ca s ud policy numbs &l
<br />N,b-, UB (65:{3L'1 3 Ep,,*?
<br />/o/t t/n Co.(n.lor:'1 i
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