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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUII-DER DEL(]ARATION <br />I h6.bt .iIm undd rm.ny or p.Dury lhd I m.rmfl fmm ih. ftnkadou Licm. L3v lor th. follovins r.ffi. (5<.70.11 5 <br />AusirBs .nl Profdion Codc) Any City or County *hich r.qut6 . Fnil lo mBlrucl. alt6. inpror.. ddnol6h or qEir .n! <br />struclue prDr lo irs isuMa. also rcqun6 rh. applEUl for such psnir lo 61. a sisn.d sl.id6( rhil h. or sh. b li.6cd pumet <br />ro rh. F.visioB of rh. Conlra.iors l-i..ned bw (Chaprd 9. comm.ncin8 snh S..rion 7000 of Division I ollh. Busins and <br />P6l*ioB Cod.) or th0r h. or sh. is d.nDr rh@&om Md rhc besis for lh. all.sed dmplion. Any violalion of Sc.tion 701 I 5 h, a.y <br />arplicanl lorap.mn subjdslhc appliclnllo acivilpdrhyolnoi morclhu fiv.hu.drcddollds($500) <br />l. a oMs ol rhc poFnt. or ny .mpl.rc wnh *a86 d rh.n sk .omFNlion. will & ih€ \rort rnd thc slrudE 6 mr <br />inrdd.d o. olld€d aor el. ( Se 7O,r{. Busin6s od Pmfsio6 Codq 'llc Conlraclois I -icosc Ir$ do6 not rpplt to s o*.d of <br />rh. pspaty sho hlildr or inpnvBrts6n..nd *ho &6 su.h $oIt hims.laor h*lao.lhmush hh orh6 oM cdl,loy6, <br />pRJvid.d rh.r such imFoymrs e mr inrad.d or olr6.d tu el.. It hos66.llE h'ildn8 or inq'ovmr b $ld sirtun on. !a <br />of.ongkiotr th. O*ro Buidd will hav. th. htrd., ofproving $d h. or sn dn nol hrild or impro\r ttc p.opsly ror lh. pu4.s6f <br />l. aoM.rof rh. F6p6ry. m.rclusiklycont..ri.r sirh li.m.n .onlrados ro connrucl ih. pmjcl (Sc. 704,1. B6me <br />snd lt{rfision (-od. lfi.Conlrctors ticosc Law do6 nol applylo o o* n6 orpo?td, sh. buildsor imprcv.srhdon. <br />and *ho contr.rs for su.h Fojds snh a ( ontarlo'ls) li.m.n puBmr ro rhc Contracto.s Licre l!N) <br />lm elen,lr und6 56lion <br />Dire. own€rl <br />tv98[EAlg,D!tE!la]Ia! <br />uicl^-BAlrQll <br />I hrehr_ alfinn unds lEnalty ofpsruryonc.lrhe fol(NinS d(lanlions: <br />I hav. and will roinlau ! Cdrilicar. o r Con$t lo S.lf-lBu,. rdr sork6 .onpdion, 6 provid.d for by Sdion 3700 of rhe <br />L.bor (,od.. lor th€ qdfome.c ofth. sort for \nich lh. p6mil b tsucd <br />I haw and Mll mainrli. sork6 comp.Gdion iNuranc.. a rcqrn.{ by sdlion I7ur o I lhc t bor (nd.. f.r lh. Flonuncc ol <br />rhc {ork lor $'hi.h rhi! pdf,n is is.d My work6- .omFlqrion i ur .. cdi6 drd policy numb6 sc <br />Expn6 <br />I c.nity lhal i. ihc pdlorm.cc ofthcwork for which this D.i'nit is issucd. I shall.or dploy a.y pcBon in.n, man.d <br />e' 6ro b.com. subjdr ro rh. {ort6' cohD€Gaon lawsoacal'lbn6. dd ari*rhd ial should tE om. subjd to thc <br />so*6 onp.Nrio.povisionsoasdrion r?00ofrh. L6b.r code I &tu1|. lonhNith.omply *irh thoe pFvtbns <br />wARNlNc Failur€ ro sur. wort6 comp.n*ion .o!d,sc is u.latrfol. s.d sh.ll subjd u oployq to nnintl pd{lri6 and <br />civil lincs up io on. hufflr.d thous.d dolles ($100.000). in addiiion to rh. cosl orcomFnerion, &magd d pmrid.n for lh. <br />S(tion 1076 oith.tibor(nde inldcsl d allom.rt a6. <br />u(lll[Dtatrrxacroa <br />DECIIBAIIAN <br />I h@ty,IIm und6 p.nalty ol pdjury ihd I m li.aej undd F.vi!io. ofch.pl6 9 (comMcins $nh Scclion 7000) ofDivnnrn l <br />ol th. A6inssd ProfdioB Codc. odmylicsc is ifl tull forcc axl.lIdr <br />c9nlltrucugl$Ilulc3lillcr <br />I hftby .mrm undd paalty of p6ju.y thsl rhq. is . .odrucrion lodha oa6cy for rh. Faomecc of rh. *ort ft'r which nris pdmil b <br />iso.n (Sa 1097. civ. c ). <br />AITJ.ICANLDTSJAAIIA! <br />I hottry atrm undq pqtly of pgjlry on. of thc foUowins dd ldlnrns: <br />IE,nolilion Pdnits-kb6los Norifi c.lion Fcddal R.8ul.rions ('I irl€ 40. Pdr6) <br />Rotun.d L.l|6 ol Notificrnrn <br />I c61i&rhar rhc l.d6.l rcBul.rioos E8sdinr ab€ios Enovalar€ no! applicablc kr rht pmjdr <br />I cdilyrh6r I hrvci.adrhtapplicarionddnar.rh.rrh.at{r. inlomarion n.otrd IalrelocomplywilhalC yttrdCounrr, <br />.rdinancd md Srar. li$s Ebii.g hd.by rulhnz. r.F.frbln.s oflhis City md Countylo 016 urrn lhe <br />a&'v. noxoncd pro!.rly lor <br />^pplic.nt <br />or Agenr Signxr <br />-("se <br />*"9- 7-)/ <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 />Communicalions Cable <br />Building <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service It4eter <br />FINAL B-1-t7 .J )cSnh G9 <br />Notes, Remarks, Etc <br />Under Slab / Floor