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ELECTRICAL-INSPECTOR RECORD <br />APPROVALS ID/SIG.COMMENTS Oq.'Buildcr D.cl@tim <br />I hdc6y affim undcr pcnalV ofp.rjury rhat I e.xcmpt fom thc Contocrot Licc.s. Lrw aoi th. aollowinS rc6on Gft roll.5 BEin6i <br />ed Prof*ioi Codc): Any City or Counry *nich rquiB E p.mir ro coisrtocr, rltq. inprcv.. dcmolish or r.p.ir My 3l'ucluE. Fior b it! <br />heuocc,alsorcquir6rn!.pplicanlfosuchp@irrofil..signcdstatmc.rlh.th.orrh.iilic6s.dpursuattoth.p(oviriosoalhc <br />Conlrdols Licc,scd Lav (Chapra 9, Comnficin! wirh S.clion 7000 ofDivision I ol$. Busing dd Prof6sios Codc) ortur hc d <br />sh. n .x.mp1 thc!.frcm ed fi. b6is fo th. all.s.! cx.mption An, violdion of Scclion 701 I 5 by ay applitul for a pcmit rlbjcds thc <br />appli.dt to . civil p.nalty ol nol nm the fivc hu.dr.ddol14 (1500) <br />l, 6 oMlr of rh. prcp.Iry, or my mployG eth wa86 a th.n sok com!.hetio., will do fi. work Md thc strucrur. ii no( irrhdcd <br />d ofts.d fr sal. i S.c 7044, Bsh6 ud Prcfssios Cod. Tn. Cont ctors Licas. kv do6 nd .rply lo e owna oa fi. prop.dy <br />who buikb or implovc lh.rcon, od who doe su.h work hiNc,f or h6.lforlhrcu8h his or h.r own mployq, provid.d $.t3uch <br />inprov.h.nli s. not irtcn.lcd or ofid.d fd stc. If. hovd6, lh. building d ihprov.ndt i! sold wilhin onc ycs of compldion, $c <br />OvncFBuilda will hav. lhc bur&n of prcvins that h. or rh. not build or improv. for rh. purTs. of sal.). <br />_1,6 own.r of rh. propctty. a qclusiv.ly conrBcriD8 with lic.nscd conhctoE ro conslrud thc prcj.d ( S.c ?044, BBin6s &d <br />Profcssion Cod. Th. ContBctols Liensc Law d@! not .pply lo d own.r of propcrly who buildi or improvg rhc@. , od who <br />contrlcs for such prolcLl wirh ! contE€tod, li@nsd puBlmr to rh. conhcrort Lic.ns. kw ) <br />_l m cxcmpt u.d6 Scclion _,8 &P C for lhis rcson <br />WORKERS COMPf, NSATION DECLARATION <br />I h.r.by.ifim und.i Fnllty ofp.rjury on. ofthc aollowin8dele*io.r: <br />I havc dd vill n.inhin a Ccnificarc of Con5cnt to S.lf.l.surc for *ork6 @np.nsadon.6 providcd for by Sccdon 1700 oflllc <br />Labor Codc, for lhc pcrf(,fucc of th. wo* ior which th. r.mn ii ksu.d <br />_l havc ud will mif,Ein wtrk.E ' compo ati@iBurdc.,a r.qutqd by Scdion.1700 of(h. Labor Cod., fo. $. p.,fmacc offi. <br />vort lor which lhis Fnn ii is!u.4 My wtrt€E cmp6uti6 insuEa cuid ,i policy nuob.r rrc: <br />PolicyNuhb.r: ' Expt6 <br />z(*^,r*^^ <br />notb. cmpld.d if rh! pfnir n for Orc hun&.d dolle {tl0O} or ls) <br />th. pdfomucc of lhc vork ior which <br />ofrh. L.bor Cod., I shdl, <br />e.l e cndoyo ro c.iminal p.nahi6 Md civil <br />, dama86 6 provid.d lor thc Scclion 1076 oldolla (l I 00,000),in.ddidon o <br />thc hbor Cod.. inlcld udanomcy's fc6. <br />UCENiED-qONIEACIOBIDECIAIAIION <br />I h.r.by afilm uhd.. pcnrlry of psju] thar I o liccn3cd uidd provtioi ol Chaprr 9 (@hfrcncins wnh <br />thc Busin6s ed Profeions Codc,my liccns. t rn fullfor@and cffccr <br />undcr pcn.lty of p.dury fi ar rhd. i5 a for lh. p*fmanc. of $c wqk fs which rhii Fmil ii <br />3097, Civ C) <br />APPLICA'\T'S DECI.ARAAION <br />Dcfroliion Pcmils-Asb6tos Notification Fcdcral Rcsuladdc (Tnl. 40, Pln6) <br />_ Rcquircd L.n.r olNolifidio <br />I asra ro conply wnh allCiry Md <br />abo!. mc"tion.d prop.ny for inlpc.iiM <br />Underground <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 />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 />EXP RED <br />Rough <br />Service Meter FEB _r z0t9 <br />FINAL <br />Notes, Remarks, Etc. <br />DATE <br />Site-Work <br />Pole Bases <br />Transformers