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APPROVALS DATE IDiSIG.COMMENTS Owna-Build.r D.cldalion <br />I hcEby atfim undf p.n.liy of r.rjury rh.r I m .xmpr fom lllc C@r6c(o6 Limsc llw for fic followin8 rca@ (ia.703 I 5 Bulin6 <br />and Prcl6sion Cod.): Any Ciry d Couty which rcqoiB a pqnil ro co.rttuct, alt .. imFov., d@oli5h d rcp.n d, !rucr!r. Fior !o irs <br />nsudc., also Equi.6 6c.pplicinl for such p.mn ro fl. isi8lcds|ar@ni ihath.o.sn. is licdscd p{Rudr ro th. Fovisions olthc <br />ConlBclor's Li@nEd Llw (Chapl.r 9, ComnacinS wilh S.clion 7000 ol Division 3 ol th. BBin6 Md Prcfdions Cod.) or $ar hc o. <br />sh. is crcmpt d1q.fm &d dE bais fo ih. all.e.d .xnption Any violrim ol S€tion 70r L5 by sy ippliat for . p.mn subjccrs th. <br />applicMt to a civil pdalty ol"d moE 60 fivc hun&.d dol16 i1500) <br />_1, s ow.cr of rh. proFny, 6 dy nployB wirh wag6 d th.n solc .omp.mdion, will do th. w.rk Md th. stru.ru. is nor int dcd <br />or otr.r.d ror !al. i s.c 7044, Bain.rs dd Prof*sions Cod. Tfu Co.r.crors Licas. Lav d@, nol apply lo an ownq oa fi. propny <br />who b!il& or improvG lnfto,, Md who dc such wort hiN.lf or h6clf or rhrou8h his or hd own cmploycG, prorid.d $.tsuch <br />ihprovmcnts e nor intcndcd or offcrcd lor sal. If, howcv.,,lhc buildins or inprovcmcnt t soid wirhin o.. ru olcompl.lrm, $. <br />Ownd-Buildcryill hav.lh.bud ol provrns thal h. or sh. .ot build or imprcvc for rhc puQ6. of salc) <br />_1, a owncr of 0F popcny. d cxclcivcly conr.cd.g *ith liccnscd @nu&to6 ro coNrucr thc prqccl ( Se 70aa, A6ine Md <br />Prcrdio cod.i Th. Conr.crocs Lic.n& Law do6 nor.pply to d omd of Ploplny *ho builds d improvs $c@i, dd who <br />coor.ad! for ruch pojetr *ith . C@hcto(, licd.d puRrer to U. ConE ciofs Lieie L.w ) <br />_l 0 cxcmp und.r S.clion <br />IABKEBS-CI}!{EENSAfIOITDECLAS4.IIOI <br />I h.reby atfimu.d.rp.nalryofpgjury on. oalh. aollowi.Bd.cl ado.sl <br />I havc dd *ill maiitaii . Ccdificat of Consat to S.lf-lnsurc for work6 @mFnrdid,5 pmridcd for by Scdio.3700 oflhc <br />Labor Cod., for thc p.rfmdcc of th. wqk fo hich lhc p.mil is issu.d <br />_l hav.ed willmainlain *orko6 cofrp.nsarion inrurdeL a rcqun.d by S.ction 1700 otrhc Labor Codc.lo, th. pcrfomdc. of$. <br />work for which lhis psflil is issucd My *ork6' @mp.nsalion insuran@ @i.r ad policy nunb.r ar. <br />PolicyNuhbcr: ExpiG:'?i;::," <br />uy'*" *t1*, . rr,. <br />b. conplct.d ifd. p.mrt is for On. hun&cd dolla ltlO0) or 16, <br />pdfomdc. of rh. work iot <br />rhc Labor Codc, I rhall,lonhwnh comply <br />work.6 compcnsalion covcrag. <br />doll6 (1100,000),ii addtioi ro thc 6t ofconp.nsation, damagB a prcvidcd for $c Sccri@ 3076 of <br />rhc Lnbor Codc. int.!6t md atbm.y s f.6 <br />lIcErs-gD_eorrBAgroalpEeua{lol{ <br />I h.rcb, amm uhdcrp.nrhyofperj ryrhatl dlicciscd urd.r provGion oaChaplcr9 (comm.rcins <br />!h. Busin.$ dd ,rcf6sioi! codc, ad my liens. h rn full forc. and cff.cr. <br />of p.rjury rh.r rhd. is a coNrrucrioi t.n aScncy for t. pcrfoma.cc of thc work tor which this pcmn is <br />) <br />APPLICAIII'S DECI-AR,TTION <br />D.molnion P.ri6 ArbdtcNoificaioi Fcdc6lR.sxlarioni (Titl.40, Psn 6) <br />_ Rcqut.d Lcttd otNoiliatid <br />isE lochply wnh lllCity od Counry <br />a6ovc h.ntioned propcdy ftr inrp.di.n <br />of this City dd Couoty ro ol.r <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 />Bu ilding <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 />EAt'il {tu <br />Rough <br />Service Meter FEU _(.u tJ <br />FINAL SAMC 8-43. 2(r0,556.667 <br />Notes, Remarks, Etc <br />ELECTRICAL.INSPECTOR RECORD