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ELECTRICAL-INSPECTOR RECORD
<br />DATE ID/SIG.COMMENTS Oha-BuildaD.d@ oi
<br />I h.r.by amm undcr pcnilty of lqju.y ln3r I m ddfl lm |hc Contracto6 Licdsc ke for th. followin8 Ea6 (se 701 I t Buirs
<br />od Prof.$ion Codc), Aiy Cig 6 CNty which rcqut6 a pmn lo co.snlci, .lkr, inp'ov.. doolish or r.pii dr ertuctua. Fiq ro it!
<br />iis@c!, .lso !.4riE (h. +plicmt for iuch p.mn b fiI. a si8n.d sr.r.funr (h.1 hc or sh. t licas.! puBudl ro fi. Fovilic of lh.
<br />Conractor's Li@6cd L!* (Ch.ptc,9, Commdcing eirh S.clion?000ofDivision I ofrh. Busiis Dd Prcf6 oi5 Codc) or rhar h.I
<br />rh. is .xmpl $mfrd ed th. bai! fd thc .llcscd q.Fprior Any viollid ot Sation 701 I 5 by ey appli@t for a p.mir $bj@B llE
<br />applicdl ro . civil pdiliy of no{ hoE fiu fiv. hsnd,.d dolla (tJ00).
<br />_1, a o*trd of rbc !@pcrir, q my .mplor6 ,irh w.gs a rhcn !ol. @mp.ns.tion, will do th. {ork ed rhr 5h.(o. ir .ot inlddcd
<br />or otta.d ld sr. ( S.c 7044, a$in6 sd Prof6i6r Cod.: Th. Contulort Liens. L.w rlc nd apply to 6 ovns of lh. por.ny
<br />who buil& or imFov6 ln.Mn. sd vho dd such wo* hiru.lf or h6.lf q lhrcu8fi hii or ha qn cmploys, Fovi&i 0rl such
<br />improv.moE ec not inlddcd n offrcd lor $1..1( howcv.r, thc blildi.g or inprovmot i sold pithin on. y.uof cmplctio. thc
<br />OwncFBuild.r will h.v. th. burdcr ofprovinS thd h. orsh. nol blild or implovc an fi. purpc. ofsal.)
<br />_1, a o*ncr of$. proFny, m qclsivcly conhctins *nh licoscd conlr&tom io cmnrud rnc prcj.c! ( S(.7044, asin6 ed
<br />Profqsion Codc Th. Contrelor's Lic.n* L.w dc, nol lpply ro a .wn.r oi proplrry who builds or improvd lhe.o. , od who
<br />conrrac6 io, such prcjclr witn a Cort@to(, liens.d puGuar to lh. Conmcror's Li@nsc liq )
<br />_l u crempr undd S.ctio _,8 & PC fd rhir rcao.
<br />loagBslortENs .uotLDEclASrroI
<br />I hcr.by,ffi m undcr proalry orpcrjury onr of rhc follovinE dccl{anons
<br />I ha,c ed willmainhi. a Ccnificarc olco6cil lo SclfJisurc for NoicB conposation, E p,o{dcd ior by Sc.rion 3700 oft.
<br />Lalor Codc, ftr $. p.rfmcc of lh. work lor whi.h th! p.6il is isru.d
<br />I hav. ad will Eaintarn wdkcE' comp.nsation iEuracc, s r.qutcd by S<tion 3 700 ot lh. Lrbor Codc, for rhl p.rtom c.ofth.
<br />*6rk forwhich tht p.mit is issu.d My work.n comFnsation i.surucc cMicr dd policy numb.r irc:
<br />(This satioi r..d iot b. compl.Gd ifdE rdmn t for oi. hui&cd dolld ltl00) or le)
<br />-71"*rO ^*^,n *. -s o. t[. vork ftr whicn nd.mlloy ay p.son in
<br />fi. Labor Codc, I shall, fonh
<br />hundrcdthouraddoll (S100,000),in
<br />lhc Labor Cod.. int.r6l ud zlbmcy's f.cs.
<br />LICf, NSED CON'I'RACTORS Df, CLARATION
<br />I hscby amm undcr pcnalty otp.rlury lhat I u liccns.d und.r provision ofchapcr 9 (
<br />rhcBusincss dProi6ionsCod.,liccns. is in full iorc. and .ff.ct
<br />uidq pddry oa pdju,r rhar 11)6 is a .eluuction ofrhc wdk ior *hich fiis p.mil i!
<br />iisucd (scc 1097, civ. c)
<br />APPLICANT'S NECLARATION
<br />Dcmolilon P.miis-AsbBrs Notilic.tioi Fcd@l Rcsrhtio,r Gnlc 40, Psn 6)
<br />_ R.quiEd L.ft r olNoifi add
<br />_l..nily rhal tll. rcd.ral r.Bularions rcsddinB ab6lo r.froral ar. not appl
<br />,rli, *, , n*, ** ,n" *r.^t:."
<br />lrdin cB d SEk taws r.l.tins bbuildi
<br />I .3@ rocdply wnh sllCit, od Couory
<br />abovc m.nliorcd proD.rty fs i.rp€.lion .-22 :ru'
<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 />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 EXPII iID
<br />Rough FEH- I IUIJ
<br />Service Meter SAMC 8-43 2.O 55A AA7
<br />FINAL
<br />Notes, Remarks, Etc.
<br />APPROVALS
<br />Da'. _O*i(
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