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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />s, Pool, FountainsS <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dam rs <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 (Rou h) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rou h F B_ <br />Service Meter <br />Notes, Remarks, Etc. <br />Owno BrildoDcddrtion <br />I h.rcby affim und.r p.n.lty ofFrjury dd I m.r.mpt fom thc Co.r@io6 Lic.6. La* lor thc iollowins.cso. (sc.7031 5 Busin6s <br />and Prcf6sio. Cod.) Any City o. Cou.ry uhich EquirB r Fmil ro construc!, aha, imprcvc. dmolish or cpair &y sh€1urc' p.i( !o irt <br />iss!ec., also r.q!t6 tu .pplicant ior sucl p.mit ro filc a riBncd st tcmcnt thar hc d sh. is licalcd pursudt to tn. provisioD of th. <br />Con!_&tofs Licoscd L.q (Chapt$ 9, Cmn..cins wirh Scclion 70OO of Divkion I of fic BBinor dd Profcsior Codc) or th.r h. d <br />th. ir cx@pi thdfrm ddlhc bais fd lh. dll.s.! cxmprim.Any violaiie of S€ion 7031.5 by dy.pplisl lor.Fmir rubj?cE rh. <br />appli@r lo a civil Plialty of not ndc th& 6vc hundr.d doua (t500). <br />_1, 6 own.r oi lh. prcpdty, or hy dployc wnh vag6 6 thci. solc comp..ratio., will do drc work Md fi. strucruc ii not intcndcd <br />or ofi6.d for sal. ( Se.?044, BEin6 dn Prof*ioc Codc Thc Co.!-&tols Licas. Laq do6 nd rrply ioan own.r ollnc prop.ny <br />Fho builds or impEve th6.d. Md who dG such wort hiG.lror h6cll or $rcust hn or hcr own cnployccs, provid.d Oat such <br />improvm.rB e nor intdd.d or ofad.d fd s.lc. ll, howcvq, fic building d iftFovmcnt is sold within on! y.d ofconplcroD, fi. <br />Ow,.rBuild.r rill hav.lh. burd.n of proaing that hc or rhc not build or imFov.lorlhc purTosc ofsal.) <br />_1, a ownd oa lh. prcp.tr, M .xclsiv.ly @or&tins wnh lic.ns.d cortretors to o rud rh. prcj.d ( Se 7044, asinB ed <br />Profdion Codc Tnc Co.t cror r Lie.e tay dG not apply lo u ownd of propdry who builds or improvs lh@n , Md who <br />codcds for such pb)Ea vi$ e Cont@to(, lis*d putsu&r lo thc Conra.rofs Lictuc Lav.) <br />_l m cxctrrpr undd Sccrion _,8 & P C fd rhis ason <br />WOR(ERS COMPTNSATION DECLARATION <br />I hc.cby 6l,lm und.r p.nalty ofFdury oru ofrh. folbwing dc.larios: <br />Ihavcddsillnai lir.C.nificr& ofco.pnr b S.lfisur. forwdt6 conpas.tion.6 provirlcd fd by Seti@ 37OO offi. <br />Labor Cod., for lh. p.rfm ccof $.vo.t fo.which rhcpmn is is$.d <br />,l h.v. d sill mrjilain *dr6' @mpaB.rin iBurD&, s cquiEd by S.crio. 3700 of rhc hbor Cod.. fd $. pdaol1@@ oi tt.{o aor fiicn dtii pmt b hsucd My wo*.B' cmpo$lio insurD.e 6ir {d policy numbc, er <br />Policy N0nba: I Erpi6 <br />##;# <br />b. conplctcd if ltu p.mir ir for Oi. hu.d,cd dolld {l l00l or l6d <br />p.rfomsc. ofrhc wo* fo which <br />work6 ' comp.sation h*s otc.l <br />lrc work6' comp.nsation cov.raSc <br />hund.cd lhoNeddolles (t100,000),in addtion lo dama86 6 pbvidcd for dc Sccrion 1076 of <br />LICENSID CONTRACTORS Df, CLARATION <br />I hdcby affim und.r poaliy of p.D ury Lhar I m lic.nrd undd prcvision of Chaprd 9 ( <br />lhcBusin.ss md Prof.srions Codc, ad my liccn* h in iull forcc and.ffcd. <br />,ith S.crion 7000) ofDivision 3 of <br />7, Civ C) <br />APPLICANT'S DECLARATION <br />D.noition P.mil5-Arb6ts Noillotio, Fcdcral R.8ulrlions (Tirlc 40, Pdr 6) <br />R.!uir.d L.rlcr ot Notifiarion <br />compl, with dll Ciry.nd Counry <br />abovc m.ntion.d plop.ny ftr iBp.crion <br />Ihc L.6or Cod.. inr.r6r ud arcm.y\ fc <br />F xplF.!trt <br />I <br />FINAL