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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE IDiSIG.COMMENTS Ownd-Auildd D@luldo
<br />I hd.by affim und., Fnllry of pqjury rhlt I e qchpt fm 6r ConFa.roa' Li@s. Lrw fd rhc aollowins l!&D G@.7031 .5 Buin6
<br />nd Proldion Cod!): Any City or County which EqliB . p.mil ro .o Eucr, dt.r, improv., ddoli5h * rcp.n {y itruct@. Fid ro iLt
<br />issudci. lho Equt6 $c applicol lorsuch pmnlofilc r si8n.d ullmar $.1hc d 6hc i licqnscd puBuet [o th. provitions 01lll.
<br />Conl@ror's Liccn*d Llv (Ch.Fd 9, Commqd.B wirh Srcrion 7000 of Dilirion I oa th. B6ii6s dd Prof4ids Cod.) or th.r h. d
<br />!h. is .rcnpl thacflm &d th. bais fo rh. .ll.8cd cxcnprioi An, violado.ofSedonTO3l.5 bydrlpplitur lor r Fmir $bj.c!r rht
<br />.pplicanttoacivilp.n.ltyofnoraorcrh 6v.hund.cddolla(1500)
<br />_I, d ond or rh? t op.riy, tr n, cmploy.6 *ith *a86 a thcn sob conp65.tion, will do th. *ork &d thc srrucrrc is no( inlsd.d
<br />or oficrcd fB sd. ( S.c 70a4, Buhs od Prcfsios Codc Thc Con@lors Lic.ns. La* d@ nor apply lo an om6 ol lh. por.ny
<br />who buil.ls or improvB lhq@n, dd who d@ such wdk hic.lf m h6da or droqSh his or hq own @ploy6. Fovid.d tlal such
<br />improv.m.n6 & not inrad.d or oirq.! fq sal. lf, hovc?cr, rhc buildiis d inproyhdr i. sold snhin onc ,ca of conpl?lo, rhc
<br />Oqno.Buildq *ill h.v. th. burdo of poving (hat hc or ih. hol build d ihprovc for c purpos. otsalc)
<br />_1, a oqa of d. Fo?.rty, m sclsiv.ly @ntutina pnh licar.d .onEacroB ro cosnlcl th. pej.c! ( Sa 70!r, Buine ad
<br />Proa6sion Code T1! Contdctor'! Liens. Llw do4 not .pply to d ownd of propoty who buildi or improvd 6a@. , dd who
<br />coifacB fo' such prcj@Lt vit . cotr&io(s) liens.d puBuet to rhc conr@t '.s Lien$ Law )
<br />_l u .xcopt un&i Satio
<br />WORI(ERS COMPENSATION DECLARATiON
<br />I hcEby affim udcr parlty oi Frju.y onr of lh. follNin8 d?cl6tioE:
<br />_l havc sd willmai.rain ! Ccnificlr. ofcons..r ro S.lf-l.s!E for w6l(s' compos.tim, 6 prcvid.d lo by Setion 3700 offic
<br />t2bor Cod., lor 6c FrfollMa of dr *ork lo' which th. p.mn i3 h$c4
<br />_l hrvc 6dwillhaintlin w6t6 ompd.tion iNuBc.i d rcquircd by S.ctio. 1700 ol tnc Labor Codc, for th. Frfme@ ol thd
<br />wdt for *fiich this pmit is issu.rl My wo*6 @mp..s.tio insu6.c @i6 &d policy numb.r @:
<br />"x:':,:
<br />E' -L*,r",r'.
<br />b. @mgldcd il thc pmir is for O.. hqn&cd dollq {ll0o) or l6d
<br />psfomDa of d. wtrk fo qh,ch rhR pmi
<br />wdkor'@npcnsti@ laB of c!l,fm'\ u
<br />oathc kld Cod., I shill, ronhvirh/-o
<br />WARNING Failurclo !.curc,orlc6 comp.nsation
<br />finB up ro 6. hund.cd oDsad dollm (3100,000),in addnion ro tic
<br />thc L:bor Co<!c, int6r {d oDcy! fc6,
<br />iomp.ns.rioi, d,ma86 s provrdcd rorrhcS.l{;on 1076of
<br />LICENSED CONTRACTORS DECLARATION
<br />I hd.by afim undd Fiahy of pajury thar I d licar.d u.Lr provision of Cnr/s 9 (
<br />lhc Aulin6s ed Protdsiod Codc, ed my lic.ns. is in full aoE. dd cff.cl
<br />I h6cby altim un&r p.nalty of pdjury th.r rh@ is t @nrtocion
<br />issu.n (s*. 309?, Civ. C.).
<br />for thc p.rtdmanc. ofrh. wot fd which this p.mit is
<br />APPLICANI'S DECLARATION
<br />D.molirio. P.mi6-Astsr6 Nodfic.doi Fcdsal R.8ulations (Tirl. .to, P.n 6)
<br />_ R.quir.d L.lr.r of Norifidion
<br />/r cc,ttty t ar
<br />$c f.d.ral rc8ulurioN r.8rdine cb6r6
<br />I hav. @d lhit lpplica{on sd sEt.
<br />odinec6 ed Sla!. trws Elarins lo buildin3 lhir Cit, bd Couiry roari
<br />ibovc h.nrion.d php.ny fo, iN!.cti6
<br />--o
<br />7- 8-
<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 EIiF IKhIJ
<br />Rough rtro -| 4UtJ
<br />Service Meter saMc 8-{3,556 7
<br />FINAL
<br />Notes, Remarks, Etc
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