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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE rD/srG.COMMENTS
<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 SIab / 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 />Lr\r I ,\E (f I
<br />Rough raD -Service Meter (uta,
<br />FINAL SAMC 8-43, Zl 5C6
<br />Notes, Remarks, Etc.
<br />OMd-Buildo DcclrAtion
<br />I hcrdy lmm ur&r p.ndlry of pdjury lhal I d.x.hpt lom lhc Cort&tod Licasc Lau for $. followins Eso, (s.c 7011.5 Burin.$
<br />ed kofesioh Co&): Aiy Ciry or CDu.ty whicn Equncs . p.mit b coBrtrd. ,lla, inprolc, dcf,olislt d rcpat by srrucrurc. Fior to ia
<br />issuuc.,.ho EquiB fi. appliBi for ruch Fmt lo iilc.signcd sGLmat thar h. or sh. iB lic6*d puau&l to dc provilios of rh.
<br />Cohtractor'i LicGns.d La* {Cha$.r 9, Cnhcncing wilh Scclior 7000 of Divisio. 3 of fic B6ir6r ed Proa6si65 Codc) or thrl h. d
<br />shc is .x.mpt lhcrcfM 4d ttu b6is aq lh. rll.Bd d.mplioD A.y violalio of S.clion 703 I 5 by ey +plicMt lo, a pcml subjeb !h.
<br />appli.sl lo !civil pd.lty ofnol norc thu fiv. hlidr.d dollE (1500).
<br />_1,6 own.r of fi. Fop.rry, or my .mployG wirh wag6 a thcir lolc conpc.&tion, will do 6. wort dd lhc srucrlr. s not ini.ndcd
<br />or ofrr.d ad srl. ( Sd ?04,1, Bu,in6 ed P.ofsions Cod.: Tn. CotE ror's Lic4. L.w dG not .pply io d .yncr of rh. prop.ny
<br />wno builds or improvc lhq.on, dd wno do6 such work h'aclf o, haclf or through hn d h.r o*. cmploy..!, prcvia.d rh.t lu€h
<br />ihproe.oor. &c.ot inradcd d oifacd for lalc Ii hNcvcr, th. buildirs or improvd.ol ir $ld wilhin onc y.s ot complcrron, tir.
<br />OwncrBuildc. will h8v. th. burdcn ol provinS lhal h. d sh. not buil.l or ihprcv. for $c pu'!6. oa salc)
<br />_1, a ownaof $c propcfiyi cxcluivcly cont'&lins with lic..scd conhctod ro conrtruct th. proj.d ( S.c 704a,Bsin6sdd
<br />Prof6rion Cod.: Thc Cont &iof3 Liccnsc k* dB nor apply to e Md oipropaty whobuil.& d imp.ov6 theco,. &d who
<br />contracts ro' such prcj.crs wilh a coDrdo(, lic.is.d pdsu&r ro th. conracrors Licdsc kw )
<br />_l d cxcml undcr S@lio.
<br />WORK!RS COMPENSATION DOCLARATION
<br />I h.r.by afim und.r p..alry of p.rjury on. olrhc lollowins ddeltio.s:
<br />_l h.v. udwill m.intlin r CqniticaE of Co.sqt to Sclllnsurc for eo*6' @np.n!rion, s provid.d for by S.clion 37OO ofth.
<br />Llbor Codc. tq thc p..fme@ of $. wo fdwhirh th. p.dit is issu.d
<br />_l havc ed will hainEin sorkcR' cmFnstim iBum@,a rcquircd b, S@tion l70O olthc Labor Co&, fe !h. Frfmu€ of rh.
<br />work for which lhh pmn is ksu.d. My wortq cmtF@tion iNu6* 6id hd policy iuntq arc:
<br />PolicyNumb.r Expt6*a:::.:"
<br />F." -i,:*,. rt "
<br />b! @mpl.tcd il0'c pfftn k for onc hun&.ddollm 1ll0o)
<br />pafomucc ol $c vork for which
<br />wo*6 ' compln$rion l.w ol Cal
<br />offic Labo! Cod.. I shall
<br />WARNING Faihrc to sauE work?u' comp.n$ on
<br />fin6 up lo onc hundEd .houeud doll8 (l I00,0o0).in
<br />rhc Libor Codc, in&rel&d.Iomcy! f.€.
<br />@, drm.e6 a p.orid.! lor thc S.diM 10?6 of
<br />I hcrcby amm undc! p.n.lty ofpsjury thal I o li.oscd ud.r Fovkion ofchaptd 9 (
<br />thcBusin& ud Prof6sions Cod., dd my licosci! in full loc dd cffdt.
<br />,. C)
<br />I hcr.by .ifim undcr ptnalry oi pajury rh.t rhd.inc. olrhc *qt ftr*hich lhis p.mit k
<br />i$ucd {S.c 3017, Civ. C)
<br />Dmolition Pmils-Asb6t6 Not,fi carioi F.dc'il Rcgrhtion! Clitl._ Rcqut d Lcnc, olNoific6don
<br />ly
<br />-d,,.
<br />6ammcemas
<br />,bo!. m.nrion.d proEny tor insD.crion
<br />6)
<br />City dd County ro cnr.r upoh $.
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