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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE to/srG.COMMENTS OM.FBuildct D.clration <br />I h.Eby .fim und.r pa5lty olp..jury lhal I m.x6pt fom lhc Co.lEclod Liccnsc Lav for6c followi.grceor G6 7031.5 Buinss <br />ed Profosion Codc) Any City or County which rcquirs a p.mn lo consirucl,5hc!, imprcv., dcmolirh ortpair&y srructuE, prior lo ia <br />issuec., dso r.q!n6 rhc appli.a fd such p.mit to filc arigncd srat€nor rhA| h. or rh. ir licdscd puBudt ro thc prorisionr oiric <br />conrador's Lioed Llw (Chaflr e, Cohmcndng wi$ scctior T0o0 ofDiltion 3 of$. Bu5i.*s dd P.ofBsiois Cod.) or th.t h. d <br />sh. ii cxcmpt thcr.froh ud lh. bdis for thc altscd cr.mplion Anyviolaion ofS.cion 70ll 5 byay appliml for. p.mn ilbjccE lhc <br />applicertoacilil pcnalryof iormd.d,lvchuidrcddollds (1500) <br />_1, 6 own.r oflhc Fop.r9, ormy.mployd rirh wag6 6lhcirrol. comp.nsarion, *illdo rh. work &d rhc srructu. is nor int..d.d <br />or oflcEd ld salc ( S.. 7044, B6in6 dd Proi6rions Cod.: Th. CorE.ror's Licasc L.w docs nor .pply ro s oa..r ol rhc prop.ny <br />whobuild! or imprcvcs th.r.o, ed who docs such work hiNclf or h6.lf or rhrouSh hn or h.r dn cmployccs, Fovidcd that such <br />imprcvcncnts uc not inkndcd or ofcrcd for $lc Ii hoqcvcr, th. buildiig or ihprovdcnl is sold wirhin onc y4 of compl.lon, lb. <br />OwD.FBuild.rwillh8vcth.burdnolprovin3lhalh.orsh.nolbuildorimprovcforlhcpu'poscolsalc) <br />_1, d o*ncr ol lh. prop.ny. o .rcluivcly conFrcting wirh liccns.d contracro4 to cotrrtruct rhc prcj.cl l Scc 70..a, B6in4s 6d <br />Profasion Codc: Thc Co.lr'&!or! Licnsc La* dG rcl apply lo u o*nr ol propdiy whobuil.Ir d imprcvB thas. od who <br />connacb for slch proj.cari$ a CodBd6(r) licoscd puRu r <br />'o <br />thc Conr.ac rof s Liccns. Law ) <br />_l m cx.mpl undr S4lion _,8 & P.C. fs lht rcson <br />tlaarE[tlor4sEtsau9N-DEcunarQ! <br />I h.r.by aftid und.r pcn.hy of p.rlnry oo. olthc lolloqig dcddaiors: <br />_l havc od will m.inoin i C.nifiatc of Conscnt to Sclfi.sur. for wo*c6' comp.bsaion, 6 povld.d fo by Scclion l?00 oflh. <br />L:bd Codc, lor thc p..fme@ of lhc *ork for which thc pmil is isN.d <br />_l hav. &d will maintain wort.Rr comp.ns.tion ituurMc.,6 rcquir.d by Sation 3700 ofrh. Llbor Cod., aor ih. p.rfomac. ofrh. <br />work ftrwhich this pmil iE is!d. My workm 6mF rarion inslEnc. cMid edpolicy numb.r sr <br />Policy Nunbcr: Expircs <br />rlYtoro@d nor b. complclc! rflhc p.mn is ftr On. hundrcd dou6 lllo0) or 16, <br />rh. pdfoms.. ofth. wo ( fs which <br />baec subjcd lo 6c *orrc6 ' cofrpcnsatioi l6s ofcal <br />@mposation provision! oiScclion l70O ofth. Labor Codc,l shall, fonh*nh <br />-2_</- o L <br />WARNING Failur.lo sccurcworkcu' compcnsation cov.r,8. <br />fir6 up lo on. hundr.d $osad dollss (t 100,000),in .ddnim io rhi <br />rh. bbor Cod., inrdBt ad ..!ohcy! fc <br />d.ma86 a povid.d for rhc S.crion 1076 of <br />ueElsEDloNIB .SrOESDEetA.EtUq <br />I h.r.by aflim ona.r pcnalry of perjury d'.r I m liccnscd und6 provisioi of Ch.plo 9 Gom <br />thcBusin.$ed P.of6iois Cod., dd my lic.N h in full forc. ed.ffer <br />'/-oL <br />I h.r.by a0im u.d.r p.n.lry of Fdury rh.r $dc is . cdntudio lddii8 <br />issu.d (s.c. 1097, Civ c.). <br />oath. woik fo*hich this p.mir is <br />APPL!CANT'S DECLARATION <br />D.molition Pcmit-Asbdl6 Notificdioi f .dcBl Rcgulariois (Titl. 40. Pan6) <br />_ R.qoir.d Lcn.r of Norillqtin <br />I c.niivrlat th. Ld.hl r.eul--z,/hi'fv lhai I havc Ead !fiis <br />dtdindcG dd 56. tlu! nla <br />adonr .r8ddins 6b6los rcmolal arc <br />appliq'ion and s6.c Ihat th.coftply witn all Cir, ud Coutrry <br />City ed County to qrf upon rhc <br />2- 2.t -o <br />Site-Work <br />Underground <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 />Alr 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 trxF lRED <br />I anrn <br />Rough r.- L) <br />Service Meter SAMC 6.43,290,556,6r: <br />FINAL <br />Notes, Remarks, Etc. <br />Pole Bases <br />a6ov. mdrion.d prcFny fd inrp..iid pu.p6B <br />-------T------