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ELECTRICAL.INSPECTOR RECORD <br />APPROVALS DATE IDiSIG COMMENTS Osd-Buildlr D.clatim <br />I h6.by amm undd pn.hy ofFrj,ry rhatI m dmpt fom rhc Corr@r.a Lic.ns! liw aor rh. aollowin8 r.Eon Ge.ro3l.5 BBin6 <br />and P.of6ion Codc): Any Ciq o C@nry which rquire a p.ftir ro comtruct, ak.r, improv., dmolish or Ep.t My nactue. prior b i6 <br />isrudcc, also Equirg l!. .ppliqnr io. such pcmir ro fi1. r si8rcd stato.rr ln.t h. or rh. ii lica!.d puBudt to th. provirions 01ln. <br />Conr.qors Li@Ds.d L5v (Chapld q CoihmcinS with Scclion 7OO0 of Divkion I of $c B6in6 ed Prcfgsions Codr) or O.r hc d <br />!h. is .x.mpl tha?f@ {d ih. b6i5 fd rh. all.8.d .xopdon .Any violalion of S..ion 703 1 .5 by y +pliMt for a rcmn tubjaE tt. <br />spplicdt to a civil pdalty oi io{ n@ th fiv. huftlrcd doll4 (1500) <br />I. a ow..r or$c prop.ny, d my 6ploy6 ehh wag6 6 th.t solc @mFNalion, willdo 6. work Md U. slruc(Uc is nor int ndcd <br />d ofi.Ed frsalc ( S.c.7oa4, Bain* a Profdsids Codc Th. Conrddk Li.tu. L.q dd nor.pply bs omd6ath. propcny <br />who buildr or imrrovg dr.r.d, dd who da sucn *ort him.lf or hdclaor though ht d hcr @n mployc6, providcd th.r tlch <br />impov6..r5 ac noi int nd.d or offd?d fq slc lf, howcvq, rh. blildine or improvcm.m ir sold enhin onc y@ ol conpl.so, rha <br />ownd'Builda sill har 6c bu.do of prcviis $a hc o. 3hc Dot build or inprcvc for Ll'. pu.posc ol salc). <br />_1. a own.. of ihc popdy. m qchtivcly conr.cring ,itt liccor.d conlracroB ro dslfucr dr prcjcd ( Sft 70.4r, Suind sd <br />Prof6i6 Cod. Th. Conr..bi! Li..ni. Llw dG iot 6pply to d o*id of propdry who buil.L d ihprove rhdcon , dd qho <br />contrrcii fo. such prcj66 *ith a conr.do(, li63.d pus@r ro rhc confacro. s Lic..s. Las ) <br />_l d cxcmpr und.r Scction <br />WORXIIIS COMPENSATION DECLARATION <br />I h.r.by.lfift u.dcr p.nalty ofp.rjury on. ofrh. iollowilg deldtio.s: <br />_l hav. dd vill naiit6ii a C.nillcatc of Consnt 10 Sclqnsur. for work6' coop.nsation. a piovidcd for by S.cion lr00 of$c <br />Labq Cod., fo. $e Frfmd@ of th. wdk aor which rh. Fmn t i$u.d <br />I havc md will Bainrain *o!.s cohr.BAtion i$uruc.t a rcquir.d by Scction 1700 oithc Labor Codc, for rh€ p.rfofi{cc oathc <br />*ork for which fiis pmir is hruad My wdt.a' conp.nsltioo i om@ @iq dd poliry nomb.r arc: <br />Ioli.yNumbcr: Expirq: <br />(flrb @tior ned not b. c@pla.d ifO. Fair h ror onc huidrcd dolla 11100) or 16) <br />y'unn,,nn',.n *^^-cr or $. *o ror <br />trcd. bi4t to th. woll{.R ' comDcnsarion lus <br />isissucd.l shall nd.mploymy p.6on in sny ha.nff so 3 io <br />4r.. thd if I sholld b.€omc subjcct to fic <br />3700 of rhc bbor Co<lc, I shall, lonhwnh <br />s@or. wort?rs compcnsation covaasc is mlawful, dd shallsubj.cr oi chployr ro cnminal Fnalti.s Md cilil <br />fin6 !p lo onc hlndrcd thouud dollas 610q000),in additio lo $c c6l of cmp.ns.don, ddaB6 d provid.d fd thc s.clio 3076 of <br />rhc Llbd Codc. inr.rd md ,riom.y's f6. <br />UCEISED.qONIBACIAB!.AI.qIA36IIo! <br />I h.r.by rmm und.r parlty ofpajury firl l u lic..*! u.dq prcvisio ofChdflE 9 (c@hcrcinS wirh Scdion 7000) ofDivision 3 of <br />th. Buiinqi dd PEf6ios Cod.. ed my licor. is in full fo@ ed.ftct.2- <br />undc! pcnalty ol pcrjury fial ln.rc is a co.rtuction l.nding ior rh! pcramaic oi$c wdk fd which rhis pcmil is <br />issucd (Src.lO9?. Civ C). <br />APPI ICA]YT'S Df, CLARTTION <br />D.froltio. Pmit!-Arb6l6 Nodlic.lio Fcd.ral R.sllalid5 (TnL 40, Prn 6) <br />_ Rcquncd Lcn.r otNolifiotia <br />ab6r6 rcmoral ec nor .ppliqbk ro ltis prcj(r <br />sElc $!r $. .bov. info@tion is .or.cl. I .g@ ro comply wid .U Ciq ud Count <br />abov. m.ntion.d prop.dy fq inrp.crid <br />z. rcpr6.nlalivB oflhis Ciry Md County to .n <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 />ltrleter Release E\rEit <br />Rough l.l. H -Lnm <br />Service Meter <br />FINAL >AMU tq3, 2 90, 556, 66; <br />Notes, Remarks, Etc