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ELECTRICALiNSPEGTOR RECORD <br />APPROVALS DATE IDiSIG.COMMENTS OMd-Buildcr D.clr.ti6 <br />I hd.!y afiim u.ds pa.lly ofp.rjury lttrt I h ?xmpt fm $. Co.lEcloR Li6s. Llw aor thc iollowinS Een G@.7031.5 B6in6s <br />aid Proi6ion Cod.) Any Ciiy ff County which equiB . p.mil ro .onstrc', .ltd, imprcvc dmolish or r.p.ir uy stnctrE. Fid to irj <br />issuec., also r.qun6 thc lppli@nr ior sucn pqhn lo filc r si8r.d stalcru.t lh.t hc or sh. t licdscd puGuet to th. Fovirionr ol $. <br />Coirdort Li.os.d llw (Chapla 9, Commocio8 with Sccdoi 7000 ofDivilion I ofdc BurinB! d Prcfssiois Codc) orthlr h. or <br />!h. is cx6pr th@fr@ dd $. bet fo lhc .llcg.! .xcdpdon Any violaioo ol Scclio. 703 I t by dy .ppli*r for a p.mn lubjccrs rh. <br />Eppli6i io.cirilp.nalty of nol norc th& fiv. hun&.d doll4 (1500). <br />_1,4 ownc! of$c prop.ny, or ny mployE wnh wag6 a th.t sol. comp.nsalion, will do rhc wo* dd thc rrucru. ii not incnd.d <br />or oficEd fa salc ( S* 70a4, Busins d Prof6sions Cod. Tn. Conhclols Limsc ks do6 no1 .pply lo e ow..r of rhc prop.ny <br />who buil& or imprcve thdon, Md who dG ilch *ork hiaclf or hd.lf or throuSh his o, h.r o*n.hployccs, provid.d th.r s!.h <br />impbv.mcnB e nor inldd.d or ofLr.d ftr s!1. Il howcv.r, fi. building or imprcvm.nt is sold wrlhin onr ycs of @mtlctoo. lhc <br />Own.Falildcr will havc thc blrda oa proving lhd h. or sh. not build or imFov. for $! purps. oa sal.). <br />_I, a ownd ofthc prop.ny, m cxclusivcly cont .clihg with lic.n5.d @hcto6 to @.struct th. proj.d ( Scc 7044, Buin6! dd <br />Profssio Cod.: Thc Conra.lorr Lic.n!. Law d6 rot apply to d ovnd ofprcpqty sho buil.L 6 ihprol4 thao , ad wto <br />coft&B ftr such prcj.crs wir.h a c.nr@b'(, lic@.d puB@r ro th. Conr.cror's Li.os. trw.) <br />_l m .x.mfl undaS6tioi _,8 & 4.C.fdfiis,!.s <br />IABKDBiCOTIIEIIAIIOtr.DECLAXAIIII! <br />I ho.by affid undcr p.nalty oi pdj!ry ooc ol thc aollo*ins dccld.lionsl <br />_l hay. dd will mainhin . C.nificatc of Cosmt to Sclf-lnsurc for wffk6' @mp..r!tis, c providcd for by Se on 1700 of th. <br />Labor Codc, ror th! pgforoc. oi rh. wo.k ror which hc pcmn is iisuld <br />_l havc od will nainrain wskcc conp€nsation insur&c., a rcquncd by S4tion l?00 ofrh. I-3lor Cod., aor $. p.rfom&cc of rhc <br />work for*hich lhis p.mit is issucd. My wo,k6' comp.nsarion insuranc. cri.r and policy numb.r trr <br />Policy Nunb.r ExpiE <br />#*il; <br />notbccomplcrdif thlpmnisforOn.hun&.ddolls {t100} orl.$) <br />Ih. pdfomdc. of thc *orli fd whrch rhtr pmrl <br />th. wtrk.E omp.nldion l.vs oaC.liaomi\ ed <br />cohpc.s.tio. provisions of S@tun 1700 of rh. Labor Codc, I 5hall, forrh*iOr <br />-L4-b <br />wARNING Failurc ro s@uE wdk.6'comt rsation cov.,ag. n td mploycr to dhi.al D.nahiB Md civil <br />nn6 up to on. hundrcd rhous d doll6 (l100,00o),i, .ddnid lo <br />rhc Labor Cod., int..d ed altoncyk f.6 <br />, d.mas6 a prcvidcd for lh. S.ction 1076 of <br />I h.r.by afllm und.rpoalry olpojurytharl d li@nscd uidd provision ofChaprcr9 <br />rhc B!rin6! and Prof6sio.s Cod., aid hy licos. k in ruu forc. ud .lic.r <br />Li@ns.Clar: Li@. Nuobf <br />-o <br />I h6.by affim und6 p6.lry olFrury lh.r th6. ir . c@rlrucdd la <br />issucd (S.c. 3097, Civ C.) <br />th. Frfmanc. oarh.wtrk fowhich lhis p.mit is <br />APPLICANT'S DECL{RTATION <br />D.mohion Pmir-Asb6t6 Nodficadon F.d.ral R.gulrtios (TnL 40, P.n 6) <br />_ Rcquir.d Lct r of Notifierion <br />_l @nify thal th. fcddal !.8ulatio.s rcSsding eb6rs <br />locomply wiln.ll City and Counry <br />ofthis City rnd Colity ro cnrq upon $c <br />rbov. hcntion.d prcp.ny fq insp*tion <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release EXr Dlor-., rEl, <br />Rough FF8 ?l nn <br />Service Meter SAuc n-. <br />FINAL <br />Notes, Remarks, Etc. <br />.-.r, 606, 6l L(rdd's Add.$ <br />f------T------