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ELECTRIGAL.INSPECTOR RECORD
<br />APPROVALS IDiSIG.OMcrBuildq Dccldio.
<br />I hcrcby .ffim undd Fnalty of pcrlury lhrt I d cxchfl lm thc Conracio6 Liccnsc L.w tor th. foll@in8 r.60. (r@ 703 1 5 Susin6
<br />and Prcfdsion Codc) Any City or Cou.ty which !4uire r p.mil lo construcl, .lr.r, imlevc, ddolht or r.p.ir ey irruclur., ,.ior ro nr
<br />isuocc, ako r.quir6 6. .pplisnr for such p€mn lo filc a si8n.d stat mal thal hc or 5h. i! lic.n5.d puBudt to tic FovisiN of tt.
<br />Coilractor's Lic.i.cd Llw (Chaprd 9, Cmmocin8 enh S.dion 7000 ofDivision I olrh. Busins &d Profssios Codc) or dial h. q
<br />sh. is cxcnpr thc..fr6 dd Oc bais aor rh. .ll.8.d d.mprioa A.y violarion oa s..ti@ ?0! I 5 by dy applidr ior . p.mn rubjcc! lh.
<br />applicoi ro a civil pcnrlty olod moi. tho fivc hundrcd dolru (1s00).
<br />_1, d ow..r of $. FoFny, d my .nploy€ ,ilh *ag6 a lhclr rol. compcns.rion, will do rh. work Md $c sElct@ is nor inr6.t d
<br />or ofl@d fd 5ah ( S.c 70,14, Bsin6 ud Prof6iN Co&: Th. ConF&tor'r Licd5. L.* .b6 not .pply lo & owncr of th. prop.n,
<br />vno buil& or i6Fov6 ihmn, Ddvho rLs such wo* hiN.lfor h6.lf q drongh his o. hdM cmploy.c!, prcvid.d lhar 3uch
<br />improv.m.rls s. not inlddcd or oalscd losl..I( hov.v.r, rh. building or inprcvcnot i! sold within d. ycrofconpl.rro, rhc
<br />Own.FSuildq vill hov. thc bu.dcn ofprcving $al hc orshc nol build or inpov. fd ln. Ptrp6. ofral.)
<br />_1,6 own.r oith. prop.ny, m qclsivcly conreirs vilh lic.ns.d conr.crou ro c@lrtucl $c prold ( S.c ?044, B6in6s ed
<br />Prof6sio Cod? Th. Cmlr&lol! Li@nr. L.w d6 .ot +pl, to u osnd of p.opc.r, who build! d rhprovB $q.d i and who
<br />.o.uds for such proj.cE wnh a ContEclo(r) lic.nscd plBuur to rhc Conft.tor's Li..nrc Laq )
<br />_l m .xcmF u.&r S6tio _,8 & PC. fdrhis rcao.
<br />WORXXES COMPiNSATION Di]CLAR]TTION
<br />I hd.by nl6m undo p.nalty olp.rlury on. oalhc lollowinSd.clrarions
<br />_l fi.v. dd will hainrain a C.nificar of Consat to Sclalnsu& lor workcB cmFns.rion, B providcd ror by Serio37OOof lhc
<br />Llbor Cod., for thc pcrfm cc of th. work fd whicn th. p.6ir is islu.d
<br />_l hav. dd witl m.inuin *o&d' mF.$don itu!tucq a rquncd by Sccrion r?0o of rh. kbor Co<lc, aor fi. p.ramM.. of lh.
<br />wo* ror vhich rhis pmir ii isucd My eortd' comFn$tio insuru.c 6ifi ud policy rlmb.r e:
<br />Policy Numb.r:_Expi6:
<br />"z::,::,"
<br />r*.,,i,,".,,"
<br />not b. complct d if ln. pmt is for Oi. hundrcd dolld {l 100) or
<br />rh.p.rfomac. of(h.work ftr qh,ch rht pcmir
<br />rh. *ork.6 comD.nsation laws orCalironrA d
<br />compcn3alion provilions of S.clion r70O oa th. &bor Codc, I rhall, fonn
<br />-o
<br />WARNING Failur. to s*urc wo.kdt comp.n!.tion colcBgc h coploy.r io .nminal p.nahi.! ed civil
<br />fin6 uD to on. hundr.d thouod dolla (t100,000),h additid !o th
<br />thc L.bor Cod., inld6r ed M.yt aq.
<br />o., d.mag6 d provid.d aorrhcS.ction 3076 of
<br />LICENS[D COTTRACTORS DECLAR{'I'ION
<br />I h@by aftfr lidc pmalty ofpc.jfy tha( I m licc.s.d uodn prcvkio. ofctuprd 9
<br />thc Bliinds ed Prof6sions Codc, dd my liccnsc is in iull forc. and.ffc|
<br />-24-al
<br />I h@by amm unda Fn.lty of Fqur, th.. lh@ i. . @rttuctid loding q;cy ftr t
<br />i$!.d (S.q 3097, Civ. C.).
<br />oi'hc wtrk ld *hich this p.mt is
<br />APPLICANT'S DECI,ARATION
<br />D.noltion rmil}Asbsld Notificaioi rcdcal Rc8ll.tions (Tirl. 40, Pan 6)
<br />_ Rcquied Lcn.r of Notilicarion
<br />_l c.,ily rhd th. fcdoalrcsulations rcgardins 6b6r6
<br />/lury ,n, t n*, *,a ,no aeu,n'o, -
<br />'odinuca dd Shl. Llws rclaunslobuildins
<br />tocomply rnh all Cily and Couity
<br />v6 of this Ciry ed Cornty ro .nrd upon dr.
<br />abov. m.nlion.d prop.rty ftr insFclio.
<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 />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<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 />ts.frlr.(Bt,
<br />Rough rr'.r: I jlnlo
<br />FINAL gAM0 6.,16, zUO, 6ti6, 667
<br />Notes, Remarks, Etc
<br />DATE COMMENTS
<br />Communications Cable
<br />Transformers
<br />Service Meter
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