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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS Ownr-Build.r Dcclsarion
<br />I hcrcby atfim urdd pcnalty ofFru.y lhal I d cxapl fm fic ConlE.lon Lic..s. k* for thc followinS r.6d (s@,7011.5 Buinq
<br />dd Prof6sion codc) Any City or Couoiy which Equn6 a pmir b consrrud. alrd, ihprcvc, d.molish or r.p.i. uy nrudur.. priG ro ik
<br />ir3!6cc, abo EquiB $. agpli@r for lud pcmi to filc a sisncd slald.nl thar hr or sh. t lic.iscd psu r lo $. prcvisiotu of rhc
<br />Cmtrclols Li@ns.d Lw {Chlplr 9, Commadng wnh Sccdon 7000 ofDivi3ion I ofrh. S6ih6 Md Prof*sions Cod.) or dat lE or
<br />6h. ir .x.mpr lh9.fffi ed rh. bak aor thc all.8.n .,.frprioi Any viol$ioo of S.clion 703 I 5 by oy appticdr for s p.mt subj@r. rh.
<br />appliol lo acilil p.n.ny of no. tuE th fv. hunrlrcd dolld (1500).
<br />_1, a o*ir ofthc proplny, q oy.mployc6 wilh eag6 a lh.tiolc @mpcnsarion, will do lh. work ud thc rrructuc is not int.ndld
<br />or olfcEd for s.L ( Scc 1044, Buin* ed Prof.sions C.<Lr Tn. Cont.cro.t Li6sc Law dc nd .pply ro d oqq of rh. prcFn,
<br />who builds or imprcvd ih.@n, udwho do.s such work hiru.lf orh6dlor rtroush hir or h.r qn cnptoyd, providcd Uar 5!ch
<br />improvd.ra a notinroad d offd.d ftr si. If, ho*cvcr, thc buildinsor imprcvm.nr ii sold eirhin oncrdof conpta'e, $.
<br />Own.FBuild.r willhlv. rh. btrrdo oaprcvin8 lbat hc or stc not build or improv. for rh. purpcc ofsalc)
<br />_1,6.wnrof ih. p!op.ny, ffi.xchsiv.ly conr,crii8 Nnh liccnscd conracrois to onitucr thc projcd ( S.c. 7044, BBin$ sd
<br />Prof6sion Cod.: rh. Conferort Lic.ns. Lav dG not apply to & owncr ofpropqry who builds or inDrcv6 U6.on , dd yho
<br />conEeu for such projcclr virh 3 Conrero(, licos.d pu u-r to lhc Confacror'i Licd5. L:w )
<br />_l m.xcmfl undq Scction
<br />WORI<XRS COMPENSATION DECLARAl'ION
<br />I h.rcby alfim undf pcnalry ofpqjury oo. oilh. followirS d.cld.rions
<br />_l hav. ud willmainbin a Ccnificatc of Consmt to S.lf'ln.ur. io worh.6' @np.nsatior, s povidcd for by S6ti6l?Oo oflh.
<br />kbor Cod., for th! pcrfroc of $. work for which ihc pcmn t islud.
<br />_lhavc d vill mainr.in wstcE composdion iGu6c., d rcquircd by Sccrion lt00 olrhc Labor Codc, fo$. !.rfomac. ofrh.
<br />wolkforwhichlhtp.miliissu.d My wort.E conprnsadon insur cc. i.r ud policy numbo a,c
<br />(Thii srdion n.cd nor bc complcr.d ifrh. pcm
<br />4,,,".,,",.. _"" "".. ",,.. _"..
<br />fmc uLla r rrrc *ot en cmpaorion r
<br />c6mp.ns.'ion proviiron! of S.clion l70Oof lh.
<br />il is ior On. hund,.d dolld {1100) or
<br />I
<br />Labor Codc, I shall, fonh
<br />D^,,cr- 2-24-o L.-
<br />wARlibrc Failur. Io s.cur. workcs' compcnsarion an cnploy.r to 6ini..l podrig ud civil
<br />fincs up to onc huodrcd thosed dolle! ($100,000),in a,idili
<br />th. Labor Cod., 'mcr..r d attomcy s ic.s.
<br />dad.sd 6 Dovid.d for rh. Sccri@ 3076 of
<br />LICf, NSED CONTRACTORS DECLARATION
<br />I hftby afllm und.r p.nalry ofpcjury $!t I d licas.d undd prcvisioi ofCha/cr 9(7000)
<br />O. Busin6s ed ProfBrions Codc, &d my liccns. is in full forc. .!d.ftccr
<br />-o
<br />I hecby .fiim und6 pcialty of Fjury $d d!ft h ! .eir!.ti@ loding licncy for lh.
<br />isu.d (Scc.1097, Civ. C.).
<br />mMe of rh. wdl fdwhi.h rhi! p.mrt ir
<br />APPLICANT'S NECLARAIION
<br />D.frdniq PmitrAsb€t6 Notificalion F.lcnl R.8ulltions ( rid. ,l0. Psn 6)
<br />_ R.quiEd Lcn.r ofNo tc.rid
<br />I c.diflrhai !h. r.d.r.l aoul,tMr Ep.!din! arbdrtr- -./'
<br />/t *.i5, ,t, r r''"..ra u,t.pDr,c.rin dd src d,comply wnh all Crty dd County
<br />odineca ud Sl.le La*! Ela is to building City dd County ro.nta upon rhc
<br />abov. m.nlion.d prcp.ny for inrpetioh purpoid
<br />u-Db
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountajns
<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 Condrtioners
<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 Erlrirarr!;.flF I rtELf
<br />Rough (!Es n ! Dnl6
<br />Service Meter
<br />FINAL SAMC 6.4t, 2e0, g5a, 067
<br />Notes, Remarks, Etc.
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