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ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.COMMENTS
<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
<br />Rough
<br />Service Meter
<br />FINAL
<br />Notes, Remarks, Etc SAMC 8-43, 290. 550, 467
<br />Omn-Buildd Dala.tion
<br />I hcrcby affim und.r paally ofp.rj!ry thd I m cxcmpt lm tt. ContDctm' Li@.* La* lor rhc followins r@o Ge.Toll 5 Businds
<br />md Prcf6id Cod.): Any City or Couy which r.quir6 a Fmil lo €onsrrucl, alrd. improv., d.molish or rcpat dy rrlduE. pri6 lo irsis!mc., abo r.qun6 thc appli@l lor sucn P.mn b filc a sigrc.l s!.r.odt thrr hc q sh. is lic6s.d puBnMi lo rtjc provisioi of rh.
<br />Conra.lols Licos.d La* (Chapr6 9. Comndcirs with Sction ?ooo of Davirion I of th. BusinBs &d Profdio,r Codr) d tfi.r h. o
<br />sh. is .xm/ rh.r.aM &d lh. b6is fd th. .ll.B..l .x.mtrion Any violatd of S€rim ?01 I 5 by ey applic r fn a p.mn subjar dc
<br />,ppli@r o a civil p.nally ot not no,c th& fiv. hlndr.d dolle (1500)
<br />_1, a owno of th. ForEdr, oi ny cnploy€6 with w.g.s s rh.ir sol. cofrpcnsariq, will do lhc wort od rh. shctr. is ror int..d.d
<br />o! ofir.d fq sdc ( S.c 7044, BsinBs ed Prolsions Cod. Th. C.nra.ltrt Li6r. tiw dc nor apply ro u owncr of 0'. ptoD.ny
<br />who builde tr imFoto ln.@., dd vho dG such wort hisclf or h6.lf or o'rcugh his or hlr @r .mployG. p.ovid.d tha! luch
<br />improvmac &c not inlddcd d ofi.rcd aor srl. l( how.va,lhc buildinB d improrn.nr is 3otd within onc ycs of.omptdi@, lh.
<br />Ownd-Buildd will havc tt. burda ol proving lhal h€ or sh. not build tr imprcv. ad rh. purrdc of s!1.)
<br />_1, a ownd of ln. proFdr, m cxclBiv.ly mntudn8 with licacd @radoE ro onstru.r lh. Foj.d ( s.c ?04a, B6in6 ad
<br />P,oa6ion Cod. Th. Conb&tofs Li@Bc Lau d.6 nor apply ro d ownd of propdry who builds d imprcve d6con , 6d *ho
<br />conrac6 for such projdb wnb a Co.hroii, Ii@nsd puBuet to rh. Cotra.tor's Licasc Lsw )
<br />_l m dmpr undcr Scctid
<br />Policy Nuhb6: I ErpiBl
<br />(Thi! selio n..d .oi bc @opld.d if $. pnir is fu On. lur&cd dolls {t l0o) or t6t
<br />Ic.nilylharinthcpsf(muaofth.wor!adwhichrhisp€mirkisu.d,Irhatt.otcmptoyeyp.Eonin,nenqsosro
<br />b€c.ftsubjctloth.wo.6'cdpcnsiorl.mofclliaomi4dda$elharillshouldb.cm.subjar!otcwdkc6,
<br />conpcn$ti provisio,s ors.cdon 1700ofdr L.bo. Cod.,l sh.ll,lonhwnh comdy wnh dosc lrovirions.
<br />o", ,l - ,zzS ,/e./
<br />WARNING Failuc lo sccuE work6' compdsdio covdas. is unlawaul, &d shrll rubjct 6 .mptoycr ro 6imin.t poalti6 ed civil
<br />fin6 up io oic hundrcd lho6ed dollm (l I 00,00o),in addind b lh. ccl of mnp.ni.rioi, &r[g6 d provi.Ld ad tn. Sed6 10?6 of
<br />drc ljbor Cod., inidd 0d rtldncy's fc
<br />LICf, \SED CONTRACIORS DECLARATION
<br />I hcr.by afrm undd paalty ofpdjury thal I6lie.5.d uidd prcvidd ofchapr..9 (@mm6ci.g wilh Scdid ?OOO) oioivision 3 oa
<br />inc Busi.< dd Prcfeids Cod., d my lic4c ir in lull f*€ ed.fiel
<br />5-/2
<br />CONSTRUCTION LENDI^IC AOENCY
<br />I h@by omm Dd€r p..dry of pdjury $'l lh6c i5 . cmElcti@ l@dine rgocy fd rh. p.rf(me. of rh. dt fa which rhii Fmil is
<br />i$ucd (Se 3097, Civ. C)
<br />APPLICANT'S DECLARATION
<br />D.molnion P@it5-Asbel6 Notifiqlion F.d.6l Rcguladotu (Tn|.40, Pan 6)
<br />Rcquircd L,trcr of Notitcario.
<br />_l enify rhd lh! ftddl rcsu!.ri6s Eaddins sbels r.moval dc.ot appti@bt. b thjs prcj.d.
<br />_ I c6tt d{ I hav. Ead o'is .pplicaton ed saE (hat ll1. abovc iniomalio ir c(reL I rgEc to cmd} with a[ Ciry &d CMry
<br />odinecB &d Sral. Laws r.hti.g Io building onslrtrdi@, od lftby .dndizc rcpr.stativ6 of ltk Ciry ed Colnr, to dLr upon $c
<br />atEvc ncnlioncd proD.ny ac iNpeiion puos6
<br />l--/z/o/
<br />WORKENS COMPENSATION DECLARATION
<br />I tcEby amft undd F..1ry of Frjuy on. of thc following &daatiors
<br />_l hav. ud will mjntrin a C.ni,l@rc of Conmt to S.lf-lcu! fq eut6' @pcnsari6, s Flvid.d fs by Sadd l?OO of$.
<br />tlbo Codc, fd rh. pc.fmdcc of th. worl for vhi.h ln. pmi t i$ud
<br />I harc dd *ill mif,aif, wdkft' @mpoBatid ituum@, s rcquiE.l by Sdi@ 3700 of lh. Labor Cod€, for tn. pofmaB oad.
<br />work ftr which lhis p.mn ii ilsu.d My wdtd' @mFnslrion iEU@e @an ud Dolicy nunbd E
<br />Licos. CIas:_ Licdc Nmb.r_
<br />\ ._,
<br />EXt',lF(r
<br />rED tl I
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