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ELECTRIGAL.INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Vo
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquin
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilin (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough
<br />Service Meter
<br />FINAL 8'43,290,
<br />Notes, Remarks, Etc
<br />Oma-Buildo Drcl@doi
<br />I hEby rfiim und.r Fn.lty ol pdjury .nll I a *dpt fom ttc CdtrctoB Licosc Lav for rhc aollosing @o (ie.703 I 5 Auin*
<br />od Prca6bh Cod.)r 4., City or C.rry *hicn rquir6 r pcmir to conlhq. shd, imprcvq dmolish or rQair uy i.uctu.., Fin ro irt
<br />hsuecc, also Equtcs lh. .rplic.nt fo. lsch pmit to tilc a sign.d !tatm6! $al h. or sh. il licds.d pusust lo $. lrolisid5 of rhc
<br />Contactor's Lica&d Lj, (Chaptd 9, Cmffici.8 witlt Sccrion 7m0 of Divirioo I of $c BBin* dd Prol6ion5 Codc) o, lhat h. d
<br />sh. k .xcmpl il.!.fm ud lnc bNit fd lhc lllcacd dmpdo, .Any violalion of S@lion 703 I J by .ny .ppli{t fo . p.mn subjeB t.
<br />applicdt to !civil p.n.lty ofnot m@ rn fivc hoi&.d.lolle (1500).
<br />_1, 6 oMd of thc Fopcrry, or my mployG wnn va86 a rhct rclc cohpGarioi, will do lhc wdl &d lh. srudE is not iniad.d
<br />o. oficr.d fd salc ( scc 70a3. Burn.sr &d PofBsios Cod. Ti. Contubr's Lictrc L.w do6 n6r +ply ro M own.r of rh. proFry
<br />who builde tr imFovo thd.or, ud wno d@s srch *ork nitu€lfor ha.lf s throuSh his or h.r opn oployc6, provid.d rh.t snch
<br />ifrprcv.onll d. nor intcnd.d or ofldcd fry sd. Iih .vq,lhc blildiig or imrrcvncnt is sold vilhin or. ycdofcomptcro,, thc
<br />Oend-Buildcr will hav. ih. budcn oa provinS lhat hc n ihc not build or inprcvc for rfu purpsc of s.l.).
<br />_1, s ownd of rh. prcF.ty, m .xchriv.ly .onmditrg with lianrcd cmrnctG lo cmstr!.t (h. p.ojcd ( S.c. 70a.. Bui.* Dd
<br />Proresion Cod. ftc ConEscroa! Uc.rs. L.w do6 not apply lo d osrd oa propBty who buil& or imprcva rha.M , md who
<br />@iracr ror such prcjea vith a conrre.o(, li@s.d puRler ro lhc connacbrs Licas. L.w )
<br />_l d .xmpt undcr Scction _,8 & PC. forthisrcso..
<br />\YORI(ERS COMEENSATION DECLARATION
<br />I hctby tmm undd paalty ol poju'y oi. ol O. follo*in8 d(lelioN:
<br />_l havc ed will mai.rain a C.nilld. ot Co.s toScl nsuE ftrwork6'(@pos.lim. s Dovirlcd ldby S.qtion 37OO ofth.
<br />L{bor Codc. for lhc pdfdlfu@ of $c vorL fq *hi.h lnc p.mir is i*ucd.
<br />_l hlvc ed will @int in w6l.R cmp.ilaid iNutu.c, { E4utcd by S@d@ 3700 of th. Labor Cod., ftr 6. Ftm&@ oa rtc
<br />wo* for vl'ich thk pamn k i$!.d My wdt@' cdn @.tio iBsrue @ia &d policy numbd a:
<br />'Y;:,::^
<br />&-*.,,1..t,o
<br />not b. @mplctd if thc pcmn ii ro Onc hu.drcd doll6 {t 100 ) or
<br />d. p.rfm&@ of thc wtrk fs wh
<br />lhc work.6 comp.nsation l.ws oa
<br />compd$rion po!irioni o( ScclronJToo
<br />,",, u3-R--o lo
<br />of lhc L.bo Cod.. I rhdl,
<br />i..
<br />Failur.lo s@!E wo,k.6 @mpors.rion subjdda cmployd ro diminalF.ahi6 dd civil
<br />fina up lo onc hundr.d thoEdd dolld (1100,000),in lddnioi to
<br />lhc L.bor Codc. inrc!61sd inom.y s f.6.
<br />@$ of compcnsation, dama8d s provid.d for$cSc.lron 30?6 ol
<br />I hdcby amm urd.! pa.lry oapaju.y ltlat I m ltd5.d uids trcvisi@ of
<br />thc Busin6s ed Prcfeior Cod., &d my li@ic is in full fo@ ed cfflcr.
<br />{chm€ncint wnh S.ction
<br />I h.r.by amm undop.n.lty of pcrjury th.r th6. is r co.sttuction lcndins lscn oflhc work for shich thii pcmi! ir
<br />issued(s.c 3097, Ci! C)
<br />APPT.ICANT'S DECLAIIATION
<br />Dmolhion Pmia-,{ibs|6 Notificadoi F.&sl R.gul.lion, (TnL a0, Pan 6)
<br />_ R.quiEd L.na of Notific.rion
<br />_l cclrfy fiar ttu f.dd.l cgul.noni r.s&drng sbqrd
<br />U1, *,'O ,nnrn*","*rn' lppt,d, sd rsr. rh.!comply wid lll Ciry ud Counry
<br />ordin c6 ud St r. lavs ,claling ro building @nshcr
<br />a6ov. mdlimd propc.ty fd inspedo pupoa.
<br />ol rhk City $d C@nl, ro acr upon dc
<br />COMMENTS
<br />.D
<br />:.U I'I
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