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ELECTRICAL-INSPECTOR RECORD ID/SIG.COMMENTS OMa'Bdlda D.clmlion I hceby affim u.d., pa.lry of pdjury $ I m.x@pi rom th. ContEctoE Licas. L.w for th. followin8 rc4on Ga.703l 5 Auin6 d Prcfqsim Co&) Any City 6 Co6ty which Equiro a p.mit to @nn!ucr, oltd, inprcv., dmolkh or rcplr o, st ucrw, ,.iq ro ir! isu&c.. ilso r.quiG $. appli@r for 3ud pmir lo filc a sign.d srard..l ih.r h. or sh. is lic..3cd pu6uu1 ro &! proyisims of fi. Conra.tor's Licalcd t w {Ch.pt?r 9, C.mmacinS vi$ Sedon 7000 ofDivision 3 ofth. Bain65 Dd Profsions Codc) or th8r hc r sh. is .xmpt thd.fM ed th. b6ii fo $c allcg.d d.mption Any yiolrion of S*ion 7Ol I 5 b, ey .ppli6t for a Pcmir lubj.cr rh. applicsl lo ! .ivil pmalty of noi hN lhd fiv. hundr.d dollB (1J00). _I. s owr.r of rhc Fop.rry, o. my mploy.6 wiin w586 c th.t sol. comrcnBlion. will do lhc vork 6d thc strucrurc it nor intod.d or ofiald 16 snl! ( S* ?044, Bqrin* &d Prcfeio! Cid.: Tlr Cont&loft Lien!. La* do6 nd .pply b a om6 oa rt. proFny who build! or inprced $.@n, ud who d6 ruch eo.k hi@lf or h6clf o. $rcu8h hii or h4 own @ploy*, prcvidd th.t ruch ihprovmors e not inlad.d tr o,I6cd fd .alc. li hw?v.r, thc buildins d i Plovmdt is sold wi$in onc yw oaond.rt@, rhc Osn.FBuildq will h.v. ttu burda of provinS rh{ h. or th. .ot blild m iopmv. fo n\. pqeqe ofi.l.). _1, s o*ndoflbc ProFfiy, M.xclusiv.ly @,trelirs vnh lic.ns.d corEactoru lo cq*ruct lnc prcj.d ( S.c. 704,r, Bqin6r 6d Prci6sion Codcr TIE Contebar Li@... Law do.s nol .!ply 10 u owncr ol p&pcrty {ho builds or improvd th@on , ud vho coirads lo, such prcj.cB wi$ 6 corBro(, licci&d pu6u&r ro lhc conr&rdt Liene Lav ) _l u q.mtt undo S@ti6 -B & P.c f( this dor. WORKERS COMPENSATION DECLARATION I hcrcby affim und.r pa,l9 ofpcqury ooc ofrhc lollowiig dccldlrions: _l hav. &d willmainbin a C.niiiBl of C@ian to Sclllmm for wd*6'@m!..$roi, a provid.d for by S@lior l?00 ofrhc L.!or Codc, lor dE Frftuc. of th. wdt fd vhich th. Fmi i5 isu.d _I h.v. md will mliruin *ol@' coepciradoi iNum@, a rcquirld by S@tion 1700 ollh. t$o. Codc,ldfic p.rfoBM.c of rhc work lor which $h pmn tu issucd My eork6' @ftp.ns.don inluree cricr dd policy numblr dc Policy Nunbq Erpid:.'Z;:J,:":: F*. *fu.o. u. b. complcrcd if th. p.mir is lq On. hundrcd .lol16 {l I oO } or 16, pâ‚¬rfomac. of th. work le which thir hmneo*6 ' cmp.Eaioi las olCalifmi\ dd G- ol-rn. L.bor Cod., I thall, fonh*ith WARNDiG: Failurc lo sccur. wor&eB comp.nsation cov.rasc h fin6 up lo onc hundrcd rhoddddolls (J100,000),ii addirion rhc L.br cod.. inlcGl dd aftomcyt f.B. a providcd for lh. Sccrion 10?6 oa I hdcby allm undcr pâ‚¬.alty of pqjury thd I m licascd ud.r provi3i@ .f Chapb 9 $c BusiflBs ud Piol6sions Codc, sd my lic6s. is in axll aorc rd.fIa( -o I h.tby 3rlim unds padq of pqjury lh{ fie h . issucd (sd.1097, Civ. c.). of thc s*t tor which rhis p.mn i APPLICAXr'S DECL{RATION Dcholtion Pmir-Asb616 Nodfic.dor F.dqel R.sul i@r (TtL aq l.n 6) _ R.quircd Ldlc, olNodfic.rid lhc t dcrql Egularions rcgddin8 6b6rc I h.!c Gad lhis applicadd ud st .ro comply vilh lll Ciry ud CMtyodiihca d Star. L.w5 rclr{is lo buildins is City &d Counry ro orcr upor rh. 3- oo -o/ Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torqurng Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release FYE)IIi,EA Rough Service Meter FEB O I 20t9 FINAL Notes, Remarks, Etc ____Er,,o;zvu;I5r, 667 APPROVALS DATE Darq Ownc abovc mcniioi.d prcFny fd i.rpetioi