|
ELECTRICAL.INSPECTOR RECORD
<br />DATE ID/SIG.OII'I{ER BUILDER DEI,CARATION
<br />I hcnby rfr'n unrLi pcn,lry of Frjurt lhar I m .rcnpr ,mm rh. ConticroB Licene tiw ro. fic f{nbvin8 rcas,n (Scc 7031 5
<br />tsusincs !fld Prcfcsio. Codc): Atry Cily or Counry whah rcquncs o lEmit lo ooslrucl. ahci impmls- tlcmlirh or q{n uny
<br />{flcrurc. tii.r ro irs tiu cc. !h. r.qlirc. rhc ,mlic,nr i1tr suchr€ndr k, filc' \igrcJ rarcmnr rhar h.orshc iq li.cnsd pureuani.
<br />to lhc pmvisions of rh C.nt,ctols Lic.nscn tlv (Ch,fl.r 9. C-omn.inB Rilh Scclion 7mO of DivGion I of lhc Blsitrcss and
<br />Profcsiotrs C.d.) or ihal tr or shc h crcnyl lhcrcliom.nd lh. hxis for lhc all.Bcd cxcmplion AnyviolllionofScclionT0ll.5hysny
<br />amlicanl for a Frmil subj.rls rhc amlicrnt lo ! cilil pcMllyofnot nmrc fian riyc hundrcd dollds (5500).
<br />\/v. .*^, r,* n-*",,. n n,y cq,lorRs w h q r!.s.r th.n bh cofrp.ns,rion. wil d. rh. wMk urd of, srEtu is mt
<br />lnrodcJ or ollcrcd for slc (5(.7044. Bu\inc* and Pirrcsions Codc: Thc ConrBcroas Liccnsc ke doc. nor,pplyro an owroror
<br />lhc Imlrrty *b hilil1.r iq,oB rrEmr .od who dm sxch slt hin.clr or h.Mlf or rhrcuen hn or hcr own cmrhyccs.
<br />providcd rhlt such iml,oEmflt! m ml inrcnacd or ofit(n 6r $h. Il ho*cw.
<br />'h.
<br />hdirdiru or impmrcmd t sold wilhin onc ,.u
<br />ofroq,lclion. lhc owrcr Blildcr rill havc dc bo.dcn oa ptulin! rhd h. or shc did mr hild or inpmvc lnc pmFny lor ltE puqnc ot
<br />_1. r\ o$mr of rhc pmFny. rr cxclurilrly conrmtirg rith licctrsd conlmcrrs ro onrrud rh. IroFr ( Scc 7or,r, BD\irc\\
<br />ond ttotusiotr Codc: ThcConrraclor's Liccnsc L0w docs nor rtplyro atr oqnf of rropcny who huildsor imtrovcs rhcrcon-
<br />and who conrmrs for s!.h roFk wirh a Cloittur.(n ltencd pn6ur.r brh. G,.t&rois Li.cnsc Ltrw}
<br />;:ta"db4 IB u** Vaartrco M
<br />WOR(ERS' CONPEN\^ TION
<br />IIECI.ABAIII}N
<br />I hcEby trlttm!ndc. pc.rlryoillcrjuryom olthc folk,winS dslnrd'nns
<br />I huvc ,nil will mintain { C.nirrarc or Con*nr r. Sclf ln\uE nn w6rkc6 .onwnelio.. 0s ,,svidcd for by Sdlio! l?00 of lhc
<br />libor Cdc. for lhc Frformflcc of Ihc sork fu which the pcrmil is issucd
<br />I hrvcand willnrn arn *orkcra comncnslriotr insurin... as nquncd hySccrmn 1700oflhc LlborCodc. turh.F lortuncc o,
<br />thc uork lbr which rhis pcnnn is iss8d. My wor tcN conFnsdrio. irsumncc .r cr ,lpolicynun$ersc:
<br />v4|ir'-,iiry rhr . rh.r..r,"mto. I rhe sork rur whf,h rhis Frnir is hsu6d. I .hnrl nor cmploy any p.Mn in rny n,nrcr
<br />so s Io h.snE subicd lo thc srtqc conqrcnsalior l0ws of Calinxni., ond ssm lhal if I sh,lld b€cotu rubid ro llE
<br />wnkcll comtcnsolion pDlisions of Sdion 3?00 of thc t bor Cndc. I nrll. tunhvil h ompl, sith rE s polnions .
<br />WARNIh"C ts,itu.c ro knrc workc6' conWnsal io. .ovcr,Ac h unl.stul. 0nd shall subjcct an cmplo,€r Io dminal pciahhs ud
<br />.Ml lincs up ro onc hundNd rhousand doll0tr (Slm,(XD), rddiliotr ro rhc.oi of.orpcnsutio., diftrg$ as prolidcd lor rhc
<br />Codc. irncrc( o.d inomy
<br />\Jrranrc. MaI
<br />-Xrtete-Z
<br />L&EILTED-qONIAAI:IAB
<br />DECI.3.B{IIO!
<br />I hcEbyafli,nund.r pcnahy ol r.rjury rhal I am liensn uMcr pmvisio. ofChaprcr 9 (comnrncitrB wilh Sdt'n 7(x)0) orDilkion l
<br />ot rhe Bu\incs and Pmfcsioni Code, aJxl my lic.n* t in alll aorce anl .tfer
<br />calsrBuquaxrEuuNc-&GtNlx
<br />I hcrcby llrrd u.dcr ,.mlry ol l)crury rhd rhc.. isa oNtudhn Lndin! rgcmy for rhc pcriormmc o, thc work for shich lhh Frhil is
<br />isslcd (S€c.:)09?, Civ C )
<br />AELICANLDECIdf,AIIQ!
<br />lH,rrrmundq pcnalry oa p€rju, orc orrhc iolloeins dcclaali{,n\:
<br />Dcnmlirion PcrmirsAsb.sros Notiicaliotr Fcdcml RCBUlaliotrs (Tirl. 40. Pd6)
<br />-Rcquicd
<br />L.trc. olNolifE4liotr
<br />-l
<br />ccrlilrrhrr thc tedcnl Esularions ECUdins {slEsror rcnoval!E.or antli.lhlc ro ihis psj..t.
<br />&t4lL.dirr rhd I hnvc rcrd rhh atpli.arn,n aJd {,r. th r rhc atnvc inromrion is coftcr. LEu ro comply *nh.ll Cnyand counly
<br />ordinamcs Md StIc trwi rclrling ro bnilding.onslncrion,.nd hcrcby Nnrhoriz Eprcsrnlstiwr oflht Cily rnd Count, to cnlcr uton rlE
<br />rtor. Df,nrioncJ pron.nyntr in\pccri{,i prlxrc\
<br />"^,, otloslB
<br />!6n!cs-\-.{Lv.4€4e-z-
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />Rough bha/R liifJh-a n-^a?
<br />Service Meter !
<br />FINAL
<br />No1es, Remarks EIC.
<br />APPROVALS COMMENTS
<br />ti'"nfnez
<br />Liccnsc Clls:-Liccn* Numbcr:
<br />Dolc: Conlmror
<br />Pole Bases
|