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APPROVALS DATE
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Sollit Rouoh
<br />Ceilinqs (T-Bar Rouqh)
<br />lvleter Release
<br />Rouoh
<br />Service Meter
<br />z.-zL|-V)/LC--r<ttt€lbEZt7FINAL
<br />Notes, Remarks, Etc
<br />OTVNER BTIILOER DELCARAIION
<br />I hcrchy !flirm unddr Fnrlly or r.iury llur I um cxc rfl rio'h lhc Conr,lclos' Licens hw ld th. folloains rcrsn (s(.7011 5
<br />Brsn'.ss lril Pf icssion Cdc): Any Ciry or counly which rcquircs ! p.rmil tr cotrsrrud. .llcr. impr.ve dcnrlhh or rcplt an,
<br />nrucrurc. nritr ro irs is\usrk.. rl$ rcquncs lhc amlicanr fo, su.h Frn lo 6lc s \isftd d{rcmm rh.l h. or shc ir li..nscd ,)!sur.r
<br />b rhc p.ovnions ol rk A,ntacttrh Lic.trscd Lrs lchsnrd 9. connrminB wirh scdb. 7tx)0 of Division I ofrh' Btrsims 'nd
<br />PDtc\sions Cod.) oi rh lE orshc i\ ex.mpr rhd.l'rom rtrd rhc h!* nrlh.alhecd crcnflion Anyviol*tunofSsrioi7011.5hvtrnv
<br />Rpplicxnr rd i p.mil subjslslhc aptli.dnr to scivill)cnalryol nol frtrc rhdn fivc hlndEd d.ll,rs(Ssu)J.
<br />-l-
<br />!s owNr ol rhe poFny. or n,.mpk,tccs eilh Bs8cs rs lhci {rh .onrFns ii)n. willdo rhstrkaDdrlt itrlm is ft'
<br />inr.ndLrd .r ofiscd itr ;lc {Sc. 7I}44, Bu\irrcss u Pmfcssions Cd.: 1 h. Gnrr,.r.rs Licctrsc LBs dod ftn tpllv ro
<br />'n
<br />own$ ol
<br />rhr pR,pcn, Rk, brilds or iq)rotts rhcmn. dd sh. des sxh *ork him{clt.r hc^clfot rhntueh his or hcr own cnPlovccs'
<br />Drorid.d rhd such impn,rcmnk m mr inrcndcd o. oficri ior s,k li howcvc. rhc hoiklin3 or hlroEmnr is sld wi$i rft F r
<br />;fonthrion.rhcOw&rsuildswillhalcrhcburd.itmvilrsrh h. or slr did nol r{iu or impnNt lhc pl.rpcnv tu thc P!,F){ ol
<br />-1.
<br />NoemrortlE lrotcny. an.x.hsivclycoftlcrin8 !irh ll.cnscd conrockns r) .on{ru.r lhc PtuJc.r (Scc ?014 B \irx\s
<br />nt Plo,i\i,nCodc.ThcConlracnr\l,iccnc.LawdocsnoraPplyronoqncrofProI). y who huilds or i'rP(rcs rh'r'on'
<br />lnd who cotrrmclsl'orsu.hptu:.Is qirh trConlrdo(n lccnscd pu^usnr k,rl*Co raclor's t.iccn$l-ow)
<br />I rcrcnrprun,lcrS..r'on-
<br />Dsl. Orner
<br />rVOIlXr''nV COltmlSrrrrtN
<br />IICIABAIION
<br />I hcr.hy aJlirln u er Fnalry of!.rjuryonc {frhc tulhwnrg dccl0rrli(,.\:
<br />I have rxlwill m!i aiDdCcnillc.lcolConscnrroSDlflhsurcInr$orkct\.onrnctrsrrion.as ptuviilcd l'orivSc'lion 17lI)'lrli
<br />binrCo.lc. rorrhc p$ao.nunceof rhc sotk for whichlnc pcrnn i\ hiucd
<br />ll hnvc !trd will m!i !i'r workcm conlrnslrbo nsrhn.c. !s rcqutud hy Scrion :1700 ol rhc hbor Codc for rhc ocr'ormn" of
<br />rhc sork r'or which rhisFrniris nsucd My sorkcK' co n{Ensal ioo insurd cc .aricr orl Flicv nunrbcr e:
<br />Pa.,<,.Cr"^€, \r,r (o
<br />r,.,.r r,"r'" i'lA arr f 7)lo.:,n.pi.cr: \?-- ls \ a
<br />-l
<br />ccnili rhnr i'r rhc |f lornlncc orrhc work lnr +hich rl,is p.nnir 1r isn'.d. I nrlln.r c,nPk)v lny P&s'n in anv n'xnncr
<br />s) r!ro b.cotrE suhjccr t, rhc sork.rs c.nDcnslrilr laqs orcrliri'rni!. rnd qn hir ii I \hould t$otrrc \uhj.t! ro lhc
<br />suAcr'conrpco\dionrn,Yison\ofScdioo:l7lx)ofrh.t]hr(inlc.l\hrll.f(,nhsirhconrdvvirhrhosprceisnrn\
<br />Frilrrc nJ \ccurc sorkc^ .untrtr\{rion d)rcrr!. '\ unh*rul. rid \h l $hiccl rn.Inl)krvcr to ciniinl lEnrhts r d
<br />tu orc hundrcd rhou\rnd dollrs (Sl(Xr.(xD). n, ddiri{nr ro rhc con ot eonrDcn\rrt$ dimrEes xs Piovnlcd lirr llr
<br />Scction 1076.rrh. L rrCodc. inrc6sl Md dlorrc! s lccs
<br />ot,1-4:t1 noorr**' /f'- 7'?
<br />LLCINSEDSTNIIAI:rcB
<br />DECI.ASAIIIIN
<br />lh.ehynifiirnuntlqpenulryofFrjur!thlllarlicc.scdundnt,mvnionofCh,lld9(curtuncinSPilhSeclionTo0o)'rDivision:l
<br />of rhe lirsitur* and Pn,Icrsiols Codc, inl m,ltcn* n in fxllnr! n dt{r
<br />,'""nr" C,o*,- lfl
<br />D",.,7-tt-13 6!s!i.!L !rr 5r rt.- >
<br />IQISI8IEIIANTENDING.{GENI;I
<br />lh.tbYullrmundcrnenlllyolD.'j[ynullhclci\acon(nlclilJntrndinstrscacyfulhcl)crfonlEnccoflhcwollii,r*hi.hlhnFi|niiis
<br />i\sucd(s.. 3097,cn. c )
<br />Lcn(leis Nr'ft:
<br />-
<br />APPI ICAN'T D!'I]I ARATION
<br />IlEr$yrfijnnundcrp.naxy.lperjuryoncotrhcrdlownr8rlelar i(h\
<br />Dcnnnirn Pcnnirl^shcslor Noiificrrn r Fclcnl Rcgrhri,nN (Iillc 4lJ. Pnn6)
<br />R.(rn d l.acrof N.rifi.arin
<br />I.cnriyrhrl rlr.ltd..rlr.guhrions tgxnlii,S r\h.io\..Nnnlxrc n.rrIfli.$h nr rhn fnrccl
<br />IZI (cn r ,hd l h cr.mll'i.rrr'kdr{I!d{.(rl-rrrrhr\rtr
<br />n;d'.JNc\Jnd Sr3l Lru\ rhrrrs r.hd'ld'hE c.nnru! Fn. rnd hc'ch
<br />;;;:", : :.i.: :;:,:-
<br />*il:
<br />2z :-
<br />Prmir* mnc,prrn,,:
<br />^,1ic\
<br />1gl {'r^'tP5
<br />l!!trrin),n.or'..r lur..n,r,trit,lvNirhrllairlx tl(i{rrrr
<br />!rtrrh,rir,.frr.. r.t^.\ !l rhi\ C[\ rnd (-'u \ n). r..rl! {
<br />"^,"
<br />? -t1-t 1
<br />g '/\
<br />ELECTRICAL-INSPECTOR RECORD
<br />COMMENTS
<br />151'1 1G
<br />lrndcCs ddrcss:
<br />-
<br />Fire Alarm / Dampers
<br />ID/SIG.
<br />I
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