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APPROVALS DATE ID/SIG.COMMENTS
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dam pers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />To rquerng
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rough
<br />Service lVleter /.-t
<br />FINAL 2_2-7"tK X -Y//1t)
<br />Notes, Remarks Etc.
<br />OWNER BU!LDER DET,CARATION
<br />I h.rchy lmrnr lndcr !.i{hy.f Filury rhd I !nercq from rh. G'nracn,* l-i...\e L:* nr rh. followins hurn (S.r70.1i5
<br />Busincs ,rl Proic$ion Cinc)r Any Ciry.r C.unry which r.qun s ! fsnrit h con(ru.r, rlrcr. imrrov.. d.flmhh ,{ rcnrn try
<br />(ru.rur.. prhl ro irs i\iutrRc, alq, rcqutc\ lhc upplicanr lor luch ncr to file 3 sigdd dllcnEnr rhar lr.r \h€ n licc.s.lr l)dnu3nr
<br />lo lhc rmvision\ oI rhc Conlmctois Liccnsd La* (Cha!r.r 9. commcn.in8 with Scclio. 70ql of Division I oflhe Businc( ond
<br />Pn'r€sionr Co<lc)orrhrt hcorrhc ncxcmpr rh.rctromlnd rhc hasn lorrhc ellc8edcxrmDrhn AnyviolrrionofS<rbn70.ll5hyrny
<br />applic0nr for r p.rnrirsubrccrslh. rytli.ant i. acrvilprnalryofnor nrtr rhrn nrc huklcdiioll*s (35m)
<br />_1. !s owncr ol lhc ,)n)Irny. or my cnrrl.,es wirh s.gc\ ar rh.n v,k .omn n\ ion. will &, rhe *urk rkl rtr nutuE s n.r
<br />inrc'ded oroltircd fitr {L (Sa 7(*r. Bu\ircs 0n'l Profc$iois Code: Th. Conlmdor'r l,i.cns La* d.trs ml {ply h m oNncr ol
<br />rhc Fnncny qk, t{ilds.r imrn)rs rh.d . .nd Nk, d,rs \kh worl him\.lr or h.*clf or rhrcugh hi\ or hc. own cf,pl y&\.
<br />pn)vidcd rhar such inr|nokm.G m nor inrcndsl or ofiiEd fin qL ll howcvcr. rhc hoilding or iDnroKnxnr h $H *irhin om lrr
<br />ormnDbri,n.lhc O*ncr Buiucr rillharc lhc t!(lcfl.f pmving lhd tr or sh. dn d boild or i'rr,oE ft. pmFny rh! llr FuTx'r or
<br />l. rs osftr of rh. Iltr,pcn!, rnr crch\ilrly cotrr.rcr inE wir h liccn\cd conr@ron b con{rucr rhc Frccr lS( 704J. Bu\incs
<br />and ltita\bn G)dc fhcConlraclriLiccnscLr*do.snotapplyromoM.rolp(,!.nywhohuild(ornnprovcrrhcrcntr.
<br />itrd who.ontr.rstursu.hptuF_**irhaConrr((s)li.cn\.rtpunurnrt,rh.Ci,nhct,rt-iccnrt.rw)
<br />I rnc\cNl, l'tlcr Sd.o
<br />I)$re ()sn.r
<br />ualK!&trauuiNlarraNl,i(L SrrMN
<br />I hq.byxllrD 0fd.r Nnrlrr_ol J{r11rtotr(.l rr. n'll,trvtr,N dc.hrrri(trA
<br />_lhrrciMqilltrudirdC.nili..ofCoi\rrr)Sclllnstrcntr*orkr^$np.\arnnr,a\Fovidcdf{rhySc.rn,nlTfirolrhr
<br />trtx, Cdc. forrhcr. nnn r. of rhc qork nr*hi.hrh. n nnir i\ i\\rc,l
<br />I hrv.ato, willnrinr8i'r *orkcri compcnsolioa insurnnce. !\ rcquncd hyScdion:r?(xlofrhc l.ahtrAxle. for rh. pcrn,nErccoi
<br />rh. worl n)rwhichrhk pcrmir ir i*xd M y uor[cr' .oml.n\al ion insuran(c ctrrir lDd lblicynumher m:
<br />Polty Norlbc,
<br />-Erpircr
<br />-
<br />-l.cdiiyrhrrirrhcp.rlhnrrn.c.lrhcworkf(*whrhih,1!.r
<br />ir n s{id. I \hrll hr c Dht dn) p(r\ inany nrcr
<br />$ n\ r,lf,lantu \ubj(r n, rhc $orkc6 .omp.n\rrion h!{ ofCr|li,rni0- trnd uN rhrr iI I slDll(l tEcou suhJccr t'rhe
<br />sork.N col|rd{riotrF)vnionsofS.crion.17(x)oirh.IjlltrCodc.Ishrll.li)nhlirh.on,,*irhrhoeIr.vhions
<br />$ARNII(; I.nrlLtr( r, \c(!'r (!'L(r\I.rrr lo ainnrlFslts and
<br />dimSc( rs Fovilcd ror
<br />'h.
<br />civil rln.s up r. onc hu*lftd rhousnd'rh.lrn C0L i.r.m{ !n.l//-tV ^I
<br />I lErcbyatftrmun.l$ penaltyofpcrjnrylhar I nn lien{il und.r rovision orChJlrd 9 (.ommmin8 *irh s.crnrn TuxJ) ofDivirion l
<br />.r rh. Buli@ssand Pofcsi,,.s Codc- !d my licco\e h in tullforcadelIccl.
<br />:.:""'2
<br />FT
<br />//
<br />I hcEby !filrd undcr ncnalry of Frrrry rhai rhse is a.on(ruclion lcndiry ag.Ny tor rh. psfonrDmc ofrtu wort fitr shich rhn !.rnrir i\
<br />i\sucd (sec .tog?. civ c )
<br />ATIUIANLITIITISAIIA!
<br />I trrhy allnnondcr pcnrlry olpcrjury nne oilhe tnlowins dccldoti.ns
<br />U.n,liri,n Pcrni( A\tc{os Notilicsrion ltdcr!l RcAuhridr\ (Iirlc.l0. Prd6l
<br />Rcquncd lxncr ol NorificrriD
<br />lccniiyrhnr rhc lad.ftlrcsuhrnrF rc!Mltrrg n\l{i.'rrm)vrl r. or rft, 'rllhlc n, rIn tn!!.r
<br />rion ls.otrcc, I i8rero conrnly rirh,llCir, rnd cnunir
<br />oilhi\ City and Couory fu cnrcr uIx]n rtE
<br />,\pDlicnnt w Arrnl rixn.lue n /.4-/3
<br />ELECTRICAL.INSPECTOR RECORD
<br />Site-Work
<br />Transformers
<br />Crrir.
<br />4-.'--
<br />4/1
<br /><8
<br />bndeas Addr.ss:
<br />V .,
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