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APPROVALS DATE ID/SIG.COMMENTS
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Lile Sate ty /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab i Floor
<br />Bonding / Groundino / UFER
<br />To rqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)1-2s-t{.k.r//.ru
<br />Ceilinqs (Hard & Soffit Rouoh t0-4-ty "$(tUrA
<br />Ceilings (T-Bar Rough)b -?-tr *vfi(l
<br />lVleter Release
<br />Rough
<br />/A
<br />FINAL t0- lt- lg k.\4I1)
<br />Notes, Remarks, Etc v
<br />htuLldc
<br />Jqtu"\ (vgU>+-hL,l
<br />OWNER BT'II,DER DELCARAIION
<br />I hdrcby rrfiror ondcr pcnllry r'f Frrury rhnr I d cxcopt lmm rhc Co.rrrc'os Li.cns Ljw lor lhc nnbsing rca$n (SN.?01 1 .5
<br />Ausinc$ and Ptufd$ion Codc): Any Cny or Coutrry whth rcqrnds a Frnrir t, cotrnru.i. altc., improvc. dcnnnnn n rcJlat dny
<br />slflcturc. prior lo its issur.cc.!l$ rcquircs rhc.t'tlicinl lor such lErmir lo filc! sisncn nolcmnl rhnr heor sh. t licc.scd ruFranr
<br />lo lhc ,mvisions ol tlE Contacrofs Liccn$d t-rw (ChaFicr 9, ConmEncing wirh Scclion 7(D0 oa DiviionJ ollh. Bu\i.csr Lnn
<br />Ptuf.*i6n\Codc)orrlLlrhcor\h.iscx.nrp h.dfron$drhcba\i!lrrh.allcgL{cx.Vrnr AnyvnnlrionofscdionTrll5ht0ny
<br />applr.n for , ,.r.rir subF.h rh. qrrli.rnrroacililp..ahyofnor hrcrh.n Uv. hu ndrcd dollus ($5tD)
<br />-l-
<br />as owncr ol th. In!)cny. or my cmtloFes wilh u!3cs ss lh.t slc comrcnelion. r'illdo rhc *ort and lhc dnnm ( frn
<br />inrend.n or oficEd io. slc (Sa.7(l{4, Busies and ftofessions Code thc Conra.roir t,iccns lre doc\ mr drpl, k, 0n owrcr ol
<br />rh€ pmFedy 'tb builds or in{,mrcs rhcmn- ald who d.as such wod( himscllor hcsclfor lhmuAh hh.r hcr orncnDloyccs,
<br />trovid.d Lhar strch impmtsftnt ft mr i cnLrl or olYcrcd lor \rlc ll ltuscw. rhc tDildin8 or irqrownrnr is sld wirhin onc )ed
<br />ofcomplcrion. lhc Ownc. Buildo willh!!c lh. hurd.n of tmvin8 rhar hc or sfic dij mr hoiu or nrflok U* In,Fiy ror rh.lu,T$sor
<br />l. r\owncroirhc pmFdy- rng.lusivrly..orr.crirs wirh liccn{d c.nrrrchr ro ..Nrucr rl[ rrticcr (scc ?1}1.1, Btr{trc$
<br />rM lhnl:\bnG)dc: Thc C.trti.kr'( Ll.cns. L.wdoc\ nor apfl,k) tr.qicr oflnrn-rr!qlk) build\ nr irt,rovcs rlNE.f.
<br />trnd *ho cotrrncrslorsuchtnic.r\*iihr(onkrcntr(rlic.n\cdnuru rt,rhcConkicnr'sl-i.ci{Irw)
<br />-l
<br />ln€xcmpt under Selion-.8 &PC lorlhnrerion
<br />Dalq ovner:
<br />wotxFns courENulrx
<br />DDCI,$A.II!]!
<br />I herel,y aiiirm undc! I,cnalryofDcrjuryonc oflhc f.llowinB d(l0r0lions:
<br />-l
<br />hlvc ad will minroir ! Ccnificlrc ol Con{nr ro Scll lnsurc for *or*cF mmpcn{rion, as pn,vid.d rbr by s*r ion 37m or rhc
<br />Llhn A'dc. tbr lhc perfomancc ollhc sort lor which lhc lamil is ssucd
<br />I hJv. and will nu i' ai', sorkrr! conlr.n\rr i.n nrsurr'f,c. rs rcqutcd hl Ser id lTlD ol rhc litu Codc, f.r lic tf,rlormocc ol
<br />rhc *ork fu$hichrhi\ pcrmir is ntud Mtqorkc's.onrpcn\rrion inrrrrtuecri.r rxl B,lky nu l}.rdc:
<br />Polky NuDbcr:-Expits: _
<br />I ccdiryrhnr in rhc pcltlflEicc lrhcworkl;rwhichrhi\pcrnriri\i\\tr.d.Ishallnorc1Pk,rrnyp$$nhnn,mmncr
<br />s. ,si. l.!-o,m subjc.l lo rhc aD*cF comFtrsdiotr loqs orallirornir. Md.Brcc th iil should llconE suhr$l rorhc
<br />wo*cs.onr!.nsdiotrtmvisi.trsoiSc.rionlTlDolrhcLrhrCodc,lshull.lonhenhcon{'lywnhrhoeprovhions.
<br />WARNING lJailurc lo $.urc workcn'
<br />civil fincs up ro oN [utrdrcn ln.us!trd
<br />Srdtr, lorrtl, rl{ l-'r^tr t ol. N(r.{
<br />'.,",2/r<///
<br />co Fn\nrion covcEgc h utrl0Ntul- end sh0ll suhjccr !n crpL
<br />iri,,n k, rhc.on .l .on{cn!rri,nr. dri srs x\
<br />I hcrchy rfiflnundcr ncMxyor Frjuiy rh!'on liccnsd rndcr pmvirion olCharls I (conrnrcncin3 *ilh Scclion Tlxn) orDivi\n,n.l
<br />ol rhc arsincs rnd Pmfc\\i(,NCod.. md n,y lircn\. n in tullftncculdcffc.r
<br />I
<br />I h.tuhy dffinn u dcr Itnrlrroffrrjuryrld r k,.onnocrion lcnding agcncy fo. rhc !.foflmncc oflhc Rork lor *hich rhh Frnrir is
<br />hsucd (Scc.1097. Civ C.)
<br />-l
<br />ccnilrrh0r lhc ndcralrcsul ions rcEudir8 ashc\los rcmovnlrrc noi applkahlt h rh'\ na,j.rr
<br />.'. J rhi\ rppli.rri(r, jr(.rhlrrhcr is.ofr{t. I +N !, comrly sith 0ll City lnd Counry
<br />lrw{ nldins ro huildin8.onnrudiotr
<br />^*/P4 4 rrl y'flat
<br />"":,",:,)/)r/;-'
<br />ttbl/rtil4
<br />ELECTHICAL-INSPECTOR RECORD
<br />Site-Work
<br />Transformers
<br />Air Conditioners
<br />Service lvleter
<br />cd€c( ?uB-P;'uu' @ ')
<br />c/2 4a1077-\
<br />)4 il/4/
<br />I rtrJ( a.
<br />^dJrc$
<br />ATTUCANLDDCIA&IIION
<br />IherebyanimundcrI'cnoltyoarrjlry.ncof lhcfollosin8d(hr ions:
<br />D.molirio. P.rmiB-Asb.sros Notinc io. Fcdcfll RcBuh' ions {Tnlc 4(). Pan6)
<br />Rcquircd trt.r of Noiirarion
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