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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Satety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />B onding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilin gs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lvleter Release
<br />Rough
<br />Service IVleter
<br />FINAL /tl{l n n ,'ilrl$,^l ?.>)
<br />Notes Hemarks
<br />-l-
<br />r owncr or lhc propcny. or nrycmnloyccs qilh rva8cs.s ihct sne conDens$ion. trilldo rhc sork ril rrf, {odm n fr
<br />inrctulcd or .,Icrcd r{tr \olc I S( 7044- Bu\ines &!d Pmfestrn! Cqlc 'l'hc ConrEciois t,i...{ I rq du.\ nor {ply lo nn oqrr of
<br />rh. rtupcny who boilds or 'rpmv$ rhcN)n. rrld wh. dcs skh triri hin\clror h.r*lfor rltrouSh hir or hcr owtr cmDloyccs,
<br />Pn,ridcdrhtrrsuch iprovcnrcntrcnori'cndcloronlBll H,h.li h.wcvcr,rhchuikliryor iarprovctrrnr i v'ld wirhi ,ftFxr
<br />oroq,hrkitr rhc {)*ncr Btikler *illhrt rhe hrd.n orpmving rhd h. or shc dil fr, huiH or inlnn,t rhc pn,pdy f(tr rhc putx,sc of
<br />l. a\ o\ rE! ot rhc rotcny. !mcichsnclyconrr.crin8 *irh lircf\ed ronrrrckrs h conitucr rk pn,rcLr lS.c 7044. Bunm(
<br />rftl Ptufcssbn Cudr ThcG,nta.tn s Liccnsc Lrw docs nor rpplyt) nnotrnn ofti.lcdysho bnilds.r imlro'cs rhcrco..
<br />a l *h. lrtrtrcr\f(tr\u.hproFc($irha(orr.lcb(nlic.n\cdpuruDnrt)rh.Cu rrctn \ I-ic.nsc Ljq)
<br />I rcxcnpr !id.r Sc.rn,
<br />UOA&'BS:C TENiA.TJON
<br />DICLABAII!]N
<br />I h.r.br" affi rundfir. rlry ofp.ijrryon. of!h. folbwnrg d.clnrrinnis:
<br />I hrvc dnd will uinrninnCcnific.icotcoD{nrio sclf.l \urc fitr w.rk$r c.nIEn\[ion. ds Drovidci lhr hySc.ri{r.]?(xrolth.
<br />L$or Ar[. lnr rhu Fnnnnin.. ol rhc wor k ld whi.h rhc p.rn,ir is i\srcd
<br />_lhsvc rnd willNi oin wolkcr'coflrpcnsatn,n insurrNc. ns rcquncd hySccln,n.l?O(rolrhc tih, G'dc. r(tr rhc l'rlornrN. or
<br />rhe wolk lnrwhichrhk pcnnir is isEd My*ork.n conrl)cns.rio imuroDce c!tricr lnd Inlic, nudbo ucl
<br />Policy Nu'nbcr:-ErliEs
<br />I c.difyrhar nr rhc !.rfrrmn.c of rh. s.rk nn whi.hrhi\ p.rmn h irsot{,I shrll .rr .mIkry .ny tl.rstr in lnynranrcr
<br />sr ar to tcco'm suhrc.r'. 'hc*o cr'cortcrsnrionlawsofcnlilorni0.trndr8rccrhariflsholldhecoNsuhFcibrhc
<br />wo c6 comp.trsarbn [ovniotrs ol'Sccrion3?$oflhc titr! Codc- | sh0ll. n]nhtrilhmmpl, wilhrbs povi\ion\
<br />rul. md shrll suhjcr tr,r cmplorcr Io ri na pcrurhics and
<br />tu rhc .o{ ol.ompcnration, d.nr8cs as Frovidcd lor ihe.N I lnA up n, rtu hun,l'rJ rhru\r.d drlh,\ ill
<br />I xt.td
<br />Ihcrcbynlltn undcr Fnrlrl olrqjuly rh.t I nlien--di cr Dmvhioo ol Chanlcr 9 ( con mncins wirh S(rn,n TUXI) .f Dilisio. l
<br />ol rhc Busincss dd Phr.ssiois G)dc. dld hy li.ctrs. a in tull for. d cffccr.
<br />nll7s ?
<br />I
<br />I hrrrhy rfinm trnlcr p.Mlryor r^-rjny rhd
<br />i\sucn (Src 309?. (iv. C.)
<br />rcisacondru.ri,nr kndi'rga!. cyforrhcpcrforntr.ccolthctr rkl'or$l,ichrni\pcnnir k
<br />rhnr inr(rn ion irconLrr I n3NroconDly*irhlll CiryrndCounr,
<br />orl l[Ebyrullrortc rc!rcscnrxrives ol rhis Ciry and (i,unry k) cnrcr trF)n rh.
<br />l\pplicnnt or Asqr Sirn.luF:
<br />"-,*".no,rn.,r1 71n-l 'tra.A"-t
<br />,",.8.r) l(
<br />ELECTRICAL-INSPECTOR RECORD
<br />Sub-Panels
<br />Etc.
<br />OWNER OUILI'ER DELC RATION
<br />I h.rcby arfirm undcr pcnrlry or Frjury rhat I dm.rcn$ amn ihc contn kn{ Liccnsc Law for rhc aollo*in8 rc,$n (Ss 7031 5
<br />Busims .nd Profcsion Codc): Any Cily or Counly ehi.h rcqutcs o pcmril lo snslrucl. alrci improle, dcdnnh or rcplir rny ,
<br />(ocrurc- I,rior to irs hsu!rce. also requircs rhc rypliclnr lor suchlEnnit ro filca sis.ed (arcmnr rlur h.orshe i\ Ii.cnscd pxBumr
<br />to lhc pmvisions or lhc Conto or's Liccnsci l-rw (ch,flcr 9. c.mm.Ning wnn Scclion 7o0o of Divkion I oa rhc A!\irc$ lnd I
<br />Prcfc$ion\Codc)orlhallrorshchcicmDtlficrcfromatrdlhchlssfo.lhcallcBcdcicmllion.Anyvtarionorsc.rirnT0ll.5bydny
<br />amlica for r f'.nnii srhj..rsrhc dptlic,nr to,civil p.nrlryornor nn,c lhan iv. hundrcd dollan($500).
<br />t---}_)--r z--\o
<br />Lctrdcrs Addrers.
<br />-
<br />AIIILCANLDECI.ABA.IION
<br />I hdr.hy rfm !.d( penalry or pcij(y bn. oirhc fouowi4 delararions:
<br />t)cnrclition PcrmillAsbcslos Notiliclrion rcdcBlRcBulutions ('Iitlc t(). Pan6)
<br />-Rcqund
<br />Lcttcr ol NoifHtiotr
<br />tidcrrlr{lhrnnN rgrJi'U r\h.{o\ rcNnxlrru mrrpnlicrnl. I' rhn l)(ic.r
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