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APPROVALS DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />L ight Standards
<br />S pas, Pool, Fountains
<br />Si gns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondin g/Grounding/UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />lQeilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lVleter Release
<br />Rough
<br />Service lvleter
<br />FINAL y/t/ltr ,?&"rl ')
<br />7 --VI
<br />t1
<br />OWNER BUILDNR DELCARATION
<br />I hcrcby o,ltm utuc{rnally {,f pcrjury lh l m .xcmfl ftud rh. Contra.rou Liccnsc tra lor rhc followi,rt rcosn (S.c 7031 5
<br />Ausin.sa r l Pmf.ssn,n Cdlc) Ant Ciry or Coonry *hkh rcquncs ! Frn ro con{ocr. alrcr, imrrovc. dc'hli* or tot n my
<br />struciurc. prkrlo its issusncc,olso Elutcs lhc.,'di.Mt ror su.h ttrmt ro lik i siBncd slarcmnl th,t rror shc n liccnrd purua
<br />r(, rhc Frvixio.\ .f $. Conrm.kr's Li..n*cd kw (Chapr.r S. Conmencin8 {irh Sc.rhn ?O0O nf Divhion I ofrhc Businc$ and
<br />ProfcssionsCodc)orrhathcorshciscxcnfllhcrciomondrh.b,sirrorrh.sllcgcd.xcnflfn.turyv,olalionofSalioD?03l5byany
<br />alplicail lbr a ricrmil subJcch lhc applicanr lo a civil lrmlty of nor mrclhln firc hundrcddoll&s ($5o0).
<br />-1.
<br />0s ouncr nl rhc ,)orcny, or my .nrf lor.cs with wDgcs * rhcn {,h c!'nn treriotr. will do lhc wo* old rtE (BlN h nol
<br />i.ren&i or oficred for slc (Se 7ilr4- Burircss and Prolt$ions Code: Ttc Conlncl.ir l,iccnsc ti* docs ml oDpl, ro d o*ncr ol
<br />rtu pmprdy whot ikLl or inp rs rh.mn. aild eh) dNs skh lort himr.lfor h.^elf.r ihdogh ht or h., o*o.dployc.s.
<br />tmvidcd rul such inDmrcnr s orc mt inl.rxL{ n orcrcd ror sdh. Ir. how$tr. rh. huitlin8 or inDms!rcnr ir skl withrn nnc t!.u
<br />of con{rtlion. lhc OqDcr Buildcr will haK ih. budcn ol l)bving rhd hc .r rhc did mr brild or nrF.ovc rhc pmpcny for thc Nr|ne of
<br />l- asowncroflhc proneny. ancrclusivclyconlliclins wilh licc.scd confuktrs ro con(rucl rhc 0mrccr (Sa. 704,1- Bu{ncs
<br />Jtrd Ptuftsshn Codc: Thc Contrcttr\ Liccnsc L"* doc\ nor,pI,ly ro 0n o*ncr urpmpcn, wh,, build\ nr ihpbvcs rhcrcon.
<br />3Dd who conrracrs i.r such rm]ccrs *irh 0 Conrracto(9liccns.{ purui io rh. Ctnrrrktrt Ltcctrrc La* )
<br />L.rcn,fl tr cr Sccl
<br />(rPner:
<br />]loxtrEls:ronruN$ItoN
<br />l,Dr;t t&rrlatr
<br />I he,c6y r|ri.nunder Fnailyoip.rjur, onc oirlE idn,winE dcclirnriors:
<br />I nrvc zd will nEint.in a Ccnificare ol Con$nl h S.li lnsur for wo*ss onpensori.n. as ,mvidcd for I'y Sd ion l7(x) ol ih€
<br />litnr Qnle. for th€ Frformncc of Ihc woll lor which lhc pcrn r is hsucd.
<br />_l havc and will munrl.in *orkcn comp(nsalion insururcc. s rcquicd by SNlion 1700 otlh. Latrx Codc, td lhe pcrlordrkc of
<br />rhc No,k fo. which lhn pcmil is hsEt My workcm' €omF.srion insumrcc caEtr and plicy numhcr e
<br />PolicyNuo Er:-Expircs
<br />l.cdi,yrhar rhrFrronn,nccorrl'c worl n, shichrhispcnnir i\ hsucn,I lhDll n.r c doydnyI.B.n in trny,n ncr
<br />s as to h$nnE subrc.l ro rhc worktr{ onDc,salion l.ws .r cahlaiirii. and .rNc rhnr il ! shuld trox sutrtcr Io rtE
<br />aorkcn' omllcnsd ion prcvnion! of Sccr inn 3?ur oi rh. tjtrr cod.. ! sh,ll. lon hf,irh compl, wnn rhsc pmvtions
<br />civil fincs u! lo orc hundrcd I
<br />Sccti.n 10?6 of thc tibor Codc.
<br />Del€:
<br />00O), in ddirk,n tu rhc cosr ol
<br />I hc'chy nrfirrn u .r |rn lrt ofprudry pn,vi\ioolChr cr9l.o'nrg wih Sftrion 7(X{D alDivisi({ l
<br />of rhc llusincls rnd ttorcsiorlc.d.. rnd ryti..n\c ir i,r lirllnr.. iHl.1li.r
<br />I hcrchy ritl.n und$ Fffllrorrerjurylhd
<br />issucJ(sN .r097.civ c)
<br />,!cNy l rhc Frforinnrcc
<br />Ar&IANLDIC]r|BAUA!
<br />I M)y dnm undcr p.nalry of txrtury oft ofrh. follosing d.cbErtr\:
<br />Dcn{niion Pcrmih Asbcsros Nolific0li.n kncral Rcsuhriotrs (firlc,l0. P{n6)
<br />Itrquncd l..rrrr ol Norifirxri)n
<br />lad(i I E8u lir ions nB$dii8 arh.{os rcnDvrl ,rc nor adi.nhlc b rhil [o].ci
<br />,ncci lr8rccioconrplysirh0llCiryxndCotrniy
<br />i{\ ol rhh Cny iM Counryb cnrr ulx)n ih.
<br />I Mvcrldrhn rld,lqriotr md (dcrharrhcnh,rc ill{.nution r
<br />LP
<br />ELECTBICAL.INSPECTOR RECORD
<br />Notes,. Remarks, Etc.
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<br />L.ndo .r Addrcs
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