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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 Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab i Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service Meter l
<br />FINAL z
<br />Notes, Remarks, Etc I
<br />OWNER BUII,DI]R DELCARA']ION
<br />I hc,c$y rllirn und.r pcoalry (,r Frrury rhdr I an crcnrpr fm$ rhc Conhcro$ Liccnsc Llw for rie lollowin8 r.d*n (sd 70ll5
<br />Bu\i,rcss nrd Profc$ion Codc): Any Cily or County qhi.h rqutcs o pcnni l(' condtucr- llrcr, nnptuvc. dcnolnh or rcttrir rny
<br />ntucrr(, rrin t, irs i\suh... rl$ rquircs rh. ,prli.aht for :u.h Frrnn h fib n si8ncd iarcmnr rhar h. oi shc h licenrd plN@nl
<br />t,' thc privkions of rhc Conrracrois Licc.rd Lae lcn{prcr 9. Connnctuii8 wirh s.crio ?olD oi Divhion 3 of lhc Bu\inc* !.d
<br />Prufe$iors Codc) .r rhar heorrhc ircx.,rpr rhcerro atulrhchflsnrorrhcallcgcdcxcmptnnr.ADyviolllion,fs€ri,nr0.ll5byLny
<br />rtpli.dnr lar o ltmir suhj.rr { rhc applic,trl o , civil l. olty or mr mrc
<br />'tun
<br />fivc hu ndEn dollaB (S50o)
<br />/]A-*,,r ,* n-*nr. nrmycn'nr,,rrc\ ! h l ascs rs rhct $k co'np..qrion. wirr do rhi vr* uld rhc (Mrurc i\ trn
<br />,/ f,ni.,i ", "nrcd r."qk rs( ?u,U. aulurcs(JtrJ Pn\fccsirr$ culc: Thc Co mdofs Liccnsc l ie docs lor lpply u on otrn, ol
<br />rhc ropcny $ho builds or i,q8,ws lLE,o. rnn who d@\ such work hinNclror hcrsclror rhsugh hh or hcr own.mpLyccs.
<br />Fn,vidcJ rhar \rch inrprovcnEnhft n.riircndcd.rof[crcd lor srh ll ho$.Rr, rh. huildirg or imFnMm n soh wilhin onc rsu
<br />olcompbrnrn, rhc Osncr BliHcr will hat rhc burdcn ol pmvitrg rh.r hc or rhc dil rn huild or in{,)R frc pRrFn, Iu rla purlx,* of
<br />l. dsowncrofrh ptup.dy, dncr.lusivelr..nL..rinS *irh li.cnkd .ortdcto6 lo consrrucl lfu pxllcr (Scc 71X,1.8tr(ms
<br />anl tto,ls Codc: lhcConrlrtr\l-icctrscl.a*d{x\nor,ntlyk,3tro*ncrofB,p.nywh()buiklsorrn{rovcsrh.rco..
<br />ind who cotrImds for such lm]ccis wirhrConhdoas) licctrscd puruanllo rh. Conr.lciois l-ic.n\c ttr*)
<br />i"t,4\i
<br />I h.Eby.flirm und.r p.n.lry ol pcrju.y orc o! rhc lollDwire
<br />I hdv. dnd will min din workc.r conrc.sr' ion insuhmc. n rcquncd hy Sccriotr :17(x) ol rhc li$or Cde, lor rhc pdroi,nn( or
<br />rhr worl loi whichrhisp.flnn is nsmn. MyworkcE .onpcisdion insur cc.aricrondFlicynumbcr m:
<br />Rnh'J Nu 'hc' l'\
<br />//-1.-,,r,r' , '* "".'n,n!R.
<br />n,,hc q,rt hr qhrh,hF n.'n , tr \\uc., , .hJ,,
<br />t/.lAu, n.-" -rn, i.,r"- (,{r,1.'.unnfl r rrs.,.r cJhrum,r ,tr,r"s\.rh.
<br />nor .mtlo, rny pcrtotr ir.nymanrcr
<br />ill rltrr'l,t tulnn {,hj.rr1orh.
<br />sorken.omp.n\in,nl(,visions.rSc.rn)nlT0OofrhctihrCodc.l\hill.lirihwilh(onrply$ilhttu)\cpmli\ions
<br />lurc lo ecurc workcn crDp.n\dion colcrrrc n uohelul. nd shall suhjNr an cmfloycr lo aimin
<br />fl*::U Ii?jTi
<br />I h.aht aTlirD undcr rcrallyol pcrjtrry rhal I n lirtr*lundcr pnNn ;, ol( hrfrcr 9(.onnrf,ncirg NirhSLiriotr 7(x[)).ll)iri\iir ]
<br />ol thc Du\irc$,Dd PrcE$hnsCodc. ond nryli.cnrc h ir tullfor.c aDdciicr
<br />caxsrBucraNrlll,ulc-dcENtr
<br />I h€rchy afltn ullccr Fnahyorpcrjury rhd rhcr. h a L1,nitucri,,n hndi'r8,!cml hr rhc pcrfotnunce ollhc work ir shich rhi\ limii is
<br />issucd (Scc. :1097, Civ. C.)
<br />AIIUI.:ANLDEIIA&U]ON
<br />I M)y aflnn utulcr p. alr y ol tErjurt onc .l lhc aollowinS dcc l,r,rnnr:
<br />Denrrin,n Pcrmir A\he(o\ Norifi.trrtrn F.d.tul Rc[ulari,,ns (Tirl.40. Pd6)
<br />R.quncd lf,trf .f Norifi .dion
<br />ffir,ffi*sr
<br />rirrrs icg dirE r\hcnos rcnrrl rrc 0or rpnli.rblc ki rh \ I,R,tc.i
<br />/1ppli$nl or aenl SianBlure
<br />'arut
<br />ELECTRICAL-INSPECTOR RECORD
<br />Communications Cable
<br />Air Conditioners
<br />I hrvc dri *ill minrrin , ccnilkrrc of Co.*nt ro sclf-lnsurc tur aorkd s conEns.l ion. a\ lovidql ior h, Sc.rion l7fil of rhc
<br />ljbor Cdc- tu lhc pcrionmne ol lnd s.rk ror whi.h lhc Frmi i\ n\uc .
<br />Cootmclo.r_
<br />txndcrtAddre!r-
<br />ro..nDlr *nh !ll Ciry id Coutrry
<br />otJ \
<br />b J,a[t/.'
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