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APPROVALS DATE ID/SIG.COMMENTS OWNEN BI]IT,DER DEI-('AR TIoN
<br />I hcrchy 0fri.n undcr t)..llty ol pcrjury lh0t I m lxcmfl frcm rh. Conrrador' Liccn* Law for rhc lolhwins r.Lqrn lsd 70.1 | 5
<br />Busincss and Pmfcssion Codc): Any Ciry or Coutrly which rcquircs 0 Fmir lo snslrucl. allq- itrltrovc, &nrlhh or rPrir .ny
<br />srtucrlrc, prir ro ns i:suarce. als cquncsrhc arplicanr fo! such pc,mir ro lilc a sighcd {ln.tunr Uar tEorsh. i liccnscd pu^umr
<br />ro rhc Eovisions ofrt* Conk0rlols Liccnscd Liw (Ch.rr$ 9. ComirctrcinS wirh Scclion 7t[D of Divhion ] ofrh. Busincs rid
<br />Pmftsions C()dc) o! thal lE or shc t dchpr rhcrcfmm md rhc bash lor rhc allcrcd c&nprion AnyvidtrrionorScclion 7011.5 byan,
<br />Fpl'.rnrln' rrnn iuhr.hrh. a.pl'.trn' rn r.,vrln nrl,, Dl q mr rh,tr nrc huod!.d dnllss
<br />'$5')01AIA
<br />[,.l. "*^, "t,r" n.,"nr. "' m) cn'rrnye. wirh q4cs J\,hctr st cnnnrn\dnn. {,rr ,,,hc*rx ard,rr rdm ', n'i
<br />n{.hl} f ,ff"-d [., *l. rs* 7044, aunml\ Jnd fturcsions C{xls Th. Conra.ror's t-icc.* I-lw dcs nor rpply lo mowmr ol
<br />rhc rDi.ly wh. hurlLls.r rworcs tlErn. ui $ho d,$ \uch rci( nin$clfo. hcr*llor rhrcugh hn or hf.wn cnployccs.
<br />,rovidcd rh such nnfovcnrnh e frn inlcndcd or oficrc ftr slc ll hoecki rlr hoikliie oi nr{hEmnr k $ld wihin orc }st
<br />ol(rIphrion. tlt Orvnr BuiB.r will ha!. rhc burdcn df Ix,ving rhnr hc or sh. did nor bxiH or in{rDk th. ptuldy fo. rh. pur,b$ oa
<br />-l.Nowncroflh.l,Dpcny,amexclusilclrconlraclirSqithlicctrscdconkecr$srocoi{rudrhcpnrj..r(Sc.7044.Buetussind lbrcs\iotrCodc'rh€ConirscttrrLicctrscLrsdcsmrarplyrouno*ncrofprolcdysh.bxildsorimprov.slhcrcotr.
<br />rni vho $nt..h ror su.h trl,j..rs wth , ConrBct,(s) lici*d , rlMr ro $c Contmcloas Li.cnsc bw)
<br />qrdt (
<br />I hcrchy.fli.,nundft Fnrlryof ,ajuryonc of rhc lollowirg dc.lam(
<br />I hrv. ard u ill nui' ain u C.nifrarc uf Co,*.r h Sclf li\urc ffi w. $s .onD.ns.rn,., .r flovidcd
<br />utx, Gxb. n, rhe l].rfqnuncc olrhc*ork tur*hich lhc p(nnil n hnrn
<br />,lh0!c ond *illmoinl0in Bo cr' compcnsarion insunrcc, rs rcquncd by Sccr ion ]?ul of lhc hhor Code, fu rhc Frromtuc or
<br />lhc so tuwhichthis pcnnit is hsucd Myq,orkcn comt ns[ion iNurrNc c{ric. lnd F,licy numb.r&
<br />utu;in lhc !'rrlonuncc oirhc *ork i(tr ehich rhh permir i\issucd.l shzll.or c'nlloyanyFsoD in ynmnci
<br />dd rSrd rh,rl should tt.onr subj.ct lolh.
<br />dull, nflhwirh.otrply*ilhtho*pmvtionr.
<br />\uhj..r hrhcuorkcr\,con,pcn{ ionl3s\ofcrlinmir.
<br />so cs co'npr'srri{,nn(,vnx,n\orSccnon lT{n of rh. Lft, Codc. l
<br />1VARNINC hihrc i. $urc mrkcrl conDcnsirion corcm8c n unhwful. nnd lhall \uhj$r an enDk,ycr h dimin.l p.mlra\ nnd
<br />nc hnndrcd rhousann dol16 (Sr(lr.{xD). in {d(lil '(ry)Y"'-p+6v
<br />I hcrcby al1lflnundcr p!nJry ofFrl0rr rhd I rh li.rtrwl utrJcr vni('i olChxfrt9r.u nk0.irg \irI Sc.rir 7(x[)] oll)ivisi,r.l
<br />ol rhc Btr\irrs in,l ltol'cs\i{r\ Gnt.. rnd ry lircnsc i\ i', i,lltu'ec rftlclfc.r
<br />IOISIBICIIoN.LEUIDCAGENIf,
<br />lhcrcbydllrmxhdrp.nalryofp.rjuryrh th.ickrorarrudionLndingrSc..ylorrncpsfof,:unccoflhcsortlorwhi.hrhispcrmiris
<br />ns!.n (Se :109?. Civ C.).
<br />gording n\hcsros rcnrxrl rrc norlpnlicablc n)
<br />llsre ro comply wirh rllCiryrnd c{,rnry
<br />lllivcs olrhis Ciry und Counryb cnr( ulxr rhc
<br />md ndcdrd rlr Dvc$Lnn on iscorrccr
<br />arxrve mnriorcd tBlcny lb. inrp.crio.
<br />Appllonl or ABdlShdlur:
<br />P€mile nnme (pnn():
<br />trNru.ln,n. md hcrhy.trrh.rizr
<br />t0 ""blsls
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouqh)
<br />lt/leter Release
<br />Rough
<br />l1
<br />FINAL ,1L6119 H\19/..
<br />Notes, Remarks, Etc rr-
<br />ELECTRICAL-INSPECTOR RECORD
<br />AITUCANLIECLAtrTIION
<br />I no$y aiiim undfi pcnalry .f p.rhry orc of lhc followine dccl,rarions:
<br />Dcmolit,n Pemrih Asbcslos Norifi.lri.n FederalRcBrlarions(lirl€ '10,
<br />Prn6)
<br />-Rcqunld
<br />Lctrcr oI Norifrlli0n
<br />Sub-Panels
<br />Service Meter
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