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APPROVALS DATE COMMENTS OWNT:R BUII,DER DET,(' RATION
<br />I hd.by rmrm undd pd.ny oapdjury lhar I an .r.nln lro,n rh. c.nt.d.6 Licm. t-as for rh. aolloNing r.Mn (56.70]1.5
<br />BusinBs and Proaesion Codc) Any Cily or County trhich r.qtrir6 a pcmril to connrucl. allr. inprovc. d€rohsh or r.par any
<br />srtucrurc. Irrr ro irs issud.c. ab. rcqun6 thc apphcanr fu su.h pcm r. lil. a sign.d rahar rhd h. or she is licosd pustranr
<br />ro rhc p.olisions of rhc Contractois l-rc.ns.d l,aN (Chaprs q. Commcncin8 sith s<hon 7000 of Divtion I ofrh. aNin.s ed
<br />ProLsions ( od.) or rhd h. or sh. L.rmpi lh6.nonr and rh. h6is lor rn. rllc*.n .xmplio.. Any riolalion olS.cli,n 70:r1.5 by any
<br />applicanl lo! a p6mil subjdsthe applicantloacililpcnaltyofnol,nor.thofivchundEddollds(5t00)
<br />pp, ^*"."',*.-"'.n,m\mDr.\6\.'h*rRiqrhe,$et.,nrmqri^n.sirrdorh.{.mr{drh<{u'u.(nnr
<br />'nrddqJ or on(cd ror slc (S< 704a. B!s'n6r and ltotsions ( od.: Thc Codracrois Licdr.l5r d.6 not applr lo an o$nd of
<br />thc pmFny Lrho hil& or improvBlnc@n. od trho do6 tuch \ort himselfor h$cllor rhnulh his or h6 oNn.mpby.6.
<br />prolidai rhdr such intm\ dmc e nor i 6d.d or oftu.n 6r sl. Il ho$ d 6. rh. h,ikli.8 .r i,nprormror is sld *'nhin onc )w
<br />orcompkion, lhe Own6 lruildq lvrll hav. lhc burdn ol pro\ ins lhat h. or shc did rct hrild or np.ort lh. Fotcly aor d. pu4nc of
<br />L a\ oNn6 ofrh. pml,61y. a,nqclusn.lrcontacrin! \irh hcosdco 6do* t\ .onntud rh. troid lsc 7L!4. BBrns
<br />and Pl!ftsion('od.:Ih.aonk.clorsLic.ns.l-aado6nolapplvroo.oLvndofproDcny*'nobuildsornnnrcvdrhd.on.
<br />and Nho.onradrforsuchlrojdts\irh.(onkado(s)li.trslpu*uanrtorh.(onr.doasLicds.tis)
<br />I am.xonpt u.do sccrion
<br />",,"
<br />, -lz//4 o"",,
<br />,R &PC lurhisr€ron:t ,*e. -tll)atrDSs:l.lutrIl IQ!
<br />DICI,r!AAUO!
<br />Ihdcbt amnntr Jc tdahy.lpaj,'ryon. olrh. follo\in! drltu.rnnr
<br />I hav. ad $ill dainiain r (.nificar. oaconsr kr s.lf lnsurc Lr ry.rkds' .onpds.r io n. a Fovidcd aor bySclion 11700 ofth.
<br />tibr Codc. lor rhc pdfomancc ofrh. s orl lor *hi(h thc lsnir s issu.d
<br />lhavcand$illmainram\vorksi.omp.nsarioninsurancc.dre{un.dh}S(iiohlT00ofrh.tiborCod.,forrh.pdfonnanccol
<br />rh. rNl for shi.h lhi t6nir is istr.d My tr orkd .onpdsdnr insurecc ..nid md polic! numb6 tr.:
<br />I cenifyihat inlh.pdfonnanccoflhcworl for \rhichrhh Fmir is issucd.I shallnot oployanypcnon inanym nd
<br />$ at, hdom. suhn<lt th.$o*d .onF$hon la*s ofcrlii)mia. sd.!E rhd ill should G.omc subjd lo lhc
<br />$ol{6s.omFnsrion ovbio.s ofSdion lT00ofrh. Lab.r (bdc.l shall, aonhwith comply \rilh lhos pIolisrcns
<br />WARNINC: raifurc lo sur. \orkst cornrEsn]n covdasc is unlarful. dd shall subjdr & ontloy.r ro dminol p..ahi6 and
<br />ciril iincs up to onc hundr€d thous d dollars ($100.000)- in.dd,rion to rhc con ofcornFhsrion. dm.ge a provid.d for th.
<br />sElion 1076 oflh.lrh,i Code inls6l and alk,mc, s ls
<br />*.". - ?bJ/qr -/DISAXAIIA!
<br />I h6cby amrn undcr poalty oa psJury rhar I dn lrm*d unds provieion orchaprd 9 (.o,nmd.inB snh Sdion 7tu0)oil)nision l
<br />of the Busif,Nand PrcfsionsCodc. sd my li.osc is in aull aor.c ud .ft{t.
<br />Lic.m.Clds Li..tr. Nu'nb6
<br />Drte: Conrrr.ior:
<br />cqtilalquoxrENDlNc.A(iIlcr
<br />I hftby amrm und.r Fnrny oi pdrury rhar lhft i! a constodio. L.dinS a-{try lor thc prlon@cc otlhc sorr f.r *hi.h rhie Fmh b
<br />issu.rl (sc 11097. ( i! c)
<br />tanJfl \ \am..
<br />AITIICANI.IECTABAIIOI
<br />I hdrt, arm uid6 Fnalry of pdjury 06. oa rh. iollo$ing d(ltrd io.s
<br />t).mohtion Pdmits'Asb.sros Norifi.arion F.daal R.Aular ioB {T(lc ,10, Pd6)
<br />Rdtun.d l-.nc' oiNorifi.arion
<br />Icdifylh.l rh€ led€r.lrqularionsres dina sb.skrs rcnro\.l.re nol apphcahl. r{, th$ p(r.1
<br />t).dilfyrhal I hay. r.ad rhis applicario.ddsr,t.rhai rn. ah.v. infonnario. iscor€cl.1.8!atocomplys haUC ya.dCotrnrl
<br />anc6ddSrar.La{telarinsrohlildingmturtudioh.ddh-rby.urhoriz.rcpr6n.livBolthisCilyandCounlyrodtduBrnth.
<br />rluc nrr i,nul lrl,lan) nn rnspc.l on pu'pe\r:
<br />,rIlli(Nnt o' Arenl si!trrh'rr
<br />r'"'-ir.".o-" tp,i,,rt' F
<br />Y&,
<br />L)AV-\^-t)(,-o.^'-r-
<br />+/-4lq
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under SIab / Floor
<br />Bonding / Grounding / UFER 1ilYlta T'w)
<br />Transformers t Ll
<br />t)I
<br />To rquerng
<br />Sub-Panels lltslL4 A&ai(r.{g {vt)
<br />Air Conditioners rl U\
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)/'l
<br />lrleter Release 7l{alo Tlttnr;d,jeyt)
<br />Ll i
<br />Rough
<br />Service Meter I
<br />FINAL 'llNh,1,fr)r r r .ulNotes, Remarks, Etc
<br />=
<br />ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.
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