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DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinqs (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rough)
<br />Rough
<br />Service Meter
<br />FINAL b:128 /tg Twwrr-lt
<br />Notes, Remarks, Etc.U}
<br />OIINER BUILDER DEI,CARATION
<br />I hcrchy 0fl,.n undcr tlenllty of pcrjury th.l I m crcmfl tn,m rh. Cont&roF Lic.ns bB nn rhc followins ea{. lS..7o-1L5
<br />Busincs ard Prolcssion Cqlc) Any Ciry or Counry whi.h rcqtrircs qEflnil ro on(tucl, ahcl inFovc. dcmlirh dr mF .n,
<br />srocrlrc. I'ior ro i8 hrnrn... ats rcqDncs rh. trptltonr for such IE n l lo nb 0 sisocd stsr.ft.r lhal lE or sh. it ltcnsd F!NMi
<br />ro lhc pmvtions olllr ConrEctols Liccned lis (Chaprcr 9. Cof,mmnrg wilh Scclion ?(XD of Divisio. S ol rh. Businc*-tnd
<br />Pft,fesrjon(Cod.)orthlr lror.hc ir.r.npl rh.rufron d th. h.sis lor lhc allcrcd cxenflion Anyvioltrk,.ofSe'i,tr70ll.5byan,
<br />nppli.anr ror a Frnn subrcck th. appltnnl lo icivilDcnallyofnor mncrhan nvc hundrcddollars($5OO).
<br />-l.
<br />rs osrcrofrhc fri,ti.dy. or nry.mFlorecs wnh wrrcs !s lhci slc.omrnsDtn,n. willdo rhc sork ord lhc nMluN i\ !o!
<br />i ctrd.d or oficrcd tu strlc (Sa.?O14. Busincs and hor.ssnnr codc Thc coDtrr.rot s l-iccns ll* docs nor .ff,ly ro 0n owncr oa
<br />rh.I,DFny $ho hildr or imtnrvus rlErsn. unl *ho d,B \uch *.* hin*clfor hcr*lf.! rhDuEh his or ls o*n cmllyccs.
<br />Dr.vidcn rh.r ech inuDrcmnh dc mt i . Ldororcr{for"rh ll ho$c\r.lhe ttildiig or in{m*tmnr h$ *ilhinonc }t$
<br />ol.
<br />'iplcrion.
<br />tlf owncr atriBtr vill h.vc rhc hurdcn of proins rMl hc o, sh. did n.r bxild ot in{,ovc lhc tmFny tu lh. puqx& ot
<br />l,.roqrcrofrlrclmpcny-amcxclusivclyconkadinEwnhli.ci*d.otid.rslocotrslr!.rlhcprol.cr(scc7(!4.auri,rc$
<br />and hrtcssin C.dc ThcContr.ktr s Liccfs. Lawdocs nor 0ptiyto anoqncrofpi{)p.nywho huildsor inr[oves rhcrcotr.
<br />r d shu .onh.$ lni su.h tmirts qirh r Conh.b(n li€n\cd p! uMi t, rhc (t nknclols Li.c.sc bw )
<br />I dncx.m.r und.r SEnon .B &PC nr rhiq rNrn
<br />D.r.r Oet.rl
<br />woru(E[-s;tt tu Pmsltrlt
<br />D!!I,A.8AIIAN
<br />! h.rcby alfinnrnd$ ltnahyoflrrjury om oirhe lollowinE delonlions:
<br />-lhlvc
<br />ard will roi.rdn r ccnificdrc of con*ni bsclllnsurc lir workss cd'npcnrnrnnns Pmvidcd fot by Sccrion l70o dtrhc
<br />Lobor Codc. for thc rErfomume orrhc wo* iin whi.h rh. pcimil is hsued
<br />rhc sork ntr*lichih'i ncrinn is issrd MysorkcN conrp.n\rri i',{mnccrlrid xM pli.yfunrhc. uc
<br />-lccnilyrll(inrhcp.rfirmaic.ofrlrw.rkfffw)richrhispcmii\nsucd.IshJlln.rellk,yanyF-sonnrrnynunncr$ N k, tr.or. iuhle.r b rhc qorlcrs compcnsalion lnw\ otCrlilirnrir. and raNc thrl ifl should t(.nE $hFr k' rlf
<br />wo&.^.orrnsdiotrtrovkn,nsolScclion.lTix)ofrhclitxnG c,l \hlll ronhwilh .ondy wirh lln)t provnioir
<br />WARNIN(;: Eilurc h R_ r. workcr\ c,tr covcrrgc i\ rnh*tu|, aid shlll suhlrxl an cnrpl{,)q ro annirrl Ftrrkis Md
<br />civil ,l'rs utr k) onc hundrcd rhou\ n(
<br />sr.rion :1076 0l rhc Lrntr cdc. inrcrc{
<br />lx).lxxr). irr rd,l nni k) rhc.r{ ol ..mp.n\Jli{,n. Jrn !c\ r\ trovidcrl nr r[c
<br />'.."'c/'t/r8
<br />I hc(hr_ ltft rund$ Nrdky.lp.rjury rhrr I atrr li.ctr
<br />DECI,I.BIIION
<br />unJcr pn,vi\n or ( hrprs I (c.mnf,ming wirh sd im Tt)(x) ) o, ll ivi\i{r .l
<br />ol rh. atri c$rnd l'lofcl\i,rr\ (-.dc. xnd oy li.ctr\. i\ in rullli)ro r rficcr
<br />/o^ta3o
<br />1ra l4c-y' "^.-l
<br />I h.rciry rr'rkn uktcr p. rlr) or ,t'jur y rhd
<br />l\$Ed (sL! 3097. civ. (.).
<br />. tr{mcrion h ing xlcncy nn rhcltrnnnnftc ol lhc w.'( fitr $hi.h rhn Fnnil (
<br />A.STLICANLDECI.AMfIQN
<br />I hodry oBinn undcr pctralry.lp€rpry oft orrlt folk,win! ddlarulions:
<br />Dcmlirion Pcrmik-Asbc(os Nolincalion fcdcrol Rcguhliols lTirh,r0, Pon6)
<br />_R.quimd trn.r of NorifErtiotr
<br />I dif\ rhar r hcldcr a'
<br />'cstrls, 'nnr F[ardrne ash.{.! rcm! 01 arc n.r {IlrJhlc lo hF pmFr.),t
<br />)4.-'tr,,I
<br />'
<br />l" *"0,n" 0nplEarion alld ndc rh,r'hc arnvc inr.nMrion h.oFccr. I ssre ro onl,)ly wnh atlciryand counry
<br />'o.ditun... rnd 316 t qs Ehtins ro tN'ldrtrE connruchnn. ard hctch, surhoriz EpEse ltnB ot lhh Ciry snd C{'unry to cnls ulon llr
<br />;,;:;,";!;::,;":,G4 4 ,, ^,C/,/18n^,**4on^/ {nrf fl-()l ?4 ,
<br />ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS
<br />Meter Release
<br />I
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