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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 />Lile Salety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq A
<br />Under Slab / Floor lo - ld- lV v^ut{)
<br />Bondinq / Groundinq / UFEFI
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />ryNM-Walls (Rough)tt ":l*1 2b.)
<br />Ceilinqs (Hard & Soffit Rouoh v\
<br />,}At a-l)UCeilings (T-Bar Rough)l:2.,till8 -r .zn)
<br />Meter Release ,/
<br />Rough
<br />Service lvleter
<br />7 rfia4a|tFINAL 'e./
<br />Notes, Remarks, Etc a t
<br />OWNER AUILDER DELCAIATION
<br />I h.rcby .lfifln ulx|cr p.nally oI p.rj!ry thrl I m crcmpl lrcm lhc ContractoN Licen* h* fo, lh. followins dasn (S.c 701 1 5
<br />Businc$ rnd Pof.sion Codc): Any City or Counly whi.h rcquircs ! |Emil lo onsltucl. lttcr iryrolc. demohh or Epdir' dy
<br />(Ecrurc. prior ro irs issunncc. aho rcquircs rhc appliconr lor suchFnnir ro filcaskncd srarcmnr rhar hcorshc t lic.scd pn6uMr
<br />t. lhd pbrirbn\ ol rh. Conhror'r Li.lns.il lrw (Cbuprc.9. C.mkming wnh Secrion ?fiI) oi Division I ofrhe Businc$ 8nd
<br />Pmfcsions Codc) or fill lE or shc k crcn t
<br />'h€rfron
<br />dnd lhc bdis lor ltr alk8cd crcnfln n Atry riohrn n ofSccri,n 70:l I 5 h, an,
<br />dmlicanrlurpcrorirslhjahrhcappli.inrn,acivilll.uhyolnormocrhxnfivchnodrcddolld*(1500)
<br />-1,rs
<br />owncroilhcpolEny.or y cmDloFcs $irh r'.Bcs rs Ihcn sb comncr\rr ioo. *ill do rhc aok dxl thc r rucrm i\ nor
<br />inrcndcd or oitcrcd tur {lc (S( 70,rj- Bu\ines and llolis\ion\ Cdc, Thc Coikr.tr's LitM Ltrw docs tror rpDly lo anowncr ol
<br />rhc D$IEny wlhtuild\.r ilr{xnq rllmn.ond wtx) (lcssu.h *brt hnnscllor her*lforlhn'ughhnorhcr.wncnpl,,y.c\,
<br />pmridci rhrr skh nnpnr.Erhr. i cndol or.flia ri,r elc lt lr,*c!ci rh. t ihinE or nr{rorrmnt h oU *nhinorc )!s
<br />oI c.ry'!:rion. rtE Osrcr lruildcr will h0vc $c nu.dcn ot prcrins rhlr lE or chc dil nol hiki or impo( thc pmFly ror rh purlDe ol
<br />l. N.srrotrhc pnrFny, amcxclosiv.ly.ontacrinE qirh licei{dd.onrrh$ tr.otrifl.' rh. pn,F.!' {Scc. ?04.1. Du\inc$
<br />rlxl Pnlcssion Codc: Thc Conrd.rs Licc.sc Li* d{r\ norrpplyro !nosrcrol'popcnywh,) blild(or impn,v.s rhcr.on.
<br />rnd trho ont!.r \ f.tr \kh pr+.h Nirh a G,nta.n,rl9 ltctrsd lrBumr t, rh. ConlDdoll Li.cnsc ti* ).
<br />".t
<br />';/7lls
<br />I hc..by rllntrrtndcr r^-nJlry of p.rj1,
<br />-l
<br />havc ud will nuin[in a Cenifictrrc of Cnirc hSclllnsureiorworkcB.onlc.\.rn,n,r [ovidLd rorbyScction3T0ooithc
<br />L.bor Codc. l'or lhe rrfonmncc of rhc *ork for which rhc pcrnril is hslcd
<br />I havc and sill tuinrain w.rkcs comtf nsarion insututrc., a\ rcrtuind by Sccr ion 3100 of lhc r:b.r Codc. ao, th. Frfonuftc ol
<br />rhc work ror whi.h ihi\ pci,bn i( tsucd. My worlcn comFnsorion insumNc .aFicr ud policy rumhcr dc
<br />-l
<br />ccnifythar inrhc rcrhrm0acc otthc *o,k i.. shththisFrnir h is$cd- Ishrll or cmrk,yanyr.^.i 'n,nyn'anrct$ (, ti.o.r sxbJccrb rh. rorkdl .onrNnsdrion lrw\ ofcalifdtu{ rnd isrcc rhd ifI should hcmm subjccr lo rhc
<br />workc^ c.mpcns0rii,i provisiotraofSc.rnrn:lTmofrh.lih.r C.d..l shall.lonhsilh comply wilh thosc pmvnions.
<br />WARNINGT F,ilurc tu sur. $orkcrj conD.Nrlion ovcn8c t unldwtul. lnd shall subj.rl .n cmpbFr t, sidinal FMha\ u'd
<br />ci!'l finc! ut k, onc hDidrcd rhrtr\nnd dollr\loo.Ulo, rn ddiiiotr k) rhc cosl of conDcnsnrio.- dlrmgc\ a\ pn,!id.d i, rh.
<br />)/t /,Y
<br />ll[(f,rlA.rlrl)N
<br />I hcrby nfiliflundcr p.trdltyol !crjury llr u(cr pmvhio. ofCh.plcr 9(mmtrtmina wirh s&rion xlro) ol Divhion I
<br />ol rl'. tiu\i'r$ r Porr$i(ni\ ( ()dc. nnd niy li..d\c n i', iiill nmo r,rl.l1..r
<br />Liensc NumlEr:
<br />Afluci TNTDECLAtrAIDN
<br />I lrn$y rfmundfi p.nohy oipcrjury om ofthe lollnwin8 dccltrariotrs:
<br />Ixnmlirtun P.rnrir+Ash.{os Norifi c0rion Fcdcml Rcgularrns (TirL 40. PM6)
<br />-Rcqlncd
<br />brrcr ol Noliliarion
<br />orc nor a,,plicahle io rhhpmjccr
<br />romution is c.r.cl I aeN to coq'ly wirh all Ciry and Counry
<br />ond (ininrlro ctrr.r trFr r,r
<br />Icn"irc"'th*fr , nn A*,^-l
<br />*"' c/1J4
<br />ELECTRICAL-INSPECTOR RECORD
<br />Air Conditioners
<br />IAXSIBICTANIEIDINC-&C.ENCI
<br />I hercl,y affird!.dcr FnolryotFrj!ry rh rhcr.iraonsrtucrionhndingrg.ncyror$cpcrfordnccolthc*orktushichlhisFermin
<br />issucd (Scc 1097, Civ. C.).
<br />lxnd.i\ Nrnr
<br />lxtrJca! ddrc\.
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