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ELECTRICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDAI DEITARATION I heby llrm unda pdXy of ldjury lhd I m qmpl froE lhc CodMlo6 Li.dg L.* fot th. fouowEg lasn(56.?011.5 Buitlg .d Pmadion C.d.) Any Cny or (oudy *hich rcquiE . Ftri ro @tud, rn6. ul9rcE daEli'h or !q.n dy n^rr6.. Fir ro i! sll,K. .Lo EqllG llE .p?ltet tor sh Fnn b nL . 3isi.d sr.rE! lhr E or rlE i! lEd!.n F rEr io rfi. FlrtbN of rlE Coturo. r Lim!.d tiw (Chrlc 9, Conllrjcr8 wht Sd6n 70m of DivrbE I of tlE B{.itB ed Pofsionr cod.) or lhlt h. or Jr i! a.o$ th6.tom ed rh. b.!i! for rhc dlcs.d .xdptiri. Aty lioldion olsdio. 703 1.5 by uy .pt lic.nr for . Fmn tubjels th. .r!li6r to r civil p.n ny ot ml mrc th& nv. huid.d d.ru6 (ltm). l. s o{E olth. FlFrr. tr m, .nplo,6 *nh w.g6 6 llE $lc @mpdBrEr rrl &, llE trqt ftl ,E harG i d idqld.d d ol'ard aor sl. (S- 7014. BuilB Dd ProadbB Co<L: Thc (bnr8oa. l-rag t p 1106 ml +pl, b e oqffi ol rhl FDFry *ho hrl& or Dprors rlE6( drl wh. &6 $h wd him.ltor h@lr or thhuah bit ot hd om mPloy6. proviLd rh.r 3uct irFoEGr! c mt iiqi.d do&Ed 6r sL.I[ how. dE hlildi'r* d irsovqcr b sld *i]b @ ta oaonpkiE th. OsE B!il& wiU llE dE h!dd! ofFDrrt rl'r lt d ir di1 d toild or i,g!E $. FlFiy 6r th. F4o.. ol I. 6 o{E ol rh. ropdy, M .rcluivcly .oirrering wnh li.G.d conrr.doE ro oErrucr tl! Foj{tl (s<. 704a, ttli.B rn hll3in Co& Tlr. Coirrsor'! Li..e lr* d.,€ mr .r?ly lo & o*c of FoFly *to tlal6d slF onu-lt to sh Flixl! wnh . Colrr-lo(, la6!.d pund h E Coffi* r Lt.E Lw). I itr, cr.mpl un\to S.rnon >=// )):)" Ll!:!l \ltl I (\ I h6.by rmnnrnd6 tHhh, orpdjuryoncofrhc nnhsiu d.(lI rioN IEr!nwill i.t&. Carifi..r. ofc.etr lo SdllM. tr wta @'qdtbn, s FDviLd for b? Sdiioi 1700 otdE r.!or Co<k rr th. Ffqtur of UE wl tu xn.n IIE F i ais!.d I havc ed will n.intsin worl6r' conp.rostion iEwanc., s Eiluitd b, s<rio. 3?00 of th. L3bor CodG, tor lh€ Ffonrrtr. of th. {orl tor *hich lhi! FEn i isr.d My *ort6 co,!F!dio. iBrn. cMit .al policy numbc &l Ceir - -. - PolicrN0nb6: l.dit th.r r rL Ffrfu. of dE *o't ir $hkh thB Fmn k $url. I $!ll mr dploy ey Fsn i, ey n:.ffi s ! ro b@@ $bd to rn. s{.l6 ohFsbn hwi olcrlrom!- !d *E rhd'r I irbuS haoft rqd b rb wo q' ompqeltun p.ovnhu ofsdion 1700 of rh. Lrbor Co{a I lrEll. tudhpilh on ly silh lho* DFvilbN WARNINC FntuE 16 cr. *orld' compcsb. 616.!. B unhetut. !i 3h.ll $bal s 6ploF lo dinld Fdi. 4l cnn in6 up ro oN hu,tded rhoB.,!d 4rlllr (tlm.ooo), r rldnon b rlE cor ol con9.6.r'o.. d!D36 6 Fotil6d lor rlE Sdlion 1076 ofih.Irl$rCnL. ddd d db|a sfc -1/-J)-Xt DEC!6a rla! I tslby .ftim un.t6 p6.ly of psju,y tbd I m licaB.d utdd Fbvtion of OrFd 9 Gonrlmcins wilh Sclion 7000) of Lnvitbn l of th€ Bch6 dd hrilBlioa Co&. ild ny lt.M i! in full fora di.It.l. c0llrBlJsualtlENDllclc[Ncl I ha!t, Im undd Isdlyofpsru.ylhd lh@ ir.oDr .lioo lois8,8ay forilE Ff.lrjle. of lh. mrt ft)r $hih 16pdtta. i$uai (S< 1097. Ci! c.) AEEUSAILDECTA8AITA! I ha*y .Itun u!xl6 llrXt of F)ury oa or rlE folbwiq &.1r.' 6N D.mhbn Pornl^tb.sc Norifidriotr F.d6.l i.suldioa {Tiil.,r0. Prd6) - R.qun d L6l6 ol l'{ori6.dion I car't rhi lh. L{rdl Esu]!r.N r.gidins 6t s6 r@rd E d .t'plt.bL ro lha FrFr I calily rh3l lhavcrqd rhE applicarion ud srar.rh!| rhcahv. inlD,rurhn is cotral. I 0*!c to comDlyuilh au Cil, ud Cour, ord.u.6 md sdr b"s rcking k)ldin* conltudirr sn hs.by urlrrtu. r.F6anniv6 of thii Cily rd Counly to o16 upon lh. .bor. .6riondt Fotdt Appnd or A8ar Shu \ ^,, //-) )- b I h l t:D l4c. /11,. Site-Work Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Groundinq / UFER Transformers Torqueing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rouoh) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) I\4eter Release Rough Service [Vleter lt \./'\ FINAL ll tc t?.1 ^)\rr{wtrl Notes, Remarks, Etc Li(.* Ndbd Rev.0B-07'2015