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APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underqround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER I -25-r,x ),t'{,11\
<br />Translormers
<br />Torqu6ing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lrileter Release il-25;-1"
<br />Rough A
<br />9\11,'Q
<br />FINAL 2-lq-Y.WJA
<br />Notes Remarks
<br />OWNER OU!LDER I)EI,CARAIION
<br />I hcrchy olfirm ufrlcr pcmhy of l). tury lhll t onr.rcnul frnm rhr Conra.ro6 LiccnE ti* l'or rhc t,llowin8 rcaq'n lsec 70.115
<br />aunrc\( dfil Protsion Codc)r Aiy Ciry or Counry *hi.h rcquircs ! IrnDir k, ..n{rucr, altcr. ingtravc. dc x,lkh or rltrir lnv
<br />(rucrurc, pri, ro irs isu6mc. rko nquircs thc lprlkotrt ior \uchl)crnirt, filcnsl8rcd (atmnl lhar rxor shc n liccnscn nursoanr
<br />t, thc pn,lknJhs or rh. Contmcroas L,ic.n*d trw (ChaPI.r L C.mrfrrcirt wirh Scciion 7ffX) oi Divht,n I ofrh. nx\i't* and
<br />Pmra$ ii'n( Codc) or th0l hc or\hd n.r.nrr rh.r.rron rtu rhchasn fo. rhe rllcs.d cxcmflion. Atry violari.iofScclion Tlr.l l 5t'tr ,
<br />umli.anr lbrr p.lnir rubj..crhc lpplicanr h r.ivilp.mlryofnor tu)drhm,ivc hundrcddollnr($500)
<br />l. r\ ostrd ofrhc pmlrnr- or 'ny.'nplo}t{s wnh w,8.s as lhcn qnc onrpcnqrtui. sill do thc wod and rh snr1m k mr
<br />inrcrhd or ofi.red ftr slc ( sd 7(!1.1. Busim$ lnd Proicssions C{nE The conr.cl,tr c l,icensc riw tuc{ .or alPl, lo sn osftr or
<br />rhc pNtrdy vh) buildr o! iqx)v6 rhcd,n. drn qtF dds cNh e.* himscllor hc*clforrhroqh his or hcr o*n cnrlnvccs.
<br />pn,!id.d rh r sr.h imfmrnEnh m rt, inr. i.rl orofibftd I(, s h lf howcEr, rhc ttuiUinE or irqmvcrEnr k $H sirhin^* )r{r
<br />ofcomplcrbn. ttrOqrcr Ruikl.r *illtuk rht hordcn ofF*irr! rh tr or shc dil n, h ild or nq,mE lhc nmFny for rtr luqnlc ol
<br />I.$owrc.oflh!nrop.ny.n cr.lu(ivclyco racring wirh li(tr$d ..trtrdon n' $n{ruct rhc ptu.{r iSN.7Ol4- Br\inc$
<br />aul th'r6si,nCod.:ThcConnacloarl-iccns.LawdocsR .rPly Io !n oucr of l'nrl).ii y who hu ilds or n.pro!c. ih.rcon.
<br />rnd rho (.trtr.r\irsuchpnJccr{uirh nC nlrr.to(9 licf\.d Jl m k,rhc C.ntracroi\ l-i.{n* Ll*1.
<br />;: }1
<br />uftlcrss.-ri(i1
<br />lrlt,)
<br />I hcrcliy rl,tm undcr p.mlrynrn rjury
<br />DD(IAAAIION
<br />I havc and u,ll rMirtrin a Ceniftarc or conrd ro S.lf.lnsurc for *orkr6 con{tnstlion. as PFvidcd lor bv Sd ion lTuJ of rhc
<br />Lib.r Cod., Li rhc p$forroEc of rhe MrL fd ehkh rhc tdmi is i$ucd
<br />-l havc a.d *iU nsintdin uork.R comFnsarn,tr insuraE.. r{ rcrlun.d by Sed ion .17fi) or rtu bho! Codc. for rhc pdformncc 6r
<br />rtc sorl rtr*hthihh p.nnit is ks.d M,sork6 comp.ns.rio. insur.rce Qd.r dixi lblty nunrb.t m:
<br />l.cnilylhrl nr rh. pcrlornuku,frh. *tr* lir shich lhi\ ntnnii i\ i\\ucd. I shrllnol .nlIk,y ry tlcmun in !nv ronncr
<br />e, rst, bccon. suhj.cr t)rhc workcn compctrsrrion l $sofcrlilonnr. md,grcih ifl \h.uld he.om sobjNr r.ttE
<br />*ork.B .o D.ns[i.n pmvisions of S(rion .]7(X) or rh. lnhrr ( odc. l dull- fonhwnh .u nly s iih rhos Pmvrirns
<br />\vARNl\(;: Iirlu. n) {curc \ork.^ r" Do'rrn .,,vdn!. i. trn l. n \holl {ri]cur an. ll'k,y.r !i mnri' l F!'ht\ onl
<br />rltr cosl ofconT.n\xri,,n. dinugcs a\ Poid.d fnr rhc.ivrl ftrc{ uI i{r om hu rcd rhoulr.d dolhs
<br />/4/4El tl!l:N$![Ar&!!U8
<br />t)1.:(t.\R\llr)N
<br />I hcrchy rlltn, u J.r |xtrrli!.f tf, Utrry IunJcrI[)ri\i()n.l(-hn/cr91.. nft..trr3$irhSc.rirn7(rlnof r)ivisi{m l
<br />ol rh.llrrnc\s ltto,i\nnn ( ()(n. rrxltrrr_ li.cf\c i\ i',lu lf.Irc rftl.llt.r
<br />-l,iccnsc
<br />Nrn$cr
<br />-
<br />coNlirBllqllaliuillllltc-&our(:r
<br />I hcrby trfinn unLr pcnrllyolFrruryrhd rhcrc i\ tr connrudhn kndi't8 rAcn.y lhr rhc ncrturnumc ollhc work nr uhich rhi\ Pcrr.ir is
<br />n\kd (Scc .1097, Civ C.).
<br />ATELICANLDLCLAf,{III}!
<br />I tmhy rriinn xndcr F.aly of pcrjury onc ofrh. folbwirlE dc_lrtrrion!
<br />tlcmlilion trcnnir\ A\bt{o\ Nolilicarion Ftttcral Rcsulari(,ns (l1lc4lr. PM6r
<br />-Roluircd
<br />I !(icr of Norifi .dri.n
<br />\ rp&lir! rshLn.\rc xrxlrrc r lDl'li. hlc ro rhi\tn,ltcr
<br />rdcrlidr rhcrh'vc i',lnnnrrirn i\.orc.r l+rud nicotrrdy
<br />,nd Counry b.ni.r uJi rh.nr.rr{. rl hrrch\ rurlrnT. r.nr.\err)rnd\ ol rhn CirI
<br />r1rrp4\ppli(anl nr ,1lcnr Sil9 rurt
<br />":il.,",;:,7-"L 6o,rq fe2ez ZL t4z
<br />ELECTRICAL.INSPECTOR RECORD
<br />Service Meter
<br />Etc.
<br />Policy Nxtr$.r:-Erln s
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<br />I
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