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DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Satety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundino / UFER
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)rB *-Ye
<br />Walls (Rough)tG Jt (-y9
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rouqh (--//-- tQ lle#lz Qg)
<br />Service IVleter
<br />FINAL t1-/{-rG Jy'{>t-€A
<br />Notes, Remarks, Etc.
<br />r ()WNER aUILDER DELCAR TION
<br />I lrrcby,fir undd Fnix;rof lErrury rhI I am cxcmpr Imrn rhc Conirruroc Licen{ L* fu rh. rou.sil{ rc,sn (scc7011.5
<br />ausirc$ md Pofcsion Conc): Any Cily o! Counry *hich rcqlircs ! pcnnil t, .unitu.l, rcr. imptuvc. dcmglhh nr rcNn ,y
<br />nrudurc. prior h ns i$uanrc. ako rcrluncs rhc irplic r lnr \u.h Frmir o filc . si8trd $alcrmnl rhlt hc or rhc i li.cnscd ,unxMr
<br />fu d. pmvisio.s .l tlE Contraclrtr s t-icen{d Lau (Chaprcr 9. Conrtuici'rg wnh S.c.on 7ux) ol Divhion ] or rhc Bu\incs and
<br />Pnrcsn,nsCodc)orrhnr hcorshc tcicnrt'r rh.rcno aidrhctusirlorrhcrllcgcdcxcnr,lion. Anyviolarionofsc.rbiTl}]l5byany
<br />rppli.rnr r.r a p.r. r\ubjc.r\rhc dpplicant io icirilpcnalryoinor mrcrh!n fivc hundrcddollaBl$5ul)
<br />_1. rs o$ncr ot rhc rollcny. ,r m, emrLy... wirh wdg6 * rh.n $k onlFnslriotr. wi[ do rhc $nrl 8nd rh. iflruru i\ ni
<br />intc*Ln orofrcNd ror sL 1se.7044,8.sirc$ and Ps'fc$i.ns Codc: Thc Conts.tr\ l-i..ns hw dcs rel atply ro rnowncr of
<br />rhc nR,Fny wh6 htrilds or in{rovcs rh.so[ ntu] wh' des su.h m* himsclfor hcficlfor ihn,reh his or hf opn cn[loyces.
<br />rovidcdlharsuch irpmEmtrls m not inlcnici ororlcEd,.n salc lt homtr. rh. buildinS or imlroEm is s.ld eirhino.c )td
<br />ofconplrri,n, rhc Oqsr BuikLr will hlw ltr budcn ofpovir8 rhd h.orsht dil mr boild or nrqov. r pmFny fortu,)uqncoi
<br />_1. as.srcro, rhc pmpcnr. anrcr.luriv.lyco.tacring uirh li$tr{d conta.ron ro mn(rucl rtE lrroj.rr (S&. 7O1-l. Burnc$
<br />akl Porssi Codcr ThcCotrlrrnn \ Liccnsc La* dcs nol aprlyk, !no$ndrurpn,p.nyrho buildsor imPrclc!rhcrcon.
<br />trnd pho.onrEdslorsuchrojecrs*nhaConrEcr.(rlian*dpu^ud n' rhc contr.lo.s Liccns L!q)
<br />I mcxcnpl undcr Scdio.
<br />--B
<br />&FC l('tlhi\rcuson
<br />]lqBtrI&l:l;!&ItI'NSA.IlAN
<br />DECI.ANAIIAN
<br />I h.rchy rflnnundcr !.nillyolpLrjuryo.d ofrhc hl].{iDg J.cl'nii,ri(
<br />I hrv. willruitrrdi.aC{ni,ic.lcotConrcnlloSclllnrurciorworl.racomr.nsdion.,srovidcdlnbySccrion.]?OOolrnc
<br />trxtr G ., ror rh. Frromtrc ol rhc wolk lor whi.h thc p.rnrir is hsucd.
<br />-lhrlc lnd willmintain *.rke co'npcnsdn)n insdruncc. rs toqun.d bysc.riotr r?u)oflic tiborCodc. f(trh. rcrronMmc.r
<br />lh: work nxwhichthis pcrnir is i$kd Mywortcn comFnstrrn,n iNtrrincc carier otrd Fnicynumbcr m:
<br />Pnncy {unhcr
<br />-
<br />Ernrrc'
<br />-
<br />_l ceniryrhtrr n, fic r.rrornun..ofih. qork lor whichthisFirnit is issucd- I \hrllnor cnlpll,rrnyr.non n' rnymrnrcr
<br />s, ,sio nccoN srhid n, rh. solkcr conrpcnsxrion laNi ofcrlili,rnir, jnd,8rcc rh.r ifl should hcom uhjcd b rht
<br />rorkcs'conDcnsolbnp&visi,,nrnfScction:l?(XrolrhdbtxtrCod..lslull.lonhsilhcomply*irhttnscpo!tn,.\
<br />WARNINC l,.iLurc ro scurc workcn'compos,suhj..r 0tr cn{ioycr lo rin,inal l).mlric\ trtr{l
<br />.ivil lin.s up ro om hu E-d rhous nD.nstion. darroBcr 3\ pnrid.d for rhc
<br />Ssri(r 3076.Irhc l.ilr, ( fr|c. inr
<br />I herh, aoim lndcr pcnaxy or F.jury lh,' I an lton$d nnd.r pmvn6n olCho!,rcr I (conrmncins sirh scdion 7({D) ofDilhion.1
<br />ol thc BusiRss atr<l Prctcsions Codc, ard dy lrcos. n i. [ill r.rd ari .ffccr.
<br />B
<br />I hcrhy.fl,rm und.r F.rllyor pcdury lhll rhcrc h ! o.slrcrion lc.dins agcncy tur rhc Frrormncc otth. rork f.r *hkh rhis Fflnn il
<br />is\u.d(Sr. :1097, Civ. C )
<br />ASILICANLOECI.AMIIAN
<br />I lErt y trmru.dn pcnrhy of p.rjury onc ollnc lollowins delaraliotrs:
<br />D.dnirion P.rmnr-Asb.slos Nolificatiotr ftdcnl R.Fuhtions (Titlc tlo. Pan6)
<br />_Rcqui&d tilrcr of Ndiirotion
<br />\t{{osr.rtrrlrrc nor !|l
<br />hcorer l lsd ro6mrlywirhall Ciryand Counly
<br />Elrr*.rariws olrhisCilyand Counrr ro oid rF)n rtE
<br />*,.,Sda/,
<br />tlr.a
<br />appln.rn! r As.nr si*nirtm
<br />Pmnthcmme;;D(\u Y y<-a-
<br />ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS
<br />rc ilrhn rmlir rrrrr llrrr rhtrr
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