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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 />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lt4eter Release
<br />Rough
<br />Service It4eter
<br />FINAL /{,/11 1. (KYldLwll)
<br />Notes, Remarks, Etc
<br />1*'Ll l)^J'r/f I r -t Iffi
<br />OWNER BUILDER DEL('ARATION
<br />I h6.b, ami,n und.r p6ahy of pdjlr, rhat I m .x.n'pr fiom rh. Conrr0doc Lic6F t w for lh€ followin3 r.&. (s.c 70:\ 1.5
<br />Rusin6s ad Prcf6sion Cod.): Any C,ry or Coudy *hi.h rcquir6 a prnir ro .o.srtud, alr6. improvq danolish or r.rEt any
<br />stucruq pri$ ro ns isuec., aho r.qut6 rh. trpplicmr ror rci pra r o ntc a sien.a on*-, ti "i * - ,r,. i ri.-*l p,/-'
<br />ro rh. prcvisioB oarh. Cookr.ror's Liccns.d bq (CBaF. 9, Conmd.in! {nh s.clion 7000 of Dilision 11 oilh€ Busines and
<br />PmlNions Cod.) or thar h. or shc is .rcmpl rhs.fton ond thc bsis lor th. sllcscd €ldprioo. Any violario. ol Srtrn 70 1 5 b! rny
<br />applica.t for a pmn subJ<rs lhe afi,licdfl lo a civ il p.tuhy of no! ror. rhd 6r. hondr.d doll&s 1$50\))
<br />I, d o{n.r olr,E propdy. orry.mploy.6 wnh wa86 s rh.n sok comp.Gation. villdo the \vorl dd lhe slru.l@ n tur
<br />inrqdsl or olT6€d lor elc (S( 704.!. Bsin6 and PrclsioE Cod€ Th€ ConrE.roas l-ic@ Lav di6 .or applr ro dn o\ n€r of
<br />rh. p.oFny who &il&or imprcvcllE6n. di who do6 sucn wo* ii'ns.laor hrylf or llmnEh his or bd ow. cmploteG.
<br />p.oridai $ar su.h idFov@ds e.ot inrndedorofidd 6i..r. Il hos6q. th. buildiu or imprcvml is sld within onc r@
<br />ol conrplcrion. rh€ O$nd BuiB6 Nill havc lh. burdo oaprovn'B Ihd hc or shc dij nor build or inrnot tr pody for lh. purlFs ol
<br />I. 6 oucr ol the ltrop.ny, en €xclusiv€ly contractins with licmed conl4cro6 16 o{od the ,mjer ( sd 7014. RNn*s
<br />and PioQsi.n codc: Th. contactors Liccnse L.w do6 nor.pply to d own( o a propsry *ho builds or inpor6 rhdon.
<br />Md Lvho conrFcrs for seh pmj€$ \vnh a conmdorls) hcm.d puuMl lo the Conradors Lic.nse t rv).
<br />I @excmpr undd S..1ion .B &PC for rhis rcMn
<br />!iaax!8t-ca!rtENrA]ll)!
<br />DECTABAIIO!
<br />I lEreb, amirn undcr !.nrllyofDsiuryoncolthe followina ddle.tiore:
<br />I har. dd *illmainlaid a C.dilicalc ofCoBat 16 s.lalBur.16r wortdt tump.Mtion. d Fllidcd lbr byS€clion3700orlhc
<br />libor Codc, tor lhc psfomncc ol th. tort ror which lnc pqmi n Gucd
<br />I ha!. and will daintain sork6 compeBarion iB@ncq d r.quncd hy Sdrion 1700 of rh. tibor Cod.. tor lh. psfom c€or
<br />issudl My worl6' @,npensar ion idurancc .mid ed p.licy numbd d c:d "y',1q4!E44a 7-
<br />I ccnilylt.l in lhc pdlornanc€ ofthe Nork lor Bhich this Frmil is issucd.l shall Nl dploy aoy pdcJn in a.y moni.r
<br />e * lo beonc subj*r ro rhc *ork6' cofrtcdsar ioo lasr ot Cahlodia. dd asE rhd il I snoold haom. ubj4t to lhe
<br />$0116 cohtdsarionpdvisioB.rSdion 1700oarh.Irbor Cod..I shrll,lodlNnn conply \virh rhoF,rovisions
<br />w ltNlNO: Faihrc to Kur€ *!*c6 coniptuat'on colsa!€ is trnla\vrul, ed sha,lsubjd d mploys ro aiminal poralriG 0nd
<br />civil fin6 !p ro on hund'di rhousand doll6 {1100,000). i,.ddirio ro rh..oe oacomp.Nliof,. dana86 6 pro\idcd ror rh.
<br />serion 10?6 oarhe hbor (bd., inldd md *trom.y s 16
<br />E'/o-rt
<br />I bdeby 6mrn undd !.nall, of pftjury rhar I an li.aE n uidd Forision oichlptd 9 (commcing Nith S..lio. 7000) of Dn isti :r
<br />of lhc Busin6s ed Prcfsio6 Codc, ad my licos is in lull forcc and efl(l
<br />oa?
<br />I hscby .fiinn und6 pen.lly of p.rjury lhal th@ is a cotr(ruction lcndin8 asflcy ror rhc daorfucc oalh. sorl lot $hicl lhis Frnil is
<br />issue!(S.r 1097. ('n (-)
<br />drg,lcANfDEcldaduaa
<br />I hdd!, atrrfl u.d6 pcnalr, of p<lury on. oalh. aollowing d6lr6r io.s
<br />Dcoohion Pmns- sb.sros Norifi.dion F.ddal R.rulalions (Tirlc 40. Pan6)
<br />Rquncd ktr6 of Ndiicdioo
<br />ELECTRICAL.INSPECTOR RECORD
<br />Air Conditioners
<br />/7
<br />""," g-D'rT
<br />and Counlylo ent6 uponlhc
<br />I c6lii rMl lhc fedr.l rcsuldioG resadinB 6b61os .mv.l aE nor aprl'eble b rhis poj..r
<br />/firf^,o ,nn, **,-o,r,s lpehca,,cn
<br />'nd
<br />*r. ,r-d ,h. iho\. inromd,cn E ccn d, r dE,a,o (onpr,
<br />Ioilmrn(6 d scr. Llsrcldms ro hu' Jiry co(nrLd'on.,nd h.(b).url"or,. RF(s,arn6 orrhn Crt
<br />' ab.\. nolonql nmFlv lor '6pdon DuIqa6 /
<br />Appronr or ^B6rsl3tr.ru,. fu D.rc
<br />",*o**-,*n*,, V -5but ark
<br />6_n 7p
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