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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />L ighl Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)I
<br />Walls (Rouqh)z/ill .-M4-)
<br />Ceilinos (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />lVleter Release
<br />Rough
<br />I
<br />FINAL ffi/rb t/il .'YtA -/,tl l
<br />Notes, Remarks, Etc ,-rSlVo-t,-1
<br />OWNER BUILDER DEI,CARATX)N
<br />I hcrby aflirm under l.n.lr!.frcrjury rhr I am.x.mg rn,o rhc CuntkIoN Liccns Law Inr lhc iollouin8 rcav,n lscc70ll5
<br />Busitrcss nrn Prolcssbn Codc): Any Cil, or Counry whicn rcquircs 0 Drrmir x) con{rud. 0hcr. improvc, tufrnish ot ml!ft dny
<br />\rdcru,c. rrir ro ils issuamc. lho rcquid\ rh.applicatrr ll'r \uchl](nnirb fiLa lig.dd *r'cnrnr (h tuorshc h liccnscd pursuanl
<br />to lhc prolkions of rh. Contr,crols Liccn{d IjR (Chllr.r 9. CommcrcirS silh Scdion 7u)0 of Division :l oa rhc Brsines ud
<br />Pmltssionr Codc) or ihsr L(orshe h cxcflrpt lhcrctomlndlhc b0si\ lorlIt rlle-scdcxcmnlion Anyvidrrio.orsccri,,n70ll.5hydny
<br />lrplicrnr nro pcnnir subj$h rhc rpplicanrroacivilpcnxlryolnornDrcrlunivchundrcddollrsl$5(xr).
<br />-1.
<br />is owrcr oilhc Dml,cnr. or mychpk'yc$ wilh *nscs rs lhcn {'b con,l]c sarion. willdo rhc work rid rh. stufun k ml
<br />i c icd or dftcrd for vlc ( Scc 70{.4. Busi'rs and hob$n,na Cod. Th. C.nkmror's Liccor Liw docs not mnly lo m owmr of
<br />rhc nmFny who huilds or impmrcs rhcrsn. ind who dm. $ch wo* hlDsclfor her*lfor lhn,u3h hh orhcrosn cnpldy..s.
<br />pmvidcd rhlr such i'nprokrnrs N nor hrcd.rl or orca{ rhr {lc ll ho}evcr. lhc huiuins o, nr{mEmd n $U wirhin nn. yer
<br />olcomfkrion. thc owtrcr Builicr * ill hlvc thc blrdd of lrovns rh.r h( or slE dil nor buiH o. nnpmlr thc lr,Iioly lor rh. purlx]s oi
<br />-l..sowrcrofthcpn,lEny..ncr.lu\ivclyco
<br />ra.linSwilhliccnscdconlraci,\lo&n{.irhcF)).cr(sc..7(}1rl.aunncs
<br />Ild Plr,tusim Codd l hc C..r:dofs Li.c.sc Lrw d.cs nor 0pply b ahown( ofprotcrry who builds or inrlrcvcs rhcrcon.
<br />rnd sho mnrBch for slch pn,lcch {irh a A,nrru.ro(n liccnscd I,uB$nr ro rhcG,nta.t, ! Licch\c lj{).
<br />I rm.rcnrr xndcr Sc.rn . B. & P.C. ld thi\.crv'n
<br />D.l.:_ O*n r worxr[sirrrvprnrslrrrw
<br />DICLABAUA!
<br />I h.icby rfllnrundcr l.nrlrt of p.rjury orc ofth. folbwntg dcclrflri.ns:
<br />Il vcxtrdsill'nai'nrin r Ccnifiuic ol Coisrir k, Sclllisorc i(tr work$s .oni|xn\.rt .r\ fmvidc(lli)rbySc.ri,,nl7(rrofrh.
<br />l,rl}1r a.dc. hr lhc pcrfonuncc ofrhe *ork ntr shi.h rhc rrnrir i\ n\urd
<br />I hrvc rid sill tu,inrain uur*fa .onpensariotr nNurancc..s ertuircd b, SNrion 3TOOollhe Lahor Codc.lor rhc l)caroflmR. of
<br />rhc woA ror which (hN p.mir is isssd My work tr .ompc.srion insurarcc caEic! ud policy nlmbcr E
<br />-l
<br />ccnifylh nr rhcpcrlornBnaolrnc wor* lor thi.hlhis pcrmil is is\trcd,I shrllnur cnrlbyanyr.son in lnynunnct
<br />!' I b hNom suhrc.r b rh. w,Ac(' confcNnriotr h*s of cnlif ia.andlBNrh ifI stould trcom subjcd iorlr
<br />wolkcs.onrFnsariotr[ovisionsofS.crion]7firoIthclj$orCodc.Ishlll.l.nh'irhs,mply*irhrho{pmvnn,s..
<br />of rh. Dusin s! d Pr.fc\!ior\ Codc, uxl nry liconsc n in tull liir(urdcllccr
<br />Bu't6t'
<br />30So(,2.1 {
<br />I h.eby affirm undcr Fmlty of pcrjury lhal
<br />issucd (S.c..1097. Cir. C.).
<br />L ingrg.tr., lnrrhcrrhnun.c olrhc sorl lnt B[ich rhi\ ]r.i,nir i\
<br />AEIICAILDES.AXAIII]N
<br />I h.rcby trfrm uMcr ,.n!ll, of pcrjury orc ot thc follo*inB dc€Ltr ions
<br />D.fr,lnion P&nrirs Asbcal.s Norificdion F.d.hl Rcgulorions (Tnb 40, P3n6)
<br />Rcquircd Lnn of Notifrcdhn
<br />rh.lcdcr{l rcsulllion\ reElrdi'rs r\tf,nos rcmovrl rc nor td'cabL b rhii proFcl
<br />ri I hi!. r.){lrhis rfln.rri,rr {rr.vc i',ronturhnis.or.ci IrerN!.conrrly$ilhallCiryatulG'unry
<br />roihtr,zc rcprcscnrtures of rht Ci
<br />L L-.
<br />'q;;r;{'"-
<br />ELECTRICAL-INSPECTOR RECORD
<br />Service lVleter
<br />civil lnr\ trp k' oR hu rcd rh.u\r d drllrrs
<br />:;:Uzr/ttr t6cirr
<br />t
<br />Lcndn'r Ad(trs:
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