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DATE IDiSIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Salety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />To uerng
<br />Sub-Panels
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />lvleter Release
<br />Rough
<br />I --_\
<br />FINAL 7 ls/|il )
<br />Notes, Remarks Etc
<br />OWNEX BUTLDtrR DELCARATTON
<br />I hercby 0finm undcr pcnalty of pcljuly rhar I m crcmF fmrh rh. Conlr..ros Li.cnk trw lor
<br />'hc
<br />rollowine m.$n (Se.7oll 5
<br />ausinc{\ rnd Plofc$ion Co<lc): An, Ciry or Counry trhich rcqntes ! rrmir to consrrud, ol!s. improvc. dcmolkh or mFt any
<br />rlru.lurc. Frior ro irs hru,ne. ul$ rqutcr lhc +pltdr for su.h pc.mir ro filc ! sirrcd sulemnr rhd hc or sh€ is li.cn*d ,uriuul
<br />tu rhc lnwision\ oI tlE A,nrrrctois Licensd L.w (Cnll'!s 9, Comnrmin8 wirh Sccrion ?00o of Divtion 3 ofrlr 8usi.c$ and
<br />Pmtcrsionr Codc) or rhat hcorrhc ircicmpr rhcrcfromsnd rhe b&\is forrh€alkscd cxc,r{rion. Anyvbl.tionofsstionT0ll J hy y
<br />opplicor iin e Frmir suhirh rh. aptlic,nr r. d.i!il r,c.alrrolnor nrc rhao fivc hlndrcd dollars (t500)
<br />Lnrowncr.llhepropcny.u.m,emplortcs*lrhwo8esrsrhcnsolconrFnsulion-willdoltEw( ondIhc slutN n nor
<br />i.ldtcd or ofcrcd fd eL (S1r.70,14. ausirc$ rnd Pmfcrsiois Codc Thc Co.krcrois ljcens Lrw d{rs frn aprly r, i6ow.cr oi
<br />rhj lmpcny who h ds or i'qx,B rhcEr. and sho Jms och wor* hinsclfor hcr*lfor rhmu8i hi\ or hs own carploFcs.
<br />pn,vidcd rhd such inlroKnrnt aE nor inrcuLi o, offsc{ ior elc lt howcE th. huitiiru .r nr{rorcrBd n sld *irhr orc }rr
<br />ofcoryrtl i,nr. ltE O*ncr Buikh will haE thc hdnlcn ol pn,vins thd lr or sh. did m huiki or inpnnt th. ln,Fny f.r rh puqxM of
<br />_1, !\ ownsol'the pm!.ny. ancxclusivclyco raclnrS wnh li..nsd conri.rors ro onntud rtr pr+.t (Sc..7044. Auiinc\r
<br />Md Pn,tusbn C(ic:Ihc Conrracttr \ Liccosc Law does not !Ipr, h anowncr of poacny qho builds or improvcr thcrl$n.rnd qho co.t,.rs ror such pmjck wir h u Conrhck (s) lienscd ,rBUUr b rhc G)ntactn r lncnsc ljs)
<br />-l
<br />aDeicnu udcr Sc.r.tr*4.4.19
<br />I2li(rrt !t!1
<br />I hcr.by.fllrn und.r p(nrlrrof Frjuryonc of rhc f(,lbwing d.clnr{nrn\:
<br />-lhavcud
<br />Rillnui nirrC.nilicat..lCrtr{nroSclflnsurcra,sorkc^'.unrtrnsnri(,h.r\ r$v'dcdlnbySccrn'nlr7(nofrhc
<br />Lab.rc(xlo.nrrh.rcrfornlm.colrh.s.rklushi.hrhcpcnnir i\i\sucd
<br />I hrvc and $illmaintrin $orkcri compcnsarion insuranc.. trs rcqutcd byScdlon l?(xrolrhc Laln Codc. for rhc rrr.rrorcc oi
<br />rhc trdk nr shich rhis pctrrir is irski My sorltcr' .nmren$l iotr in\ur!rcc .lricr lxl plicy .u nthcr m:
<br />l..n,fy rhir i. rhc l'rrf{r'ek. ofrh. Nork lbr sti.h rhi! lcnnir is i\sucd.I shrll nol rmploy y pc^o. in any nrMftr
<br />$ ash h.Lux subj.rt to
<br />'hc
<br />sorlcs'.onwnslrion lnws ofcrliromid. Md aCec !h,! il I should k*onE subjd lo ll'c
<br />*ortss.olnpcnetionpmvisionsolS(lionlT0oolihchbncodc,lshnll.lbnhanh.oq)lywirh$osFrovisions
<br />W RNIN(;. Iirlltrc (i srtrrc trr'kc^ ..rrtf, \iro r.r.'r8r i\ tr lntraul. nil.lrllnrh.J..r ri.nrpl,yo n,
<br />ciril lincs up to onc hund..d thous0nd dollars (S nrr ro rh. co{ ofcompn<lrnnr. datr
<br />L^4:(
<br />"a
<br />I hcrby rlllnn rnd$ pcmlry ot Frjury thrr I a lirnsd undcr pn,li\nrn ol Chrtrd 9 (
<br />or rhc Du\in.s and Pn,rcsi,'n\ Codc- nl m,liccns. is in lirllturNa etltcr
<br />-Liccnsc
<br />Nu$cr
<br />g)N$rallgu0lrrNDllc-acErcr
<br />I hcrby rit'n trndcr lcnnlry. t pcrju.y lhar rhsc n ! con\rdcrion lcndins,c€.cy ftx rhc ptrf{,tun.c orrlc work ror whi.h rhii Frmir i\
<br />itsucd (Scc :1097. Civ C ).
<br />I ccnity rM I luvc tuM rhis i{u 'kl inrrrl,nilr ah,v. inlnrn ri,n, nro,rrrr r. c. lflly wirh all Ciryrtrd Counry
<br />onli,rn.cs lnd Srrr. Lrw\ eldin8 huiUirigcoi{ .ri{,n. mJ hrrrhrrdhorir.ofrhi! C[, rnd Counry r' ctrrd uF rhc
<br />lrrc trf,nrtrmrl fn,p.ny,,tr 6-AppliGtrt or /\Actrl Siamlu )r
<br />DT C)
<br />r.u7
<br />ELECTRICAL.INSPECTOR RECORD
<br />APPROVALS
<br />Air Conditioners
<br />Service Meter
<br />AIfLTANLDECI.ABA]]O!
<br />t Ercny ailimr undcr pctrolly of pcrjury one olltu hllowiS dNlsrlions:
<br />Dcnnlilion Pcrmih-AslE(os Nolilicalion !-cdc.r I R.Bu L! io.s (Tir tc (). Prn6)
<br />-RcquiFd
<br />L.rrcr ol ,ldiff,.rion
<br />_l ccnify that the fcdqal E8llari.ns Esadin8 ostEsros ,cmval arc nor arplicublc ro rhis pnj.d.
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