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APPROVALS DATE tD/stc.COMMENTS
<br />Site-Work
<br />Pole Bases
<br />Li ht Standards
<br />S FountainsASPool
<br />monumentSins
<br />Lile Salety /Low Voltaqe
<br />Fire Alarm / Dam ers
<br />Communications Cable
<br />sBuildin
<br />Under Slab / Floor
<br />242-/\^Bondin / Groundin / UFER /2fu/D't
<br />Transformers
<br />Sub-Panels
<br />r4t /t9 t
<br />Facto Wired Unit
<br />Ceilin hSHard & Soflit Rou
<br />Ceilin S T-Bar Rou Dbl/rt
<br />Rou h
<br />Servrce [/eter u/v//k z 5ri/1k bt--
<br />Notes, Remarks Etc.
<br />FINAL
<br />OWNER BUIT,DER DELCARATIONI ncrcby amrnr utrd.r pcndlry of Frjury lhat t 0'n er.mpr tmnr lhc Conkr.b^ t_iccnsc Uw ror rh. r.tk,sin8 Easn (Scc 70.115
<br />Borincss a.d Prof.i\ion Codc): Any Ciry nr Count, which rcq ncs B lEmil ro con{ncr. lttcr. inlrovr. d.mthh .r mpoir any
<br />sld.luE. priorlo iIs irsu,ne- also rcquncs dc atplicmr fo! such pcrnrir b tjte e sisncd slalcnEnr rhd hcor she k ticctrkd pursuanr
<br />x, rhc ptuvi\i.n\ ofrhc Conlm.rocs Li.ensed L{w (Chdprcr 'r. Commcncing wnh s..inrn ?OOO ot Divnion I ofrhe Bu\i.e$ otrd
<br />Pmfcsiotrscldd)orthlthcorshch.xcdptthcrciron,ndrhcbnshiorlficrtlcgcdcxcrtrion.AnyliotaliotrofS(lbn70.1t.5hya.t
<br />,ptlicanl ioraFrnh slbjccls rhc 0p0lic, k, u civil txtr,lry of nol mrc rh fivc hn.drcdd6ths (3500)
<br />-l-
<br />0s owncr.athc pmpcny, or mycmplorlcs wirh waScs !s lncn qnc.o.rl).n\dn,i, si d. rhe wmk {Id rrr dmn,rc h sn
<br />nrdnded or ofrcr.d ror salc (Sa 7(x,1. Busincs snd Piof.siors Codc'rhc Codrn rors Li.cnsd lj* docr nol opply k, d.srcrot
<br />rhc tDFny wlF huilds or nnpmB rlimn. !ft *tr dms luch slk hinrcltor hcFelt or thrcu8h hh ur her orncmploycus.
<br />Providcd rhar such imprNtEnk e mi inroxlcd or otrlrcd for sak. I t h.welcr rhc huitdin8 or i,rpr.snrni ir $nd *nfiin o.c ,roroftunl{llcriotr- I hc Owmr Buildq uill hrr rh. hurdcn ol pnvine rhar hc or shc dil mr bdu ni iq,mE tlrc fmtEry fo hc I,!lTn{ ot
<br />-1.
<br />owncr ol rh. ,)tul.ny, ! rxclusircty.onklcring wirh ti..nscd (onrnrlon ro otrjtu r rhc llmF.r ( Scc 7O1-t. BunR\srl llofcssi Conc thcConrra.tofsLi.coscL0sdou\i.rslptyr.ano*mror,rropcrly*hobuitdsorimrrovcsrhcrcorand who conrrrcts ror such f,mrccF wnh r conr"crorlg lircn*d poFum kj rhc Contridor's l_i.cn{ Lrw)
<br />I r crcnrpr undff Sccr
<br />D.lq OpD.r:
<br />won<rns, coupexsarrrrn
<br />DECI 'rn,llloNI hcrcbt arhrmon{jcr !cn0h, or rrjury onc or'rhc nrbwins dstarariotrs
<br />l-nhor co,lc. nr r[( t).rronnrkcolrlr *ol tur shi.h ih. ]r.,trnr a str.d
<br />rh. qork rnr trhi.h !h\ trm rt\ i!s11 lrlrso,[rr\'.,{npcr.rrr]ri,Nr,)D..(,tr1(rntrdlrti.rnunrh.rxr(.
<br />-l
<br />c.nilyrhar in thclttrrormrnccofrhe wort for shth lhh p.rnrn is hsmd,I rhr| nor cmptoy dnypcrs,n in (ny monrcr
<br />vr s to tEcom iuhF.r h thc eon(c,s con{bsarion l.ws orcrtitorn[ and r8rcc rhd itI choutd lllTorrc suh]c.r ro rh.sorkcn conDctrsr'ion pmvtionsolSerion l7O0afrhc tibr C{ c,I shnt. iorihwnh ennpjy $ irn thos fmvhions
<br />IVARNIN(; Fi'lhtrc r, r.urr (ork.n .o[Dctr\rrirnr i)v.r,rg. i{ trrlr$,1t. rnd n t {,h]c.r I cnrtnortr ni cri'ninrl riirrics ,ndcilil fincs u, 16 dm hutrdrcd lk,utrnd dollar (o{ conDensarion, dmEger s\ pmlidcd for rhc
<br />s.criqr 1016.r rhr tnti{ (i!t.
<br />!2l:L!:1.8.!Ur2:
<br />I hctoh) lllflItrnrlc' It rlrroftrrturyI (contrnr c a wirh Secrion TlXIr olI)ivi\i0i.]
<br />ol lhc Btrsi,rN! rtul Pdtsbn\ Codc. ml my licctrsc is in roltftre ai clf(r
<br />I hcrchy rllnr undcr pctrrlly.fpcrlury rhar I n,.ri lc nrg i!cn.r- f{tr r pr orirutrcc ofrh. so for shich rhis pcnnn L\i$u.d (Scc 109?. civ. c).
<br />L.ndcrs Nnnrc: _
<br />APPI I(]ANT DFCI ARA]'I(IN
<br />I hoE{'y afm !.dcr p€nslry.i trrjury one ot lhe foll.wins drlamrions:
<br />Dcmolirk,n Pcrmils.ash.nos Norifi corion tcdfiat Rcgrlllions (Tirlc 40, paa6)
<br />-Rcquied
<br />Lexcrol Norifi carir
<br />_l ccdilithd rlrc rcdcralrcsul ir rsEsardina0shcslo\rcnxrvularcmr.f0ticrbtchrhi\ptr+cl
<br />-,."0n,u,'f.n. ^,r,n^,nn,'.',,,r(]ndr\n.rlhr L,tr" Rti r," hur,\rnr
<br />FE Fiyr,rm\nN,nn
<br />Applic!nl dr Ag.naSlsnatup
<br />lhc lt.vc inroirn nnr i\ cotrcd I r8rd b.o'nplywirhnllCiryrnd Cuunry
<br />.urhorir. Eprcscnr ivcs ufrhn Ciry od Counryro cnl.. up.n rhc
<br />^'t!9il wa.5
<br />*,.1"/+/LK
<br />ELECTRICAL.INSPECTOR RECORD
<br />Underqround
<br />t _6)
<br />Torqueinq
<br />V>oaAir Conditioners ',6)
<br />Boof Top Equipment
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />h)
<br />Ivleter Release tt-L-
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