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APPROVALS DATE IDiSIG.COMMENTS OWNER AUILDIiR DIiLCARATION
<br />I hcrchy ifllrnr uM.r p.ntrrty ol Frjury lhnl Ion.xcm liorn llrc Conlrlcror' l-iccn\c liw ror rh. r(nbtrin8 rc.$r (S(?(rll.5
<br />Busirc$ sM Proltsion Codc): ,Any Cily or Counl, ehich rcquirc{ u pcrni lo oniru.r, ak&. imptuvc, dcnnni\h or rcprt rny
<br />\rructurc. priorro irs issuumc. lko r.quncs rhc lllnlicant r{n skh Frm[ b fiha siSncd iarcntrnl th.t heor shc n limn*d pur\uf,n(
<br />ro ihc pNvtions oi lhc conlmclo\ Liccn{d Luw (Chnpicr 9. Conm.tuioe *irh s..iion Tun or Divhion 3 olrhc Busi.cs und
<br />PR,rirsidr Cddc) or rhar lE or shc is cxcnq lh.rcfromand rhc hsi! lor rhc 0llqcd c\ererirn Any viohtn,n of Serion 70:l I 5 by iny
<br />0pnli.anr tor !Fnnir subjNlsrhe apl'licanr ro acivilpcralryol nor rmrcrhrn firc hundE{d.llrs lS50o)
<br />-1.
<br />n\ oq cr.l rh. pbltny, o nry Mrphyccs wnhragcsr! rhcir rlc.o pcn{li,)n. silldo rhc \ut rfll rtr {MUt is tror
<br />rncM orollcrcd hr eh (Scc.7t),1,1. BusiN$and Polcsions(idc: Thc G)nrrict, \ l-iccNt Liw diJds or.rPlytootro$ncroI
<br />rhc pnpcny eho ln'ilds or i'npoEs ihtmn. rnd slr, dGs shh $\,rl him\clfor hcr.cllor lhrongh iis o, hcr o*. emfbycr\.
<br />tn,lidcd rhsr such i'.pn*tnrft m ton inrc,rhd d ollcrd lnr $k ll. ho*r\tr. rlE hDi[]irr or nnpocnEnr h n,ld wirhin ,,nc )tr
<br />ofconDlcli.n. rhe O'rcr Buildcr willhnlc rtr hnnlcn ofrroving rhtrr hor shc did tur huiu or nntrD( rhc pmpcny lor rh. purFr{.f
<br />l. aso*ncrofrte pmp.dy. n cxclusircly.onri.ling wirh li.cnrd conndoB r,, con(rucr rh. rs'jc.r (s.c 7(x4, lrNtrrss
<br />aRl frrtssirn Codc: lic Conlrrlols Licensc Li* docs nol urly ro ai oNn.r ofpi.ndi!y who huild\ or improvc. rhcrcon.
<br />Jhd who.onrd.hr.r\u.htejc.kwithiG,nrmbnrliccn{dpuru.nrn'rhcC.nhcr.irl-i.cnrLnr)
<br />-l
<br />amcrc rpr undcrScrrid
<br />I),le ()rner
<br />rroRxrrks cor\r'r;Nsi I]aNi
<br />D[rlA.8aIlaN
<br />I h.'chy rliirn,utrdcr I'cDrlryof pcrjurt. colrhcfolk)$i'rE.lcclrnnnrs
<br />_lh0!c.ndNill.mi.ruinaC.nitsarcorCon*nrrosclrln$'€rdsdkc(comr.nsltion.!strcvidentubySccrionlTo0ofrhc
<br />L.hor Cfrle, a$ rhe psfoflmne of rhe sork rbr ehich rh. pcnnir ir is\o.d
<br />crri.r rnd F)lict iutr$cr ec:
<br />Ct r r ll
<br />I.cniryrh.ln'lhcpcrr'ornuNcoirhcsorkiorehichrhnlcrnnisissuc.Irh{l!mrrmlloytnylEnonintrnyiBiRr
<br />vr skrn o@ slhjcd ro rfic *ork.r{ ..nfcNrnnr bsiotcriiromir, i agrelhd ill $a!ld hcco'm \uhjc.r ror[:
<br />sorlcm ompcnlar ion pof \ions or S(rn,n l?mof rhc trtrtr C(xl..l \hnll. {id hwirh conDly * irh rl$s Pmli\i(nF
<br />WARNINC: Frilurc t, rurc workcn .. rt'.nsnridr.ovcnrc i\ unlirrul. rnd shall srhjc.r rrr.f1llk,ycr t' ai ird I'cmlrics itrl
<br />cilil finc\ up h onc hxndr.d rhousand dollrs (S|U).UX)). ir indiriotr ro rhc cod ol.onrtcn\nrion, dinre.r ts lrovidcd for rhc
<br />S..titr.1076.flhc titDr Codc. inlcrc( and lnomcy s l'es.
<br />f/, s/tt ,rppri""rr, (
<br />LII[!SIII!9NI&[IA-Bl2rtl"t-l!tr&!
<br />IhcrchyllltrundcrpcnalryorFrjuryrhdIrfrlic.n*{undfiptuvisiotrofChafrs9(comnrcncirswirhS.tri 7(xn) ol Division l
<br />ol lhc Busine$$d Plolt$ionsCodc, and nrtliccn\c h ir lull forcc n.ffc.r
<br />CAo /a45 XS\
<br />7/2y18 c-r.*,..;L
<br />CONIIEIICIIONI.ENIIIN GENCI
<br />I hcEb, arfi'm xndcr p.nalry.r!.rjuryth,l lhcrc h a.ondrudion lendins oscn.y lhr rhc p.rfofrrftc orrhc work for trnich rhis llcmir i\
<br />issucd (Scc.309?, Civ. C )
<br />AITLII;ANI.IIECII,8AIION
<br />I hqc$, allim tndcr pcnBlryofpcrjxry onc oirhc fdlowing drlararions:
<br />DcnDlition Pcrmils.AslEslos Notincarion F.dcral ReEularions (-lnh 40. Pan6)
<br />Rcquirn L.llcr of NolifKlrioa
<br />_l ccnily rhlr rh€ rcdcol rcliihriuns rgddin! dsb.stosr.ff,val!rc not npplicotlc h rhir pR*d
<br />0n!?l ccnrry rhtrr I halc md rhi.0mlkrrnn lnd "rdc rhsrrhc otnvc i.fordarn,n ir.orml. I a8rs k, comtly sith allCiryuod Coury
<br />ordinanes 0nd Srotc Lrss rlsrinB ro huildiq .on\rdcrion. rtol herchysurhoriz. r.F*nlarivcs oflhn Ciryand Cnunryro enrcr dFn rh.
<br />ilrrc nriri(N In'|crrylnr irstcdio! !urlr\cs
<br />.\ ppli(-l .. A!"nl SiH",,l.r. )(
<br />rcrnrrennmerpano:X ?qa Alaty.l,at
<br />rlzvl l!
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Building
<br />Under Slab / Floor
<br />Bondinq / Groundinq i UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />It/eler Release
<br />Rough
<br />Service Meter
<br />FINAL tt4-ta k,P+r0
<br />Notes, Remarks, Etc.vvl
<br />-+
<br />ELECTRICAL-INSPECTOR RECORD
<br />Communications Cable
<br />p"txyr.t,.w, @t*N*,
<br />Ixndci\ AJdrc.\
<br />-
<br />t--+--
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