APPROVALS DATE ID/SIG.COMMENTS OWNrI BUTT,DER DET-C]AI fi,
<br />I rEEbt rfrtrm uftrd p.Mlly of tE,lury lhd I fl .r.r0 fn,f, rrt Coffitn Li.nc tiq lot lrf, fdh,in3 Bstr (5.{.?011 J
<br />Buri*$ dd P.oli$i.n C(xL): Any Ciry 6r c.unrt whah EtuiEr . FnDir to o rln.t. rlid, idphk. &mlnh or qE y
<br />dtu.rm, tm, b nr frud.. .h, rquiB rtE rlplaMl for st Fmt 'o
<br />6l. r \i8tr! dd.md rhd rt tr dE ir li.u(n PoNrn
<br />n' tlE pmvi\ions ot rlt Conra.tr r Liftnsrl ta* lch.tr.r 9. ComnEEinS *ith S6ridn 7Ur).f Divisitn.l .r$. alriBs..nd
<br />Phr.rsio.i co&l o. rh.r h. or rtr n .rcnv'r rlmtum un rlt blii for rtr .lh8.d crnprbn. Any virhlion of Sarion 701 I 5 6y uy
<br />!t li. nn ! Fm'i ut'J.<rr rlE {ipliur kr I civit ,xulry ol m' frrc
<br />'ha
<br />fiv. hundEd dolL^ {S5(n)
<br />_1. s ovmr olrlr FoFny. n my 6q,t'Fd wnh *rg.s ( rrEn $l otrqrB.lbn. Ei[ & lli {rc* &n ltl rnnft 6 or
<br />inr.irlcd {, ofrcad l( {L ( Sa.7oaa. AusiE$ sd Pmf.srbnr Codcr Tll. C,ntddt tiaE Le dc! mr tapl, ro u ovE of
<br />th.Impcly *b hiktror Lrpoh rlEtutr. iwhodcsshft hnB.lf or h.elf or rhftr8h hk or h.t own .mtlor.r.
<br />Fovd.d thr sh lrgDwn3 e d irdLd tr .nEtld fd qL. lt hoEw, rlE trildii c inr.Gm'r i! $E urhtl d lar
<br />of mrykb( rL O*M Blildi eill IEE r,E hftr.n ol Fori,ts thl lr tr rlE dn f,{ t!i! .t inlmE 0t F rqt, nlr dt IElrE of
<br />-1,
<br />ar owfr otrlE FoFdy, mcr.tuirclyodrerms *'lh lkcnsi comrEt^ ro &!nnM dE FrFr (Sa. ?oail. Bulixs
<br />id Pnltsirn Codc, 'rhc Conracroir Liccnrc trw de! mr ippl, lo un owncr of prulcrly who hrild! o, imlrriwr lhcr.nn,
<br />rnd w,b 6ildi for rrh FtrFds s t r Co Ero(il lie'Ed pu^rr ro E C.drdd r tirtrE l,v)
<br />-l
<br />m.rc.rpr uE cr sdr
<br />lt!8f,EIN:lOMtAtAIlll!
<br />DECIdt Uq!
<br />I lritb, trmrm ulld.r pc l'y or Frury or ol rlE folh* hs d(ls!rk,B:
<br />_l h*. ,n *ill midrin . Cdiror of Con*nr ro S.la hsrc fr u,ls on+.ndhn. ri tmtircd for by Sdtior l7(D of rlE
<br />libd Cd., ld rtr lEfrlrjm. of rh. wrt ti, l,ri.h th. Fml is i$Ei
<br />_lhrBrd*iltm, rin wnln mrp.ndbn iNrr.,.! rcqurti by S(tbn 17fi)6filE t bor Cod.. fo. rh. F.lolrrIR ol
<br />rh. *orh fd ehih rhn Fmi is ir$El. My *od6 odpcnr.liotr iEgl..K ceE {n polky numlEr r.
<br />P.licyNunfi..,-
<br />-l
<br />rcnily lhll in rhc p.rlorruE-c.f rtrc *ork fin *hrh rh'r I.rnir r isx*d, I snlll nor.nlrbr ry PcBr i..ny rurcr
<br />y, N ro lx{r.E subj.ri ro Ih. wo.k6 co.{Enernrn hws ot C.lifomi!. ud lsr thd ir I dr,uld }E oft bjrtr L' l,r
<br />*r!*6 .o'qrn€rsn pnrrniJ.s or Sdi'n :tr(L of rlE L.tior Co&. I {Ell. tdh* h nrtry tnh 'rrc tovniflr
<br />WAI(NINC PntuE lo su. wl.B'oi{rtrt lbn NtBsc lr !.LBfuL ,rl rhrll rubJ.d d crf'bltt to nin l lxflli6 rn
<br />.N'l fiftr un lo oE t[dEd rhou!.t'd dollB 1,10.000). in dd hn ro rh. .or of conlEnslion. d.nlrlr .s Fv'{kd fr rlE
<br />Sr.rion :ll)76 nfrh.lrhn (ixl.. inr.rc{ xi{l rnonrvt- /l-L (
<br />D.ri rL L: Appuor
<br />DeqdEaM
<br />I lErby rr,m uBL. Fflh, of Frrury lhrl I m lieNcd uid.r F.vni'n or CrLBd 9 (tunmmin8 wnh S.nitn 7(ml oa Diiiion l
<br />of $c Alrift* {*l P6fc$io6 Crxh. !d nry ltcns is in rull fora rtl cfie!
<br />B-aro 16 Zcq, vLLl
<br />(f -ct' contndor /
<br />Q!EIA T:E8.IEN]A!jJiEMA
<br />I h.rcby rmnnudcr Fmlry ofp.rrury thrl ihcrc k ! cinsluli'tr hndins,seL..y r.r (h. FrrolruBT orlh. work nn shth lh Frmir i\
<br />irtuad lsd. 109?, Civ C.r
<br />APPI ICANT DECL IATI(IN
<br />I hdrht rtrm u .r F..ny ol Frrury om of llE folh*ins <krlr6rbn.:
<br />l). nnion P.rnirsAsb.{d Nolincr'ion F.dcnl RcSuhlio.r(Tnt 40. Pdln)
<br />_RquiEn t nd of tadifErirn
<br />_I dify ihi rlE fcLrd rc8lL'rrs rc8d{in8 .rtE!!n icm,vd u. Ln lpdrlbk b rhn pNFl
<br />I (cn it rhrr l lur. crJ rh'\ rtth(iri,,n dl nrrc ihlr rh. rh^r inri)rur nnr r\ (ore.'r l rsrr n, .omnlt wirh nll Cny afrl counry
<br />ordiNrs rnl Srarc liwrc&r'n€ro h'U'n rtr{Mi8 rn h.Eby .urlr'ria EF.Edd ol rhri Ci! t rnl Coudy ro .rtd ulFn tlE
<br />d)vc nE nmd pmFn, for
<br />ADrli.mt o. ,tr.nr sisMroR Zcli, J dlr',
<br />Sile-Work
<br />Underground
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER I Ur X.\t\tffi\'l
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Roof Top Equipment 1_11.1,1 bA&t1 1
<br />Factory Wired Unit I
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Solfit Rouqh
<br />Ceilinqs (T-Bar Rouqh)
<br />Meter Release I 4u L,l \ttVll I
<br />Rough
<br />Service Meter l
<br />FINAL \\'k#s,
<br />Notes, Remarks, Etc.I
<br />Rl:v 08-O7-2015
<br />ELECTRICAL.INSPECTOR RECORD
<br />,,*!-4r I
<br />Communications Cable
<br />Air Conditioners
|