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APPROVALS DATE tDbtGl COMMENTS <br />Site-Work <br />Unde rground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life S afety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough .bul/4 flnfilil-/r? <br />Service Meter <br />FINAL r./z/7/7 PzO//6/42 '- /r)q' <br />Notes, Remarks, Elc <br />O$NER AUILDER DELCAR"ATION <br />I hr.6y aflirm u.dr !.nrlry oarajury rhd I m .\cmpl 6om thc ContradoE Licoe Lss lor rhc lollosrs r.en (S.c.70lll.5 <br />BBin6s and Prof6ion Codc) Any Cirv or Colnry which rcqutd , D6hn 1o consrtocr, iltd. ida,o1r, dGnoltsfi or qEt dy <br />struclu., pr6r lo its isu ... al$ r.!ut6 rhc arplicd aor such pdmi ro fiI. a $s..d $rodr rhar hc or d!. ie li.Nd p6uur <br />lo lh€ rmrisnrN oflhc Cooiraclors t,iccrscd ti* (Ch.Dla 9, ConD.ncin8 sith Sdio. 7000 of Divieion I ofthc BNincs ud <br />Prcf6sions Codc)orrhrr h. or sh. t d.nfl th6cliom dd rhc bsis for rtu allq.d qflf,lion. Aoy violsrionolsctn. T0l I 5 by any <br />Epplicanr ror a ptmit subjcG lh. applicsl to a civil p.nahy of,or norc rhm liv. hun&.d dollds { l50o). <br />l. s ownd of th. proFny. or mt .mplorG wnh $rsd &s rh.n $L .ompdi.rion. $ill do lh. *od dd lh. stM@ i! nor <br />ioladcd or ordcd to! sl.lSE 7044. 86ind ed Pmlsions ( od.: Tfi. ft,nlraclois Licd. tiN do6 nol arply to !n oun6 ol <br />rhc proFdy *ho hilri! or injpm6 rhdon, ad shn &6 such *!rI hNs.lf or hhcllnr rhrough his or ha oNn.npLy6. <br />provid.d thar such inlprovdEls e d nnad.d or ofidEd for eL ll hos6d. $. h'ildiae or inlFlv.tml is FH wirhin "n. )6 <br />ofcomplclion. th. (}*16 au d6 wiU hov. th. htrdo oaFovins rh, h. or sh. did mt hiild or in .o\. fi. popcly for th. pntPo$ of <br />I, d o* ncr oflh€ pFpqly. m clclusivcly conlreiins rvilh licd$d conlractoE to consho lh€ rroj.d (S€c 7044. BBrnB <br />Md Pl\ft3sion cod.: Th. ( ont,crocs Li..ns. b* do6 nor aprly r. d oqnd olpr.rd, *ho builds or nnpro!6 rh6Nn. <br />and rho conrracrs tor such Fojc.rs trith a ConrFcio(s) licdMd pusunr ro th.Contraclois Li.s.lr*1 <br />I &' crc'npr und- S€crion ll &PC lorrhurmon. <br />ORn.r <br />uaBK[8S:(AMtEXlArIO! <br />IIECIASAIIO! <br />I horby rlli"n trnd6 toalry.l pdJury.ic ofrhc foll(Nin! d(lararil,ns <br />I hav. tud Nill hainrain , Cdli6$r. olcoent lo Sclf'lBur. for son(6i .ontpssaion. a povid lor by S<rion 1700 of th. <br />L.bor Cod.. lbr lhc psfomanc. o I lhc worl lor *nich thc pann t issucd. <br />I hav. a.d will mainl.in worl6 .omp.6.tion iaura., a r.quir.d b, Sdlio..1700 oflhc L.bor (bd.. for th. p6aomm. of <br />lhc Mrl for which lhis ps,nit is is.d My worl6 onpasliion iau&c. c&nd rnd policy numb.r E.: <br />c*i. 5i7.r/2,',.,'z;z <br />?ae a'/ t <br />I ccnifylhat in lh€ Ffomancc ollhc worl lor vhich lht pnnit is issucd. I shau not onployany p.Eon in any du.6s a o b.6m. suqal <br />'o <br />rh. woltcs snFMion I!* olcrlilo ia, edaerfrrhd ial shruld t.om.subjer torlE <br />wolkds.omp.roarionprolilioBofS.dio.1700of(h.LdnrC6dqIsh.rlfonhwnh.onplywithrhoepolkioB. <br />WARNIN(:: Fa'lure r(, sccurc \orkql comp€nerion coverage is unli\ful. and shal! n'hjecr M enpl.)er ro Eimnal F.rhi6 and <br />.nil nn.s up t, one hund'cd rhdusand dollds ($l of conp@rion, droag6 a prolid.d aor rhc <br />s-ri.n 1076 .l rh. LalnI Cod.. inr66r dd dtufty <br />7.2-z 4 <br />undB provision o lcfiapl6 9 (commcins Nilh Sdtion 7000 ) ol DNision 3 <br />of rhc lrNin6s md ltof6sionsCode. <br />/ <br />t - / -' <br />I h.Eby afrm udda pdahy o f pajury rhar <br />issu.d (S(.1097, Civ. C.) <br />is a consrrucr ion lodin! rlmcy r.r rhc tdfotumc. of rh. r ork for \nich rhis p6nn i! <br />AIIUCANLDECIAIAIIQ! <br />I hdlby .ftm unda parhy olp6j6y or. of rh. lollovins dcldarions: <br />D.fulnion Pmirs'Asb6rd Nolificdion F.dral Rcsul.rions ('lill.40. Pe16) <br />. RqtutcdtrldofNorifi.nion <br />I cgliay rhar rh. a.ddal r.guld io.s ESarding 6b-!os r.froval d. not .ppli.ahl. ro rhis pojftr <br />I.diryrhdlha..r.adrhisamlicarionddsrarcrharrhcatsrcrnfom,arioniscord I asrc r. comply wnh all C y and Counry <br />ordn[n(sn d Srn(c I a\5 rc]arin! t, htr,l ,n!h6cbyaurhonze rcr,r6orariv6 ofthir Cny ud Counryro dtd upon rhc <br />itxn e mcnlioneJ prop€ny <br />Applionl or s€nt Signr .7 7-tr <br />ELECTRICAL-INSPECTOR RECORD <br />,-0,,*,,ZZ?Z2 <br />I hcEhy amrn, undcr poaltyof pcrluly thal <br />ny lictr i. in tull for. sd.lTal. <br />)g[,{,/ <br />r------T------