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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouoh)
<br />Ceilinqs (Hard & Solfit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Rough ltlt ltfi ti\k7
<br />Servrce Meter I'/
<br />FINAL t/9vh 1\*4
<br />Noteq, Remarks, Etc
<br />'(/
<br />l. ns o*,ri of rl.i, lr)liny. or ny cnDl.ye\ wilh wrsc\ os rhcn sb cnmFn$rnnr, *ill tL rh. uork ud rhe srBlur c is nor
<br />int$Ld or oftrud tu srk (Ss 701.4, Ax\iftrs and Ptuf.\\nrn\ Cul.: Th. Connrdoir L.iccnsc lr* lll)cs nor.rplr ro dn o$rcro,
<br />rhc ptrr.ny $tr huilh .r i'qr {,vc\ lhcG)n. nnd (lD m\ \uch ruk hinr(clf or hc^cll ot th.ough ht or hu own cnPk,}ccs.
<br />!tuvid.d rhrr urch i'nfl orcmtrls m not inrcal&l or olicEn ft sob lrl ho* c,ri rh hrildi'rt or i':{mrontrl h $U wirhin onc lur
<br />oico'nphri.n, theOencr Auiucr will htrlc rh. hurdM ol povin! rlllr hcor\hcd d toildor inlnovc lhc pRJptny fd tlx N4n{of
<br />l.a\owncrulrhcltropcilr.0mcxctrivcly.onrrmlirssilhlicctrrcdcofkr.ktr!h.on{ru.lrhcpreiccl(Ss.' 7044,Bu\nrt(
<br />nl lilssion clnh 'rhc Coirhdoi s l-iccnsc L w doc\ tror l|ply ro rn os ncr ol lropcny who bu iU \ or nnprcvcs lhcrc.r
<br />md wh. &nnt .rs lrtr such lIoj.rrs with o Conlmcl.n r) liccn*n nursuml lo rhc C. kacttr-\ Licctrsc litr r
<br />trll8f,&&r:rautliNiaiJ0N
<br />I'ES.AAAU}N
<br />I hcruht nflnm tridcr $nrkyoll[rjuryonc olrh$ nn[)wir8 (lcrldrnrnnF
<br />I hdrc rnd will uinain workcrs-conrEtrsnrhn insumrcc.0s rcquired hySecrion.lTmofrhc L$ol(tdc. forlhcPcrinnEmcol
<br />rhc uorklor shi.hlhh pcrn l is i$Nd. Myworkss .otrfcnsllion insurln(c cxricr and Fri.y nunrbcr trc:
<br />l.cnitrrhrr inrhc p.rfonmmcolrhc work lor wli.n rhis Nirnt is issucd.l +xllnor c pbyntrt pcra. in rnynntrmr
<br />v, mtob.om suhJ.rl h l hc *r,rlcF .onr. srri{D hq\ol Cnlifunil,.trtl.grcc ll ifI should trconr suhjcd brhc
<br />wortcn con{cnsirion prcvhnrnr ofSari.n.lT(O ollh. ljhtr C.dc. r \h,ll. ttnhBirh conrply Birh lhosc |)rovi\ii,ns
<br />WARNING: Flihrc ro snrc w.rk.rs co.rrcnsarion ovmCc i1unhwtul, Md shall sthjNr !n e'4lorci ro dimtu0l i'cni[ics ond
<br />c'vil fincr un ro nnc hdndrcd
<br />'houqn{dolle/(Slm.Uoo).
<br />in lddiln lo thc cosl of coBpcni i.n, dsnDS.s as [ovidcd tor rhc
<br />shnon lr)76.lrhr tf,hor cnd.. mrcrcq\na /omv. tcc' ,- ---2
<br />"",",
<br />ct,l2+ l]8-Y**, L/ \ LICENSES llt(Iaa
<br />DESJBA:IION
<br />I hcebyamrm undcr ncnalry ur r.rjury th,l I am lirNd undcr pmvkion olCh!flo 9(co.rftncinC wnh sdlion ?OO0) ofDilnion:l
<br />of lhe BusiEss and Pmfe$ions C.d., and fry liccns ii ir auu rorL!,nd.ffccl.
<br />,/oz42z6
<br />I hcrcby f,lnn xnd* !.mlty of pcrj y rln rhcrc is
<br />nsucd (Scc 3m7. Ci! C.)
<br />cotr{n(riilr L ir! rgr .y lor rhc tc'turirrr.c olltu \.rl ktr trhi.h (h \ l{Innr i\
<br />APPLICANT DECLARATION
<br />I hcR.lry utim hdcr F.trlr, orFrjury onc ofrhc rallowine d.clardn'.s
<br />Dcnnxion Pc nil*Asbcslos Noli{icoln'n Fcdcral Rc8ulationr ('lillc40. PJna,
<br />R.{tuncd kncr of florifi.dion
<br />xr.clo.r rrnv uirhxlll irvrnil(i{ v
<br />\.\,n rlr\ (-[] n8L(irny ro.nr., utotr llr
<br />L-/-1 a ltDrrrc // /- t | 1o
<br />-l.cnil)
<br />rhlgthclcde rlrcgulari,'i" Fpsr,irhC Ahc{^. '.m,,vrlh{ n'{ rpfltublc rvi
<br />f6, *,1n,,,.,/t'" *, *F trpntEa,ntrJrd {,c,\J, rhcotn*,n,nm,ion *codd I
<br />orJiuhy\{A,ak rj$tmL DA n'hurldrn8 conjrucri.n. and hcrch) aurh,nb rer{i.nrsr
<br />dhn€ mnri{lkJ D,oh-n\ nr ht "-'--a .-)
<br />Appri(snr dr As.y'sluru( *E1---
<br />*"-u*\(n*,, p,,1klg She.cho.,
<br />ELECTRICAL-INSPECTOR RECORD
<br />Pole Bases
<br />It/eter Release
<br />-.*L;d-3
<br />OWNER BUIT,DDR DELCARNfl ON
<br />I hcdby sffird undcr p${lry of p.rlury rhd I m cr.,nFr fio'n rh. Clr rrcro l-iccnsc Law for rhc l'olloeiog rcN,n ('ic. 70.11 5
<br />Btrsirlcs ,nd Pnnassn Codc) Any Cny.r Coutrry which rcqnncs tr lcflnil ro con{tocr. alrcr, impr.v.. ilcnn ish '{ rcnir; otr)
<br />srrucrurc. prio,ro ns hsulncc- aho equnc\ rhc arpliclnr tu. such ocrnrir k,lilc tr signcd dd.mm th0l hcor shc k li.cn{', nufudnr ,-
<br />t, d.Ircvisnnr olrlt Contlc'ols Licenscd Law (Ch.prcr 9. Conrmncins *ilh Scclion 7O0O of Divkion :l orrhc aunncss 0nd
<br />Prcti$ions Codc ) or lh hor shc kcxcnrtlth.rcfmmrnd rhc b.sh lor rhc lllcscd .icnrplioi Anyvi.lii.nofScclion7031.5b!rny
<br />an!licanri(n r p.t!nir su$jccrs rhc arpli$nr k, trcivilpcn!lrlnlnor nndrnan nvc hutrdr.ddolhm(1S500).
<br />I arcx. rtr undn sccrio.-.lr &PC turlhisrcrnii
<br />()wn2r
<br />-l
<br />havc anl wiu minr{in o C.nificdc or Coi*nr t, sclH nsuru rttr uorkcrr (nrrcnsar ion. as pmvided ror by s..rion 1700 ol rlrc
<br />hbor Codc, ld rh. psfommc ofrhc $ork for,hth lne pcrnrir is issocrl
<br />""," q I z+lik
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