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APPROVALS DATE ID/SIG.COMMENTS
<br />Site-Work
<br />Underground 1 lD'> ro I $ s" elL 6Eo $q'flc
<br />Pole Bases ( o.r r*r.,,. i" d
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Signs (monumenl)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding i Grounding / UFER )q lUt
<br />Translormers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilin gs (Hard & Soffit Bouqh
<br />Ceilings (T-Bar Rough)
<br />Ivleter Release
<br />Rough
<br />Service lVleter
<br />FINAL 6-44 I }."v$(I
<br />Notes Remarks EtC nn
<br />il ---rars7ld
<br />;.t;"":r "ff lilfi: n?lilr r#? fl ,'',{,"r"'jiFlilil1tiH,*l;::,':: l;:t:x;;ilril
<br />id.rurc- trirb iri is\u.cc. rl$ rcquir.\ rh. lpllkatrr for\!chFnnir h flLc! \ilncd {.runr.t rh{rl[otshc6l( {d turql
<br />t, rhc pn,lntun\ of rhc Conrracioir l-ic.nr.d tis (Choprcr ,)- Connnrmin8 $irh S.crn,n ?(XX) ol Divi\nr :r ol rhc Buslnc* und!
<br />PR,rr\!i{,.sCode)orrhrrhe.r\hchcr.mprrhcrcfioha l rhc ba\i\ rar rhc rllcScd cxc.rlrion. Any viohtnrn ol'Sd n70.rI 5h}rny t
<br />t rFr(li.rnr lartr,rrmir \rhj.cr1rh. lltli.rnlroa.ivill[n,lryorinrtrktrcrhrtriivchundruddollars(S5(I))
<br />-l.rlo*ncroirhcpropcny.ormrcnDloyccswnhwd8cr{\rhct\olcconrpcnsarion-willdor}a{nrlandrh.ntulurntuliddxLd or uncrd fff {lc (S( 7014, Bu\i'rcs atrd Prct r\n,i\ Cdl.: Thc G,^ra.r{r'\ Liccns. I-r* doc\ nor .{ply b rn otr rcr oI
<br />rhcrmF*ny who boilds o! iDrNq lfuNn. $xl trh dG\ \kh wo* h im\cll or hcrrcll or rhoueh h h or hcr own .ryk,y..i,
<br />Frvid.J rhrr \uch irnpmknrnG rc rx, ir .dsl or oltcr.J nr qt. ll h.Lv.trr. rhc huilliq or irv.vcnE i\ n,kl wirhi'r onc ytar
<br />olconlPldion,lhcOsncrBuildcrsillhiErhctrlldcnorDmvinsrharh.or\lrdx] orhulkl.ri'nfn,rrrhcD^,p.nyli'rlhcpuqnEol
<br />l,rs.wncior(hrJn,p.ny.nmcxclusivcly.otrrrctinSwnh.cnrdcodm.lorloconstrxdlhcFDjcd(Sa.70'14,Bu\iru*
<br />und ft{csbn C(ic, Thc Conrracrois Liccnsc l,os docr not aDnly ro 0n o$nc, oap.opcny *ho buildr or hhprov.s rh$.or
<br />8nd who mnrm.R for.r.h pm)ccr eirh r Conrmcro(s) li...s.d pursu0trr ro rhc Q,M$tols Liccnk tj*l
<br />I ancxcnDr undcr Scrio
<br />)rcatrE8eiQMtlNs r()!
<br />DIgIABA.II9I!
<br />I hcrc6y ar'ltmundcr pcn!lry or pcrjury onc oflnc n,lL,wirB rlcclirarions:
<br />IhavcaMwillnDinrrinrCcnificricofCoscntroSclf-l,NtrrclinworkcNompcn$rion.!\pmvidcdl],,hysNri(,nl7(x)olrh.
<br />Ijbor Cbdc. f.r rhc pcrfornDi.cofrh. w.rk for whi.h rh. pcrmii is i\sucd
<br />-l
<br />hJvcand Nillmrinlain *orkL6' compcnsrrin insurircc. (\ rcqtricd 6rScdnn.lT(X)ofthc IrhorCodc, ftnrtu pcrfonnancc of
<br />rh. work n, whn_hlhi\ pcrmir is isrcd Myworkcrr coDpcnqrn,n in\uancccrni.r rl fl'li.yronrllr c:
<br />I ccniS rhar in rhcp.rformnc.ofrhc work ror whi.hrhis pcrmn n hucd.l shrllnor cmplo!nny pcrson inany manrcr
<br />$ asr0 L(,M uh]ccl ro thc mrkc smpcnsdion hws ol Crlilomir. nnn iBE rhar ifl \hould hcconrc $bFd k, rh.
<br />sorkes conFnsarion trelisionsol Scdn r lr0oollnc Lihor C'odc.l sh,ll. tonh*nh comrly wiih rho* frbvki.ns
<br />IVARNINC: Failu,. 'o sxrc workcs co!ry..erion .ov.agc is utrl,wlul. 0nd shall su6rc.r cmtlo)€r ro sininal lcdlrts dnd
<br />civil nncs ut ro oft hundEd rhou*nd dolldr ($Ioo.fix)], in dddili.. ro lh. cost ofc.nwtrsolion. d!roEcs !r plovided fu rhc
<br />Sc{ion 1076 ofrhc bhor Cod., i.r.rc{ d0nomyt16.
<br />D.,.: 4 t,lre Appren,: Tnl*q J*1"-"< za ^ 1f-
<br />LTTENSELCONIXAj.:ruf,
<br />DECI,Af,A.IION
<br />I hcrcbyorirnundf pcnahyofF.jury thar t am li.cns.n xndcr pmvnion ofch,pln 9 (c!mm iry trirhScclion 7000) orOivi\ion l
<br />.r rhc Busir.s ,nd P,olcssioos Codc. dxl 6y li.dos. n in flll li,re dd.Uccr
<br />Ac9 -'"""."*,.*,, Y 0<L O
<br />S/n( rO 1J_lA,a o rhtt.-",< CO "tcf
<br />CONEIX.IJIIIONIENDINS.&CENCI
<br />I hcnby aflli,n und.r p.nalryoficrjurylhd lhdc is !.onerucri( kBlin8 qcncy for rhc rcn'onmncc olrhc *orl lor whi.h rhir l.nnir is
<br />i\{,.(trsd. looT civ t i
<br />Lcndcr's Addrc$
<br />-
<br />l.cnili rhrr I hlvc rcad rhisanpli.rtt,ndilsdcrhdIh.at vc info,nrrn is.orar. I r8re b comlly wirh atl Cirr and c( y
<br />odirdn&( id Sr,rc ljwJ rlli'la b huildihS
<br />nti,v. nr otrcd pn)Nny lnr iNtrdiotrturt
<br />durhtrrzcrcDrc{ .n!c\ofrhnCilyanlCounryl(,.nrc' ulhnrrr
<br />S-/ 2<//o
<br />,\prlirn l or ,\At lSiAn lta
<br />,/ , ^-,$^ *-_
<br />ELECTRICAL-INSPECTOR HECORD
<br />c*r,, Oa,.D (ZrapOt2 L\1-
<br />,",',rn,^*,,n,c-"rblqlTob o * lof ,/lg
<br />ATILICAII.I}ES.AAAIION
<br />I hodry !fimudcr pcnalr, ol periu.y.n. ofrhc folloqinB dehturions:
<br />D.nnlilion Pcrmih-AstEsros Nolificrlion F.dc!!l Re-subl ions l rnt 40. Pan6)
<br />_R€quired brro ot Norifsrion
<br />_l ccnillihai ihc lcdrrrl r.grlrrnnr\ rugrdin! r\h.no\ r.nurlrrr otat,flr.rhlcl('r,ristr.lc.l.
<br />II
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