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APPROVALS DATE COMMENTS OWNER BUII,DER T'ELCA R-ATION
<br />I hcrchy aftlrm und.r pcialry of pcrrury rh.r I dr.rc.ll,i fon rhc G)ntr.ros' t-iccns tiw for rhc f.lhwing rc0son (5(.7011.5
<br />Busincss ind Profcsion Codc): Any Ciry or Counry whi.h rcquncs a tr.mir ro strslrucl. !lkr. inwore. &nmlkh or rct',n lny
<br />eoc'urc, prff b ils is\u*c- al$ r.!uirc\ rhc lprltonr lor such Ilcrmit lo filc a ri8ncd \rarem thar heor rh. is licei*d pu.$ul .
<br />brhcpmvhiotr{oflhcConlErortLi.enrdLlw(Chlplcr9,ComDrcxin8wirhScctiotrTOoOolDivnion3oflncBusinc$ond,
<br />Prof*smnsCodc) orihar h.oishc krr.'hpr rh.Efron ud rlr basis furhe alLg.d cx.ntrrn,n Anyviolnri.nofScriu70.1I5bt ny
<br />rmli.a lnrap.rmr srhj.rh rhc lPflic.nr ro,civil!.n,hyorn.r nrc rha. fiv. hu,rdrcn doll,r\($5{D)
<br />_1. as o*ncr oa rt. pmpcny. or my cmplores *irh ao8cs ns lhcn sE ompcnsar ion. will do rhc qork and rtE sturN n nor
<br />imcftLd or o8crcd tor slc (S( I)t4. Busin.s ud PDfcssions Codc Thc Conracbis l-kcn* liw docs dn apply b r .wnfi or
<br />rhctop(ny who hoilds or irtroB rtuNn. bd whll dms skh wo* hins.lror h$slfor $mu8h hn o. hcr o*n.nrployccs.
<br />ptuvidcd rhdr $ch nnprovcnrnh uc nor i' eDdcd or ofltRrl n, slc. l( h.sw, rtr buildi.S or irgrcwmn' is sld within om )rr
<br />ofcon!,krio., ltE Ouner Buildcr will harc tfi€ h.dcn oi |)n,vint rtd h. or shc tlil fr, huild .r in{,tuh rhc ,turdy ror rhc t,qir or
<br />I. il own.r ot rhc Inrrcny, rn cxclusircly conrracrios *irh liccn\.n conrracron t, ..niruc' rl* toi.r (s( 7014. Bu\inrs
<br />md t'rDf.sim Curlc Thc Cbn[aclol s Liccnsc Law d6\ nor apply b o own.r of pbFny qho htrilds o, inprov.s rhcrcon.
<br />and who ontmclsfor such pmjccIs *irh ! Co ntacto( s ) Ii.c.scd Nsurtrr to rlE ConrEctols Liccnr Lnq)
<br />-l
<br />Jmcrcnrpr n cr Scctio
<br />ugatrEBii-courlNsAfl0N
<br />I}ECLAAAUA!
<br />I h(r.b, afllrnund.r pchrhrof D.rjnryoncof rhc folk,$ing dcclanrion\:
<br />lhrv.rndeillrminrri.aCcnificareofConscirt,Sclflnslrclor$orkcrro,mFn{rn,n,aspn,vidcdnrbySc.lDtr1700ofrlr
<br />lf,hor Codc.lor thc li.rfonmncc olthc wolk iorwhich thc p.rnir is nsucd.
<br />!l hrvc and witl mi.tui. wor!(di' .ompcnsalhn iNudcc, 0\ .cqxied by S(t io6 ITOO of rh. bbor Code, for G. pcrfomukc of
<br />$c Mrk for whi.h tik Fnnal Li ircu.d. My workch' onFnglio, i.slmm @hr iJrd p.la, nnmb.r a.
<br />a-t 1174 zzst
<br />-l.cdifrrh
<br />i.tlr r.rrormmeofrhr sort rur whi.hrhi\ pcrd i\ i\\rd.l sltull nol.npluy ey !.sotr in rtrymanmr
<br />v, us to hccom subFcl lo lhc workcF conr..sriotr lo*s olcalifnni!. and oxrcc lhlr ilI should b(oDr subid l" ltE
<br />so*crl compcnsor ion povisn'ns ol Sccrion 3?00 of rhe L{hr On , ! shrll. tunh$irh omply * irh rho$ polhirnr
<br />WARNINC: Failurc to su.e q cri con[cnsulion covcn8c is unl$ful. ann \hall suhjcc' u cmplo,tr h sim'.!l FMIli.s Md
<br />civil nncs ur lo orc hundrcd lhousao'i dolhs (Sl(x).ix$). in iddirion lo rhe co( ol compcniarion. danrscs as polidcd ftt rhc
<br />Seri.n :1076 of rhc Lilnr C.dc inrce{ !.d drofty s f*s.
<br />o',,, 6'1 -tt---App.@r: ?4
<br />LICENSEl) C(NTRA['TOR
<br />PECIAMITONIh.eb,affir undcrlE.,lryorp.rjurylhd I a li.cns.d undc, pmvisio. orchafl.r 9(.onmncinS wnh SNtion ?000) ofDivision ]
<br />i,r rhc Bxri.$s an., Pofc\siona Codc, sJri ny ltcns ir in full tonr and cfac.r
<br />loc Yb(r-l L-(,
<br />'D!-
<br />7
<br />IOIiIBI]CUONIENI}IILGAqENCI
<br />I hcrchy arhrnundcr p.nollrofpcrjuryrhd lhrc h ! oNiruclhtr lendin8 rsercy for lhc Pcr{ommc ofrhc sork ld uhi.hrhi\ p.nnn i{
<br />issucri lS...1097- Civ C.)
<br />ATTLIIANLOE!;Id.EAIIAU
<br />I trnbt dlm uklcr pcnahy ofpcrjury onc ofthc LlbrinS dsldrrions:
<br />Dcnslnnio Pcrmirs Aabcdor Norir,.arn,i F.dcalRc8llurions ('Iirlc rl0. Pd6)
<br />Rcqtrmd l.rrcrof Norifiriro,
<br />_r.cnilyrhd rhc fcdcr.l rcsuhrio.s rcBddin8.sb.(os r.n$volarc nor amlicablc ro rhh l,n)jccr
<br />l( ilyihsr I hlc ruadrhrappli.rin)n!'{lnrr.rhrlhc]hn. iDnrn i{r k.otu.r I ErN k, dDflt wir h rll ciry ind c.unry
<br />odinrnc.s rnd Srarc l-r*s nLring b brildin8 coNflcii{nr. rtrd h.rcnt idhnilc rcprs.nrrrircs ofrhir Ciry und Counlyti ctrrcr uBnrrlr
<br />rtlvc nEnlnnred pDleny for iNl,.dn,n "P-e
<br />fr'L k -,,, 6'lt t I
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Slandards
<br />S Pool Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Bough)
<br />Ceilings (Hard & Soff it Rouqh
<br />Ceilinqs (T-Bar Rouoh)
<br />Meter Release l/z/ta >b 9<a
<br />Rough
<br />Service lVeter
<br />1 Yt/rr 9\v Rrf5) at
<br />Notes, Remarks , EtC.
<br />ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.
<br />FINAL
<br />OPrc.:
<br />r,.,e 6, 'lt'l I ('on,rec,or
<br />lJ.do r Addtcs _
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