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APPROVALS DATE tD/stG.COMMENTS
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Sions (monument)
<br />Lile Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />It/eter Release
<br />FAAe.-JZRouqh4l{lK -t-.I 9
<br />Service lt/leter U\
<br />FINAL f-.r-rrz G)
<br />Notes, Remarks, Etc.
<br />OWNER BUTLI'ER DEt,CARA'I'ION
<br />I hcr.hy allirn undcr rD.lly of l)c jury lhar I om excnDl lrom rhe Contfl.br Liccnsc Laq lor lhc follosinsrltr\on !acc.'lorl.5
<br />8$incs rnd P,ofe$ion Cnic), Ady Ciry or C{ y which rcquits a Fmil nr conslrucr. trl'cr. idpr.vc. dcnrlish .r rc|ln rny
<br />dru.ru...prubiis isum.c.nho.cquncsthcarulic0trriorsuchpcrnrirronbasiAtudst .mcnt thalh.orshehlicentd Pu^uanr
<br />ro rhe provhion\ ol rhc Conrldoas LiNtrscd ljw (Chapr.r 9. Comnrcmir8 *irh Secli{nr 7000 of Oilhn i 3 ofrhc BusiNss ond
<br />PnJrc*nrCodc)orrh,rh.orshckcxcnDlrhcrcf.om.ndthchNhforrh.dkscd.xcnrprbn.Anlvrcl{lionofScc!ioi70,rl5byttry
<br />opflic.nt aora pcrmit subjcck lhc imlica lorcivilpenllryotnor m.Brlr livc hundrcd dolla6 (5500)
<br />-1.
<br />$ o*ne. of rhc pn,pcnl. or my cmplo)ccs vnh rvr!.s as Ihcn sob conruns i.i. will d. th. sork dd rhc rrml@ n nor
<br />idcnd.{ or oncr.d ror silc (Scc ?044, Busincs lod ltonsiox Codc Th. cDftr.lor's Liccns Lrw docs nor npply t' atr osn rol
<br />rhcpnp.ny wlm builds or nnpsws rhcen. tod who drcs nrh $o.k hi selaorhcrElforrhrt,ughhi\orhcro*ncnDloy.cs.
<br />[ov]dcd rhar slch inrfrokrrcnh arc nor inrcidcd r oflci8t n {kr. Ill tuscvcr lhc lnriHing ot irprcr'mnr k bkl {irhfl otrc }car
<br />of.orrldbn. rh. Ownd Buiud uill hlE thc 6u,rlcn oi provins lhal hc or sh. did i.r build or imPmvc Iic lmFny tbr rh. purlbs of
<br />l. ,s owrcr of thc l,opcny. m cxclusivcly contmcrinB wirh liccnscd .otuacros lo construcl llE pmjccr (Sc. 7Lv,l. Busines
<br />and Pmlcsion Codc:'l hc Conta.tols Liccns. Law docs not applylo !noNncr ot propeny wh. huilds ot imptoves lhcror,
<br />nnd who onlmdsfor such proJcch sirh a Conhcror(O liccnsed pusnanl k, rlE c.ntractols Liccnse t!s).
<br />I Jm.rcrnDr undcr Sc.rmn . B & PC nr'hi..cr{tr
<br />Owmr:
<br />Iy()4EriBll!:9llt[Nsrr!!]N
<br />I2irEI!$AII0!
<br />I hcrrhy aJltm trklcr t).trilly.lp.!u,y oD..lrh. ftnL(n\ i',9 ,lcclx'rri,nr\
<br />lnlrtrGnlc- lni r\. NrloirnrDrcofrh. {.rk tur slri.hrh.Nrmil i\ i\qic,l
<br />My trn'\r' j n,mn rstmn Nu'ancc Lnnic, Jld rli , numhc' !c
<br />sL.n.I4^.aL A*bx1^
<br />-l
<br />ccnily rhrr in ihc n.rfontutr.. dfrhc soik lor llrich this Frnir h issucd- I rhnll 0or cnPh! ntry rcron in rny mrnntr
<br />k, N k, b.o'n. subiL\l tu lhc sorkcs' conFcnsrliofl laws ol Crlir{flir, aid rgtc I har if I should hcconE suhicd k, rlt
<br />work$s.onlcisrrionpovniotrsolSslionl?firoirhclrtuCoJc.l\h,ll.ronhwirhcomflrLrilhrhoscrmvti{,ns
<br />WARNING tiiluE n, $ur. o cri co '$n\nri(rr ov0ns. '\ utliwirl. drill n'bicrr o c rdolc' ro Lrimirr{l P:nrlrics rnd
<br />.ivll fircs u! r. om hundrcd rhousnnd dullirs (S100.0m)ion, d,.rg.s os proli{lcd lor rhe
<br />1,""--4.i5:tt'
<br />.l rl,c Btr\i',cs\ tr{l Prort$iorN Codc. d nry liccisc h ir fullhrerndcflc.r
<br />t/l-,LLp \
<br />I hcEbt afltn undcr pcn.lly of pcdury I h,r rh.rc i\ r co.stu.ln,d lcnding r8ctrcy ior thc pcrrbrmance of rhc work ror which thh pemil is
<br />hiucd(sc 1u97.civ c).
<br />AIfTIgAITLDECIABAIIO!
<br />I tB.by afllm undcr p.nahy of pcrjMy onc oithc followins dcclararn,ns:
<br />Dcmoliriotr Pcrmirs Asbcsros Norin.ari.n Fcdcal Regrlari.ns (TirL40. Pd6)
<br />-Rcquned
<br />Lcrrcr oa Nolifrarion
<br />t.cnilrrhrrrh. fcdcrrl rc8ulnriotrs rcgrdin! ishesros rrn)ul c mrr|fliuhlc b rhh ln.t.r
<br />-lccnilyrhlr
<br />I Mvc rcad rhis rhnr thc rh,vc nrbiin iotr hcotrsr I rgd r. onply wirh rll Cily rnd Counry
<br />ordiNn.cs md Srilc Laws rclarins dh.'chyrurhorlzcrcnrcr. !ri!csol rhi\Ciryn dC.utrrylocnlc'
<br />rborc trEtrri(nr [.pcnyior
<br />Y
<br />4,.i3'\?
<br />ELECTRICAL-INSPECTOR RECORD
<br />I. a,t,,'\ ,t,r.-
<br />tA^
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