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APPROVALS DATE COMMENTS OWNER BUII.Dl:f, DFICARATION
<br />I hcaby dllrm ! lcr trnolly,,f p.rjury rlHi I d cxcnll'r ln' lrE Contnctfr t-i...* Ljw rur rh. i)lk'*ins fu$n (^L70]15
<br />B!ri61 6d lt L\si'n Gric). Any Cny or Coutny *hah tqrn.r r FrM t) .onr.Er. !h6. i'qroE. &mlnh or rcFi' rn,
<br />srrudurc.Fitrr'ik i\ruotra- ller rcqut.r lM uprllh,nr t(,r su.h Fmril tn lilc a riaftd {lrcftN lhal hc or r,E n li..nE l puNunl
<br />h rrE rm*bN .f rh. Co.llxrd r l-irnrd tru (Ct fld 9. G,nftm'r3 u{h S(rin 7fil) or l)'r Fnn ] or lll Bt{m rnd
<br />P('fcsnns Codcr or rhll l*ot \h. n.rcnrPl lhercfmnond rhc hr\ir ro h.ulL8.d crcm0liotr Anyvnnarion lSdiri70.115bvlnv
<br />rmlia ntraFmnohFhrtE.fitlic.dto,ri!,lFMrryorr,niErh..llr.lrudrddour,((SirD)
<br />a
<br />-1,
<br />rs owE or lrE F|Eny. q dr.,PhFs *nh Eqs $ llEit $t on{moii.. *'ill &, llt *rt,n dr {tElG n d
<br />inr.id.d m ofi.'.i ror sL l sd.7044. AuriBrs snd ProtHrhnr Cdc: Th Contreld r Llene Ir* ds ml tlDlv ro u o*rr or
<br />0F [rcFny *h tritt c itqm6 r,tE ad els dr. {En q,i hioElr or txrullor rhmuln hlr q lu o*n.r{'hyes.
<br />,rovi(H rh.t st iqmwds G d in.nLd.noff.tsl fn -L lf, hrw, rtE lnildit{ d ltlre'd Lr rfi wihn w Fr
<br />olon{|krhc tu O*Nr Btrills witl hlw llr tlrd.r of F*itu rh.t hc,' dE did mr t{ild or intmh rh lmpdr} for E,ulx'tot
<br />-1.
<br />!s o{ rr ol ilqnIrny, .m c(lu\i!.ly co rrlin8 * hla.n<n$ 1116 k, i,nrtu1rlE PoAl ISd lora Busns
<br />ad ftnf6rm ( ode: Th. c{,nhin s Lic..r.l,ip dftr mr apnly x' !n ownr. oflroFny who huild\ o, i6lNE! rh.ro'n.
<br />mJ *k' $nrRls f(tr sh lroFl! wirnr C.nrd{d\r lt.n<n I'uriu,l krrh.(.l, rdnslilnslr*)
<br />_l rn.\rnu urdcr s(liotr-n & l'( ln' rhi\r.r\nr
<br />lhl. Ormr MBlil:Blrarlt}:Jtallorll[llA&rroli
<br />I lx'.br rlr r.r urdcr ,!nrlrr fl FJUrJ otu ol rh. l,)lhq 0t l..l-tr i,trx
<br />-l
<br />hrv. lri will Binrdn ! (tniarllc or ( nn*nr tu s.lr. lnsur. fot *orlcn @nvhnqri('n. &\ lmlidct lor hy s.clbn lrlD ot tlt
<br />t lxr Cqj.. f6 rlE Ffolffi ol rlr sorl d *hih rlt Fmr a irGn.
<br />-l h,rr rn rill ninr.'n lorls comFn\lil'nin{EB.,.i,aiuiEdhrS<rit.lT(I)oart L.tnt Cod.. tu E,Erfc x. ol
<br />rhc wor* ror whkh rhn pcmil rs isqrn My *ortdi sn{fnsrrrn insnre ffi.r !d lrniy numh.t e:
<br />l..drrtrhd i.tlr FnnEN or r$o* ii shrhrhirFrmir '1i\rkd.I rh.ll Dr .trnl'y rny F$n i.!.v ,mEr
<br />s' s r. tEom robj.y! tu th. worlc.{ con{E.slrl,n la*! of Cdlrf(,miu. ..d .3r rfid if I rhuld tr.om subj.cl ro I lE
<br />*ortcr' s,nrFnqrir. tmvni'N ol S.crion l70lr or rh. I jlnt (]n . I trll. ltrrtq hh Nr{ y snh 'nx Dolni,s
<br />WAiNINC friluE ro qoR uf,Irtr Nrm.nuion drvcns. is bhurul. r,n .h.ll ruhrd rn di0l',F t' diniMl Flti.r rd
<br />.Nrl imr uI r' om hundrd rhou\and .ll.^ llllr0.l[x)). rn aJd r)n t' r n, dnmg.r ar pmvA.d for th.
<br />\r.rtr{' xr74a! rrf, ljtstr(irLr n','r!rrlJrrr'r) \nu.
<br />,,,,. O ll lrB \Dpu.*,, (1
<br />IIECI.A8A.IION
<br />I llEbt nrm unLr Frolry of Firrry lh,r I rfl ll(ttr<rt und.r Flrnntr of (lufld
<br />of rhc Busimls and PmLsinB Cdle. un my lkcns n in lull trmt nrd cfiar
<br />immNr8 rirhS(rDnTUlrr r
<br />l;ru/rI ts
<br />(r)\\t kt cl t(r\ I t.\tI\(i ,1(:!\ct
<br />I i.rby rnm und.r Frny ol Fiiry rhrc rhdt a . oNMi{ hnins .g*y ld rll Fn|m of rlE s,t for rfih lhn Frni it
<br />ksu.n 156.3097. Civ. C ).t dLr'. N.m
<br />-
<br />AISLIIiIILDESJaAIIOd
<br />I h.rd,y dnim u ndo ,.nrhy or Fcrjury orc of rhc rblloqinB ddl(rt ion!:
<br />D.m|ili,n Pcrhik Aslr.tor |*nfr.lrr. tu nl Rqulrtbnt lTnh,l(). P.n6)
<br />-R.rtuiEi
<br />l.tr.r ot t*iifkdbr
<br />-l
<br />c.nity rn r E f.rlcEl EgulrrbB E rdinS rtb.gor Ed$rl E ff{ +Pliahh b lhn FmIr1.
<br />I cdrili rhd I lIE Etd rhn lmli{rif, an tul€ lhd rh. drE inrotElhn ir ..tur. I i{td x' Nnply wirh dl Cnv rnd Coun',
<br />ohlrBLr\.,n Sr.r. ll$Ehr,I{ rot{rBin8 (n{rdhoriu qrcerl.larn 6f rhlr Cry .rn Counry ro .rrd rF. rlE
<br />rh,vc rirk cd trup!nyinr tr^nccr(n,
<br />Aprllnrd "r axmr si*tr.ruft \shlL
<br />Underground
<br />Pole Bases
<br />Liqht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Buildinq
<br />Under Slab / Floor
<br />Bondinq / Groundinq / UFER
<br />Translormers
<br />Torqueinq
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unil
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinqs (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rouqh
<br />Service lVleter
<br />FINAL /z/-/2 J./.trh Gi)
<br />Notes, Bemarks, Etc
<br />ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.
<br />Site-Work
<br />Communications Cable
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