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APPROVALS DATE ID/SIG.COMMENTS OWNf,T EUTLDET DELCARATI('N
<br />I 1186! rr"n ud.r lEElry or Fflry rhd I m.rcn$ tum rhc G'dm.1G Lts{ 1,, fo. tlf ft'll,rins ra6n (sc.'r0ll J
<br />B$'ncs .d Prolcsion (txlc)r Atry (iry or (ounry wiict ,.quirc\ ! rE mii k, c,n{tur. rhc. i'qrcE. lrcmnirh ur qEn My
<br />rlu*re- Fior ro nt isu(r. .ls Ea!i* rlE lrplk&r tir rkh Fmr k, GL r riSEit nd.rnt rhd tE or rlr ii liln<rj luBint
<br />to th. pmvn(,ns of llE Contrelitr { Lienst l,r (Chrrcr 0. Comnrn(inr }irh s(rion ?00o ol Divhhn I trrh. Busincs{ rld
<br />P,of.\rbnr Cod.) o' rhrl lI i, rlE n cft'r9i rh.r.from r,ri rh. tsri< n" rlE ilLtd cr.nplhn Any vi'hrio. .f S(lnn 7o.l I 5 b, lny
<br />imlid nra Fm ruhFrln .lplicanr ro rcrvil,nuhyol.ol nn.rhan rrc hrndEn dolla i l5lxlr
<br />_1,6o*EotrlEF,Idr.rhy.q,krswhr!!6r\rtkrskdnFnoio.,wil!6rlEw,(on'lEqulri{D|
<br />inhJdl or olTcrcd fir sk l Se.7O4l. Burincs! 0 Prufc$irtrr Cixl.: Th. C.dr(o' 1 I-icnE bP dms mr .{Tly t, !n owmt of
<br />rh. FThy $tblliltlrirt rE\ rh.Gn..r *h, d6 sh \it hi.Rlf or lErclf or rlml8h hi. or tE o*..rit,ycr,
<br />F.ovr,cd rh.t sxh i,{mwnl! E rDl inlc.'d.n {, oirsd tu {L lt lr,M, lrE txiUme or inlmwmnr r $H wirhin om ys
<br />or.o,rl)ljir. rrr O*Er BuiBcr *ix hrh E hnrln orF,ving trd lru.ilEdd tu t U.t intmE dE rrorFrt frrit purF.ol
<br />-1.
<br />.r ou*r of tlE FtrFnr. m crclusircly s,rrl1h! *nh liInri.on'ar(h ro on<ftr rh ,ftrd ts< 7(x4. B6!s
<br />dd tltrEsid Cfl!. Tnc Conrakn s Lkcns. lrs &*! mr rtfr, ro rn osk. or I,mFn, wlrr bu ildr or imnroEr rhdcon,
<br />!trd rho mnlnds ln suh FsFts witt ! Co Eck,nn lt.nEd p!flMt to rh. G, r-roa! Li!trr t!*r
<br />I{ rxr'htr un&rS.rrii,n .l! & l']( iorlhN rcrv
<br />ll(ll{r(t'&s' ( ()i\rPnrts:tl I(}\
<br />l)}:rl.u.tuQl
<br />I hrr.hJ ,'rl 'tr, trn(|., trnxlr\ oltxrr'tr) otr. flrhc l(i]l(i{ tr'rr drcl.trrrtrtrA
<br />_l h.r ul rill minrlio r Ccnir..r. of (nnrnr b Scla lnffi ftr $nt6\' d,n{Ensr io.- !r Fovn.d ror by Sdtn :l7m of rlE
<br />Iit{lr Anc. ltr rhc p.rfomNc ol lh€ wort for *hth lhc Psnir 6 irslcd
<br />Ihr!.{nd*'llnmnsih$ortf'romrtn(rirn'n\ututuc.r\rdlundlhtSc-.,rrn:17(x)olrh.l-alxn(i..lurhrf[rfornrnccol
<br />rhc *ork ntr*hihrhG p.rnn ii nt!.d Myqfk(i mnFn€rir inuraBr dtri.r el pli.y.unt{, m
<br />.** rJa\4.r/ @Lrrc
<br />n,,,,, n,-,., kl!411;fl4e3us <.1,r$
<br />_lLcnit)rhdinrlElrrntrnureofrh.qorktutrhihrhtrp.rmnsankal.I!h.llk.n{'k)}.tryJrreflrnlnyD8n'Er
<br />{, r\ r, hmoar \uhjrrr k rh. wortch.o'nFn\rri,,n hssot C.litnmia. d l iAr. rhll il l shaulil tEonr \tB{ r.rlt
<br />roa.ri inqi.n\rrnn pturritn( ot Sdir lTm .l rlE l rt C'rL., \hrll. f(nhsilh(o'qll q'rhrhleIm*M,ns
<br />.r,l rtrn\ trf r, on. hutrJr.Ll rhotruki tl,'ll,r\ i\lr{r.(ir
<br />;:;HAn'" ii' 1')u TB:;:i'''
<br />DE(IdSAIIIA
<br />, h.Ehy afiirm u..lcr !.ulty of Frjuy ln l I o lianEd und.r FDvirhn of Chap'd 9 ($nmNin! wnh S€tb. 7mr I of Oitti,n .l
<br />of rlE axm!( rn Pmt*ri,n3 Ctik. .rn ny la.nr ir in tull n,N &n cfld
<br />(>,
<br />0f 2um.-,*,-
<br />\o9'11s1
<br />\) P-
<br />g.tlNraucuo!.LENltMgEE{il
<br />I ncEhy dmrn h<hr pcnshrol Frjury rhd rh.n is o 6n{rucrion LndinS rt.try for lhc Irrtormmc of rtt wort fttr lhih rhis r.mi k
<br />trEd (s(. nl97,civ c )
<br />AITIIIANLTI1jI.A8AIII]B
<br />I hcEt! 0llim unlcr prtrrhy oftErjury nne o! ltc full,'*inr d.cld{ri,n\:
<br />Ikml,rk{ Prnts.A\tijor Notifrl n. Itdcr.l R.BuLtbn! (TitL.l0. t!n6)
<br />Rrquft\t Irll.r ol Mrif.di'tr
<br />-l
<br />ccn if, ltul rh. tcdcrll r.8!hrl,nr tgdding f,llEjor r.nrvrl uE fr,r .Ppli..nb lo lhi* IrDFr
<br />Afid,ry rhar I hiw rid rhis lpplicr n,h o,n (.|c ! ha! rh. rn,rc inf(trmr i,'n is corel I eaft !o .on{ry * h .lr c y ..d C.unry
<br />onimNr.,tsr.r.t vr ELri,B ro h{illi.s mNrnx1in.,n Ercny'lnlnrirr rrtulldivB olrhi. Ciryltn Cou !k,cnrduFnllE
<br />!hrc rtrrknk\lnn,p.ntir, irrtRlk,nNr
<br />,\ppli.rnr or.rxtnr Sixn{ruR
<br />,-9o,,,u|4,.^
<br />.i,,. 'l '/2018
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under SIab / 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 (Rouqh)
<br />Ceilings (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Bouoh)
<br />Meter Release
<br />--.atO
<br />Rough Ef,r"--
<br />Servrce lr/eter r 1 'rflt:,
<br />FINAL trYPIRET ,5Lr
<br />"' R43' 290;5wt*-Notes, Remarks, Etc
<br />S/\MC
<br />ELECTRICAL-INSPECTOR RECORD
<br />,/ ,/ ,-'A
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