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APPROVALS DATE COMMENTS oWNTN BI III,DNR DI1I,CAIATI(IN
<br />I hcrcby lIirm undcr Fnahy of p€rjury rhrr I un cxcm0r imm rlE ConrEroF Liccn{ Liw ntr rh. rollosin8 rc,eh (s.r.7orl 5
<br />Busincsl &n ProLssion c()d.)r Any Cn, or c.ury *hkh ,.quic\ i Fnir ro s.(dd. ah.r. impruvc. demlish or rctuir any
<br />slrudue, pm. ro i's irsuarc. al$ r.quins rhc aDltmr toi su.h Frnir ro nb a siSrrd s.tcmnl rhal hc or sne h licensd !!nu!nl
<br />ro rh. F)lnions olrhc Contracroas Lianrd Lrs (Chlrrcr 9. Commftins wirh Sc.rion 7(xD of Divhio.I oi$. ausin.$ od
<br />Pofcsbns Codc) o, rhlr h.or shc ncicntr rhcrclronand rhc blsis turhcaur!.dc&mprtn AnyviohrionolSdhn7011.5hyany
<br />nptlicanr for a D.rnir ruhjfth rh. appli.an! ror.iviltcn{hy.fnor mrcrhan lrvc hund..ddoll0( (J5m).
<br />-1.
<br />u\ o$ncr of rhc ptr'tEny, or nry cnrployes wilh wr[cs 0s Ih.n sb comrcn\rr ion. will no lh. work urd rh. {ndm n .ur
<br />inrcndsl or.fcrcd l'or srlc (Ss 7(114, Busincss an.l ltof.sionr Cfrlc] Thc Contrctn\ I.i.cns. L,w d..\ nor ryplyio atr owncr.l
<br />rhcpn)Nny wh. bu ilds or i. rpro vcs r hrrd,n. lkl qh. ddcs{ch w()& hnn\cr or tur$ll .r rltrouAh hk .r hcr own cmploycc\.
<br />F)viJcd rld such i'npn,rmnh uc ton i,ncntud or oll'crul li,. $lc ll howcv.irh. hildiu.r irpn,vctrrtrr is sokl withinonc yclr
<br />olconpklion- thc Owncr lruiucr wil nuvc lhc burdcn oipmvirs rlut hc or \hc did nol ttrild or i,Dmvc rhc pnDdry ror rh pury)$or
<br />_1.!sowncrofrhepmpenr-lnrexclusirclyconrrx.rinswirhliccnrdcon@ttrst,conndcirhcpR,j..r(sc.7o{4.Buencss
<br />.lld lbfssinC.dcr Thc Contdor's Li.cnsc Lrv docs orrpplyb atro$ncr offnJpcny*ho huil&or impn,rc\ rhcrcon.
<br />rnd sho conrr!.rslorru.hP,njccrs*irha(ilrrr.rin(I liccn*d plrlanr hrhcConhci(n rLi.cn\d uwr
<br />-l
<br />m cicmpl undcr S€lio.-. B. & P.C. f(
<br />I h$cht rffinn uidcr I{iahy.l pcrjury ono olrhc lnln,trnrg tl..lrrx{niis
<br />Ihrvcdd sillnri' dinrCcnincdrcotcon{.r t, Sclf lnurc tur sorkcA cu rrcnsdion, rc !$vidcd nn hySc.lior3700olrlrc
<br />LntttrCor,c. rbr lhc pcrformne ol lhc Nork r'or rhich rhc |rrnrii k i$ucd.
<br />Ihrr3trd*illnuirrlinwork.rr$nrPcn\rtnrirNlrlncc.rsrcquncd$ySc.rnrl7(X).frhcl-alFrCodc.turrhcpctfonnoNc.l
<br />rhc *ork nn $hich rhisFnnir is is\d.{ Nly*ortsr.onr.n\rri{,o insurume .aricr rfll F,lic, nunih-r u.:
<br />_ErI,irc\
<br />Iccnifyrhrr inihcn rlnnnam. of rhc w.rk for wh(hrhnl.rnrir is issucd.I sh.llnor cflnloy rn} pc oninunymrnncr
<br />so s li, hccom subjcd ro Ihc workcn'compcns$ion laws ol colifornir o.d lercc if ir iIl \houkl hcco'm $bjcrr tJ rhc
<br />workc^ conrt--nsari.n rrovniois orScclion:l7lx)ofrhc l.aIry C.dc.lshall. ronhwirh comrl, $irh 'hot tn)vL\ions.
<br />WARNINc: I,.ilurc r. sccurc porkcr ompctrsdi.n cov.i Ec hj..r nn .n,Ilotrr b cri inrl f(trrllic\ md
<br />civil fincs up ro o.c hundrcd lhousind doll$ (Slu).000), ir addir h rhc con ol conrlErsrrion. dr'tulcs r( Ftuvirlcd fd rlr
<br />Scclbn .lr)76 ollhe titry Codc, inrcrcsr !frllllomcy \ lccs
<br />I1l.i1!:\-ts1!9r
<br />I h.rchy rfln'n uf,drr p.nalry or p.rjury r hrr Lf lm ad und.r lrcvison of Chnpr$ 9 ((ntrrn.in8 unh Scd ion 7(]00 r of Divilion 3
<br />ol thc Uusirc$rtrd Proac$iorr C.dc. and nry licn\c i\ ii tullrar.c dcntcr
<br />colsBlJgll()xLlrNDlrli_aliINtI
<br />I hcrchy (rrtn undc. pcnalry of pcrjur, thlr rhcrc h, co.nodhn lendin8 rs.nc, ru rhd p.rroirrritr.. orrhc work for Nhich thG rennil n
<br />hrucd (Sc..1097. CN c ).
<br />AIIUCAIL.DECIrISAUON
<br />I h.rdy !frm undcr pcnally oI Erjury om olrhc nnh*ins dcclBralions
<br />Dcnnlition PcrnriG Asbcstos Nolilicalion Fcdcral Rcsulolioas ffillc.(l- Pan6)
<br />-Rcqutcd
<br />t llcrof Norifiolion
<br />l.cnilyrh lhclidcrrlrc8nhlnN rc8ndiD8nsh.(osrcnNv.lirc nor aollnrhE rorhi\ nrcrcc!
<br />',1rhhC yr Cuunr! r.cnr$ ulItrrh(:*,rH;liL:*$;,T,";H"i,:l'i';*[]"'""":-"''h'lau'|hJn''clIc{n'|riv'L
<br />^,,,".",..^,;,:;.,.* r., w v\w
<br />1l
<br />q_,,.," P-l[2"))
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Translormers
<br />Torquerng
<br />Sub-Panels
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Sollit Rouqh
<br />Ceilings (T-Bar Rouqh)
<br />Meter Flelease
<br />Rough
<br />Service lrleter I I
<br />FINAL /4l-TtlK a{]/*74 -tl)_--
<br />Notes, Remarks, Etc.ul
<br />ELECTRICAL-INSPECTOR RECORD
<br />ID/SIG.
<br />Pole Bases
<br />Air Conditioners
<br />II
<br />I
<br />I
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