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APPROVALS DATE ID/SIG,COMMENTS
<br />Site-Work
<br />Un round
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Si ns (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />(T-Bar Rough)Ceilin
<br />Meter Release
<br />Ro h
<br />Service Meter
<br />FINAL SAMC 8-43,
<br />Notes, Remarks, Etc.
<br />Oma-Blil&r Dcl&.d6
<br />I ha*y.flim urda Fdry ofFjw, d l h aon!'l lffi ln. C6r.ao.r'Licae tiw fa ln. follryint ffi (c 70rt 5 BGia
<br />Dd Prcf6i@ Cod!) Any Ci9 d C@ty ,hich '!q!iE . pant lo cdrucr .]16. iB!rcv., ttalElirh d E9.r e, .!ct(t, Fla !o itr
<br />ia@cq ako roqund thc .ptlinr for ruoh Fmn lo 6t . riFcd !r.t@or (hr h. or !h. n lic.n.cd plnu&l b th. Fovi.idu of ln.
<br />C6EEd! Liqd.d trw (Ch.pta 9. Cdllfficiia rid! sdri6 ?000 or Divirio. 3 or rh. Bqi,B ud Profaid codc) a dfl h. n
<br />thc i, da,r ln6tun ad ln. b-ii ta rn Jl.a.d d6Fio Any viol.rj6 of Scrld 70.r 1 , b, uy.rpliqt fa. Fmt Nq.d dBrppli l lo r civil FnJt, oa nd ':e d, ,]rc hu&.d doll6 (t5OO)
<br />_l.a o*n.r orth. propqrr, dny mployd wirt p{. s th.ir&l! @mpa id.*il|&d.workddln?!tru.r@tnotin6d.d
<br />d oltd.d fd rdc ( Se 7O{r, B6i'E url PEf6is Con Th. Cdr&6r'r LicaE L.r d€ rcr .DIy b x 6ma o{ r,r. Fleqry
<br />who buitlt d 6Fov6 thaa. Dd *ho &€ ft[ rsl l"@.lf q h6.ll d lh@rsh ha, d ha o$ deloy6, Fqvnbd rha rEr'ihproffis edi arLd tr or6rd fd r.lc. If, hrea, $. hdldini r imFpvoMr i. rold *i0in @ ,{ of ffirl.ll@. $c
<br />Owna-Build.i will t.v! lhq burda of p.ovin! $.r h. d rh. not brild tr ihprcv. for $. purloG ol BIG)
<br />_1. r drd of rn. F.pstr, m acl€iv.ly cdrt&tint ritn li.oEd @ftdr !o cdlrlc tn. Fojd ( S4 7oaa, as'na ud
<br />Pbadid Cod. Tn CdErlq.t Ueu Lr dG r.{.ppl, b a orE of Fopqly rho b!il& d itrlFIE rhau . srd rho
<br />cdEeu fd tu.h piojea ,illl . CqEEro(, licd.d Flltet to $. C6r*r6! Licnr. Ltw )
<br />_l e s6pr uda S*lid _.8 &Pc.frrhnlt!@
<br />WORI(EITS COMPENSANON DECLAR TION
<br />I hctby aflim und.r Fdity of Fju.y m. of lh. follmini d..ls.rrd
<br />_l hre! ad sill mirt in ! Ccni list of C6tor to S.ll-lnru,. lor edt6' c6p.n!.ri6, ! pDvi.Ld fd by S*ri6 i Too of dr.
<br />Libo Co<L, td th. pcfdl@@ of th. worl for vhi.h drc p€mn n i!u.d
<br />_! hrv. e.l pill Ninr.in (rtd' cdFdid iEufu@. . rcqsi !d b, Scrid ,7@ of rt Lb.. Cod., ad rttc Ftl,]ll.@ of rh.udt aor vhich fit tt il i. i!!.<l M, rdid' .d4al.Iio iduoc. Mid ud policy nuhb.r E
<br />lolo l'J@b? ErdE
<br />(Tti. lcdon ncd nd b. cmddld if $. Frnrt i. ld On. hundld <tollD it I oo) d ld)
<br />_/t?nify dr ri E Ftue of fiG sdl td whi.l rt'i Forn i! isuc4 I rn.ll nd dploy D, Frs u uy ,mn6 D r bba.e sbjd'o 6. rrra .dir-|rl6 lB of C.lildit rd.sE d.r if I lhold bdft $bd lo t. rotd..@Fr.!i6 Foyirid of S&!id r?00 of dE 1.b.. Cod., I thdl rdrnridr .@d, riln du. ,.@nid..
<br />WAR!|INC F.il@ ro ,cw rata' co.rEaBdq @va.S. t lnLrfd, rd rhdl eqcc 6 atploya b diBiirl Fr.lrio nd cirilfi.6 up !o d. hundEd $ousd .iolln (l100,000),in .ddrti6 lo th. d of .@D@:.ti@, dr sa ! Bovid.d fq $! Seri6 ,0?6 of
<br />thc L.bor Co&, inr@r u<l .nmcy! f6
<br />LICENSED CONTR CTONS DECI.AT rION
<br />I hq.ty .fiim u.dd padt, of tEury tlla I o liorcd @&r Fovnid of Chaia 9 lmir8 *id Seio TOOO) of Divirim I of
<br />th! Sudnd ud Prcraid!. Cod., &d n, lic@. t in lull foc md.lIdr
<br />o1l\---*A /a,(
<br />CONSTXUCTION LENNI G ACII\CY
<br />I h6.by .flim undq F..lty of Fjdy rld tia ir . cdirl<tid ladirt {sry f6 $. Ffdilr.e ot rh. wnl tr rhi.h rni, pmi ir
<br />isu.d (Sd ,097, Civ C)
<br />Attllcax I.s Df, clrutATtoN
<br />['cml'ri6 PtuiB-ArboI! Nodliodd F.ndrl R.suhi6r (Ti{. {o. P..r 6)
<br />_ Rcqutld L.nq of Noti,ic.tio
<br />_1.€dfy d.r dc f.d6rl r.Sdrri@ Esrdiis atd.. turl d.ot qliqbL l,o rlir Foj.a
<br />J,r@iry rh.r I h.E rc.d rhtr .Fpldr rd .r.r. $.r rh. rtoE inforrrion i! co@L I .t e to chdy wirh .[ Cir, ed Coury6.dinr66d Slt|. Ls drirr lotdldry 6uE!.rt6. &d harlr uhaiEE .aadi€ of thit Cit ud Cdbry io6tr upodln!.!ow lBrio.d Fqary fa ii.p.<lie FIpq..
<br />Appl,.&tor is.nr,s 1r
<br />-
<br />)/ -/-al
<br />ELECTRICAL.INSPECTOR RECORD
<br />o.,, i-=42 / neetx-, Ol= il/ .---.
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