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APPROVALS DATE ID/SIG.COMMENTS OI{NER EUILDER DELCAIATION
<br />I h.rcby rmrm und.r Fnlly or Frjlrt lhir I m .xcnql from lh. ConlrElon Lij.trE Lr* lbt lh. followi.S rcrsn (56.701 I 5
<br />Busin.$ cln Pioftslir Cd.): Any Cn, or Counr, which r.!ur.r r |toi 16 omtud. ahd. inprcE &mlnh or rFn sy
<br />srMrN. Fi,r ro irs ii\urm.. 'te riliE! irE q',,ad fo, lkh Fmil b 6k . siSrEl nd.mnl lhol ,E or at i lt ,t d pus.rr
<br />ro rnc pmvniaB of tr Cdnrr,.roi! l-icn€d tie (Ch4t r 9. ConnENi.8 wirfi Salirn ,CIl, o, Diviriotr I o, . AuriEri d.l
<br />ftor.$nr.s Codc) or rnor tr or 3nc n crcmrt rlErcrror ,trd rlE bssi! tor rh. dlcscn cxcrjPrbn. Any vbllrior of SN'ion 7ol L5 by rny
<br />lrDl!,rt r.r i Fmn \uhJrh rh. rnfl'.lnr ro a ( rvil Fmlry or ior turc rh.r liv. hun&.n doll$ ( $JoOr
<br />, f I
<br />->LLlr o*Erorrll( reFny, or my ('nphF! $irh *!gcs.s rhn st omF.oin'. wil dn llE *.rt.d thc rrtre k ml
<br />idc tn or.fr€r.d ror qL (56.7014, BuriBs.rd Pmf.srions Cod.. TtE C.nlEdd 3 Li.n{ Lr{.ro.r d {tpl, ro sowror
<br />the F)Fny who b{ilds o. irprsE. rhcmn..ld *lm dms sEh wrl himr.lfor l*rellor rthoBh hn oJ lE, own.nph}t.s.
<br />provi&d rnlt !!ch ihpflrhlmls e ml inrc.dol ot oflcBt ror sh lr, hoMw, lE triLli,8 or iqn,w,Erl is ell einin orc F3r
<br />ord,,rpbrirn. tr OsEr luiltd will hlE llE h!rL. ofFovina dE lrornEdn ml hildu itrFoE tlE Fqaly f., E FnF* ol
<br />_l- r\ owEr ol rhr pn)lkny, nn dr.lusiv.ly cotrtrrt ir! wirh liccnrti .onrrtor k' con{rucl rlE |m,J(tr (S( 7l}4.1, Atrs*$
<br />rd Pt)r$\hn Codc thc Co ru.r(tr \ l,i.cnsc Lu*do.\.or rpplyk, !nosno oaproFnywh. hurlds or imfn,v.s lhcrco..
<br />rnrl *lx' ronrocr f., \u.h t mJNk wirh r conra.k (srli...\.dpur rdiorl*conrrctolsl.tcncb*)
<br />-l
<br />M .r.mpr urdcr S6ri6q--
<br />(*,, a4l LtlfuLt""*,Tu.L
<br />1DECIAf,AION
<br />I h6chy ,num u.d.r Fndry or Fjury om of ilE rolbrin8 d..lnlhns
<br />I hdv. ul will trtsintoin ! Cd irr0rc of Conscnr l0 Sclaln\uE ln lorlcn comncn\ati.n. !s ffuvidcd ror hy S.crhn X700
<br />l-1kn CDd., toi the pcdornMcc ot rhc rr,i* ror *hi(h th. Fnnr $ isrutd
<br />I hlvc.id $ill mn.i, *o&.ri .or{EHrion nBrmB.,6 Eqund hyS<io.l7(lotlh Llrlor Code. for rlt tErrnte ol
<br />lh. e.'t fo, whi.h rh Fmn ir ii$.d. My wort6 on{Ers.lion insunm. fftr od F lt, nunb., @:
<br />L$rce
<br />U{f, '-, t * --** r * *kf- -*r rhir pdnir is hsu.d. I rtuI n,r chproy sy ,Erutr r my tunM
<br />$ Lr r, .**onE rubi.r ro th. workds' .omFnstion l.ws of C.lifomh. ud .xE thd if I rtnuld lr.oe rubj.d lo th.
<br />eolt61 .or{ENlkrf, Imyisionr of S..lion l7m of 0r litor Cd.. I dulL fonh*ilh conply wnh lhos provLbN..
<br />ltALNlNC tsrlurc r' {(uc *orkc^ R'mpctrrltn,n !ov.68c r\ utrl!*ful. d lhall \ohF-r ,n Mlihr.r t, Lnnrind ,f,Elrs !'
<br />civil fir\ ut to onc htrndrcd rhou$kl dnllan (SllD.lx)t))- in 0.ldirion lo rhc cnsr or comFn\Drn,n. dmds.r $ Jrovirlcd r(, rhc
<br />SNri(,.107(, olrhc Lrhtr CGh, itrlcrr
<br />( .*..-*, TU T#r KE!(6itstlw IU&u{,ullIsEllranlxlqla-[
<br />I2Eq.rl3AIloN
<br />I h.Ehy uflnm lndcr F.Mlty of p.rrury lhd I sfl lieisd u.{td rlliion or Ch4r.r 9 (comrxing with S6lion .(Ilo) of Divisbn l
<br />or rrE BlsiEs lrl PrulissiJB C L, ,,n Ey li...s is in tuI roE! 8,ri cflccr
<br />II,DSIf,IJCIIONIEITIN;.AGE!!:I
<br />I h.Eht sflnn und6 Jinolry oa pcrjury rhar thcrc n . $$rBtbn Lnding .8.my ror
<br />'h. tsforrurr of ttE wqk for which thh FimI i!
<br />issad(sN 1097. cit, c ),
<br />AIIIICANI.DI:IIdBAIIO!
<br />I ho6, rrm unL, Fnrly ot Frrry oE or rhe follo*i.E .kr!.r{hns:
<br />D.mhirn Pcrmjrr-A.lErloi NolifE hn F.d.r.l RcSobrions (Tnk.l0. Pd6)
<br />-Rcrluicd
<br />t rrd olNorindiun
<br />l f,/d'ry 'h!t
<br />rrr t d.nl Eellri,n\ Essdiry .th({6. emv,l r. mr rpnl.sbL h lh\ pmFr
<br />3+l..nrryrhd I hlvc Ed rhis lpFlic.htr !d $arc rhd rtr {borc inloinarion ir cotrdr. t lg@ roomplyvilh.ll Cily tnd Counit
<br />*:r: ffi:ilT*r'Wil;il;frru; ^,''WiA,l
<br />".-n.n.,.,p.in',,-l! E;E*U 6 T)tl {1.tr L--
<br />Site-Work
<br />Underoround
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Founlains
<br />Signs (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm i Dampers
<br />Communications Cable
<br />Buildinq
<br />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Boof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soflit Rouqh
<br />Ceilings (T-Bar Rough)
<br />l\/eter Release
<br />Rough
<br />Service Meter
<br />FINAL zI JK .2,t)
<br />Notes, Remarks, Etc
<br />ELECTRICAL.INSPECTOR RECORD
<br />Under Slab / Floor
<br />Air Conditioners
<br />.t-4--L,\
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