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Home My WebLink AboutB2002-1820 - PermitsCity of Newport Beach PO Box 1768 Newport Beach, California 92658-8915 Building Department • CIP Permit No: B2002-1820 • Permit Counter Telephone (949)6443288 'Inspection RequestsTelephone (949)644-3255 Job Address: 1 HOAG DR Floor: Suite: Inspector Area: 7 Legal Desc: Owner: Address: Phone: Applicant: Address: Phone: HOAG HOSPITAL - FOULKE, P 1 HOAG DR NEWPORT BEACH, CA 92658 949-574-4488 TAYLOR & ASSOC-CUNNINGHAM 2220 UNIVERSITY DR, STE 200 NEWPORT BEACH, CA 92660 714/574-1323 Code Edition : Type of Construction: Occupancy Group: Added/New sq.ft. Bldg: Added/New sq. ft. Garage: No of Stories: No of Units: 97 V-N U1 N N 1 Issued: 08/19/2002 Receipt;. Bldg: 1 Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Description of Work: EAST CANOPY (BLDG #8) 1531-2002 MC CARTHY BUI 20401 S. W. BIRCH STREET, SURE 300 949/760-5580 411173 08/31 /2003 BT00021561 03/31/2003 Workers' Compensation Insurance - - Canier: ST PAUL FIRE Policy No: WVK8500217 Expire: 04/01/2003 Building Setbacks Rear: Front: Left: Right: Use Zone: Parking Spaces Construction Valuation: $73,000.00 Building Permit Fee: $655.10 Plan Check Fee: $471.67 Supplemental: $0.00 Investigation Fee: $0.00 Clean Up Deposit: $1,100.00 Energy Compliance: $0.00 Fair Share: $0.00 PROCESSED BY: ZONING APPROVAL: FIRE A7P:2OVA'_: GRADING APPROVAL: PUBLIC WSRKS: Microfilm: Excise Tax : Park Ded: SJH Trans: San Dist: Ca Seismic Safety: Disabled Review: $17.00 $0.00 $0.00 $0.00 $0.00 $15.33 $0.00 / Architect: Address: Phone: Engineer: Address: Phone: Designer: Address: Phone: Special Conditions: Bwee UD State Lic: TAYLOR WILLIAM C 2220 UNIVERSITY DR, STE 200 NEWPORT BEACH, CA92660 714/574-1323 State Lic: S-000702 FEES Hazardous Mat: Add Fire Dep HMQ: Other Fee: TOTAL FEE :$2,286.12 TOTAL PAYMENT :$0.00 J . .0 $0.00 Fire Department: $0.00 Plan Review Fee: $0.00 Inspection Fee: Planning Department: Counter Review : Zoning Plan Check: OverTime Plan Check Fee: TOTAL DUE: $2,286.12 OTHER DEPARTMENT: PLAN CHECK BY: APPROVAL TO ISSUE: J4I NaU $0.00 $0.00 $0.00 $27.02 $0.00 WORK MUST BE STARTED WITH A PERIOD OF 180 DAYS FROM THE DATE OF VALIDATION OR THIS PERMIT BECOMES NULL AND VOID. APPROVALS FOUNDATION. ROUGH GRADE DATE BY LINE & GRADE CERT/SETBACKS ERECTION PADS FOOTINGS COMMENTS212o./f Op� o c T+ l')rtig- 6010 T° J- 3 SLAB ON GRADE 4-0 w ah( 3144092) fi fif/a3 FRAMING: DECK SLAB ;AO y pitr24 zit) SUBFLOOR ROOF & BUILDING HT EXT. SHEAR/HOLD DOWNS GENERAL FRAMING FIREPLACE THROAT OWNER-EIUILDER DECLARATION CE41L LAW FOR "I L FOLLOR: MS REACC N ;SEC 7J)11 8..5.^NESS AND P•::! =3411' T CO - SA COUNTTIYi •IL' ( PET) TPEI •'. PEPL T T1: CNS RCC ALTER. N R_-E ,SENTSTsc 011 ...,L:.....r. i,.q]• _D r'• aq'.:h.^e !' c ^.CL ".-e ; E `34' r V ' F.re 3 r I ^f.Y+1 IC:NES STATEMENT 'FAT 1- OR SSE S L {. Fl -1 T) TNE FERN:3)1 ' 'TM i TF LICE E I A 1 HS C rDl FL`;I• ARO TPC-t)381046 CO8E8 1-1» F E T N k_FS8)::: AND THE P S FCF 'F._ At.ESC, 1XIM,710,1 ANY v CLs1' N E Y ANY AP•.I.ANTE F A FERMI,IYL'C THE AsPIMMT:f EC A c,SCI PENATY CAN0 P Y 1J40k i .. ❑ ,. AS U.i , .r 1•1 PNSPES Se CS t'Y .r7CV( _3 WITS Iv_C AS rests :CIF '0I•°_R3STEIS'C VEIL TT' F_ WORK .ARO THE 31R)LC-SHE 3Nv ma:crier01 Yi VAS FOR :.'LE :AEC L.. _ S NESS At: PFi435"MS C7CG TFE CO^.1Pa7TEAC L C Cori LAW G.1i AST %%FLY-(. OR CESTIP:2T.R0:-Yv1:US OR 1!CP CAN 3:,P:C'Y•_CS..^F.Cv;DC WV Ate. STPRC'VETENS AST )' .3TEHLE: CR 057E :EL FRE STJ.E. I' HOWEVER P 5 ELTLITA3 AR IYPRCIEV EMT 5 SO_' WHAP. AYE YEAH .W COMPL " OS '•.F CN.EE-EJ.L`ER :41- "'AVE Ivb 8LFC3N OF-POT:kG 'HAT re OR :i• C' ^'• 4C- ERRS :. '•: P3Ll£ FOT'LE 'J5P:i3C OP SA.. E 1 O . pc_ 7P.' :P 05 T•.E FROFFR'Y ENCI.1P::ELY 4ti IT:AR N3 'i.'1 L'CENsTE CST:W Y:TO:3 TO OCHITTISCE THE P'C.ECT EEC '41. EMS 1551 AND "RO 3SSAHS (CAS -PE i0td 00(001 J7E3SE LAP: DONS RCi APPLY -C AN CV.T1F .5 HtTHOTERTT'i&0 'T _Ds OR Pik:RA`E 'O'I.E CCh13ACTOP5 il;3RSE TAW 1 O I AM EXEC: I. 030EO EEC PC' £i,R ' H 8 REASON ES INTERIOR 8 EXTERIOR INSULATION DRYWALL SUSPENDED CEILING SHOWER LATH EXTERIOR LATH SCRATCH (PLASTER) (2 DAY) LICENSED CONTRACTORS DECLARATION NE>E.^Y NEE 3M DNLE0 EFYJ.)TT OE FEil00V THAT AM LP:EASEL) STAMP C:CGth¢V NS 'ATM SECT ON TEN. CF DIY 3 CT.) r) 131E sLSI^. CODE ANT TY L(WISE 1:i T4E-L t00Co AND LFN:CT. LO-v1ECI.i:8 ITC NO. 004'330rop_ /'l 'y��e WORKERS' COMPENSATION DECLARATION / i'.I SE TA AFF kQ LL';:.R PCT..A' TY O2 Pt NJu1:r C4r r. LAVE ANS 'r"..L Rix'ti N A 7CR(PTCAT or CONCCN( TO SLiF. 'TIT: El r-0- MASONRY PRE GROUT MISC. INSPEC [IONS: PERMIT EXTENSION 1ST EXP. LETTER 2ND EXP. LETTE BUILDING FINAL CERTIFICATE OF OCCUPANCY TENANT NAME: TYPE OF BUSINESS USE iS 1/- r olD 5 DATE TO. REFUNDED FATE .TN: a 0AI3T0 h 003<01:: COt1PF451TCn 783J13--0CE. :') REA JIFF' P.- (HA icG 1 0STMFRI tvRARA 0 IHE 1:S k SA.3 F? r' ?': ! IS r$'3J' 1; MY iY1�:KE 35 COQ L48A"!:i4 N?.IkFh<Y SANS k hh:: )ry ';- CAESIEP FCLC:'AARFR I MS RTC-0', NiED 4 'IL ;CA%ATE: 'F'FE '190.I': FCH: ONE H..G8R51 DO I APE ' CE0T.FY -PA1 IN WS.. PE1F':AfMA'ICFO- 13151373' PLAT:- TT 0710-ERF1 S 5JE0i "TASTE •S ('0':'F'SF?' OS ,AWL: C CAJECPN A 00) 0057>: TEAT IF : T.::;::I:: NELCRF. sUsTECTTTP).3:F.RCLS'COWEN:WI0)P':?i SI0`.S .Jr SEELON MAT NT'F': LAsC(: :ALL tOS ^9TG CC4.IP_r 'MYTH 0 OSE P '..IDN 7 l -02- --=,PUDA. ,rcc P]'3 LRP WORKER:: SC.THEl:r: 0'9 F A1,9i9E IS UMW ".ORES TG >51 ;'IPAL "ENALT '1 %TT C:41 •8 CP :CCons% F.PI(i i4) I! TJ i001'P N 10'IFIE O03' V: 'TYR 'LSSN'I:R, TA:>4)15 AS (3:73,,:7 C'I1601 C :E 0, 3>r .r..)r., L,.:.tr. AN CONSTRUCTION LENDING AGENCY :..011>12n:-:331.0)LR;::.169.Y::=:,E2J:r TRAY Ih 1P s A GC.^<:R IL r:3, L•,'.0NO A.i'_n'•• CT 'T1^y "ECi,t'S1iCTEE rbT.: iJi. C+1: L053139fdE_ __ __ `' ' T. J ) LCKC0-1S AFESECE , 1 ) , ' ' (SEPT ET -FAH I HATE P7I : -F S A^PLC NOT AND STATE THAT THE %E: DTE G :'.WA ON 3 SCENES- I AifR1, TO CST P..1' is 1- All C h' AND 001.•1, V CCPT% 3mN74C .^.•J S'A 1: LAW: RFy NG 7011-010001ST4V'1>AY AN. (CRUST( A'J703 C>1 -1l ll9.TAC;CS :;P 7'+I300' N'i TO CATER OFO09' ., NT1"t0 FSTPTRTT PSIS S'T 0031" ,APS8:7S s 1) ) am. Ler4Ac$I4 , City of Newport Beach Building Department CIP Permit No: B2004-2357 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Job Address: 1 HOAG DR Bldg:1 Floor: Suite: Inspector Area: 7 Owner. HOAG HOSPITAL - FOULKE, P Address: 1 HOAG DR NEWPORT BEACH, CA 92658 Phone: 949-574-4488 Applicant: TAYLOR & ASSOC-CUNNINGHAM TAYLOR WILLIAM C Address: 2220 UNIVERSITY DR, STE 200 NEWPORT BEACH, CA 92660 Phone: 714/574.1323 Code Edit : 97 Type of Construction: Occupancy Group: Added /New sq.ft. Bldg: Added /New sq. ft. Garage: No of Stories: No of Units : Issued Date: 06/30/2004 V-N U1 N N 1 Legal Description: Contractor: Address: Phone: Lic Expire: Bus Lic: Lic Exp Date: MC CARTHY BUILDING CO 20401 SW BIRCH ST #300 SUITE 300 949-760-5580 Con State Lic: 08/31/2005 BT00021561 03/31/2005 Worker's Compensation Insurance Carrier: ARCH INSURANCE CO Policy No: 51WC13594800 Expire: 04/01/2005 Building Setbacks Rear: Front: Left: Right: Use Zone: Parking Spaces: Description of Work: EAST CANOPY (BLDG #8) (REPL EXPIRED B2002-1820) 1531-2002 Architect: Address: Phone: 411173 State Lic: Engineer: INSPECTOR Address: 2220 UNIVERSITY DR, STE 200 NEWPORT BEACH, CA 92660 Phone: 714/574-1323 State Lic:S-000702 Designer. Address: Phone: Special Conditions: Construction Valuation: $0.00 Building Permit Fee : $0.00 Plan Check Fee: $0.00 Supplemental: $0.00 Investigation Fee: $0.00 Energy Compliance: $0.00 Fair Share: $9.00. Record Mgmt: Excise Tax Park Dedication: SJH Trans: San Dist: CA Seismic Safety: Disabled Access: $0.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 FEES Hazardous Mat: Add Fire Dep HMQ: Other Fee: Planning Department Counter Rev: Zoning Plan Ck: OT Plan Ck Fee: OTAL FEE : $707.80 TOTAL PAYMENT : $0.00 $0.00 $707.30 $0.00 $0.00 $0.00 $0.00 TOTAL DUE : $707.80 Fire Department Fire Inspection Fee: Fire Plan Review PROFESSED BY:' ZONING AFFROA'PJ GRADING APPROVAL : PLAN CHECK BY: APPROVAL TO ISSUE: $0.00 $0.00 to(4/1- PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION APPROVALS FOUNDATION: WATER QUALITY BMP'S ROUGH GRADE DATE BY COMMENTS etdi/$Jv4osa�yseo—/`%�. Is IS /AIL LINE & GRADE CERT/SETBACKS ERECTION PADS & -fa/%}C. FOOTINGSF///j�.TIf//y��L�,,�� `/nn�y�q /_�,//I Griot YT'am� / L SLAB ON GRADE `/' FRAMING: DECK SLAB SUBFLOOR ROOF & BUILDING HT EXT. SHEAR/HOLD DOWNS GENERAL FRAMING OWNER -BUILDER DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT 1 AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON (SEC. 7031.5. BUSINESS AND PROFESSIONS pre: ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT. ALTER, IMPROVE; DEMOLISH. OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE. ALSO REQUIRES THE APPLICANT FOR S4CH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW (CHAr mu 9 (COMMENCING WITH SEC. 7000) OF DIV. 3 OF THE BUSINESS AND PROFESSIONS CODE)) OR THAT HE OR SHE 15 EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION. ANY VIOLATION OF SEC. 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS (55C0): ❑ 1. AS OWNER OF THE PROPERTY, OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION, WILL DO THE WORK, AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE (SEC. 7044, BUSINESS ANS PROFESSIONS CODE' THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY VOICI BUILDS OR IMPROVES THEREON. AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE. IF, HOWEVER, THE BUILDING OR IMPROVEMENT IS SOLO WITHIN ONE YEAR OF COMPLETION. THE OWNER -BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE.L I, AS OWNER OF THE PROPERTY. AM EXCLUSIVELY CONTRACTING WITH UCENSED CONTRACTORS TO CONSTRUCT THE PROJECT (SEC. 7044. BUSINESS AND PROFESSIONS CODE THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF THE PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) UCENSED PURSUANT TO THE CONTRACTORS LICENSE LAW.). ❑ I AM EXEMPT UNDER SEC. B A P.C. FOR THIS REASON DATE OWNER FIREPLACE THROAT INTERIOR & EXTERIOR INSULATION DRYWALL SUSPENDED CEILING LICENSED CONTRACTORS DECLARATION 1 HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LIC.NO. '��` C/// ATE ONTRACTOft r ,L—C/ SHOWER LATH EXTERIOR LATH SCRATCH (PLASTER) (2 DAY) MASONRY PRE -GROUT WORKERS' COMPEN ATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF -INSURE FOR WORKERS' COMPENSATION, AS PROVIDED FOR BY SECTION 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MISC. INSPECTIONS: PERMIT EXTENSION 1ST EXP. LETTER 2ND EXP. LETTER BUILDING FINAL CERTIFICATE OF OCCUPANCY TENANT NAME: TYPE OF BUSINESS USE: Monika1Fonns\BIdgPennit(Back)10103 1 HAVE AND WILL MAINTAIN WORKERS' COMPENSATION INSURANCE. AS REQUIRED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT 15 ISSUED. MY WORKERS' COMPENSATION INSURANCE CARRIER AND POLICY NUMBER ARE: CARRIER POLICY NUMBER DHIS SEC I ION NEED HUI BE I:UMPLEIEU IF IHG PERM I IS 1UH UNb HUNUHW) LA it I n¢1 (9100) OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS COMPENSATION LAWS OF CALIFORNIA, AND AGREE THA I SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF OF THE LABOR COp¢; ISHrya�FORTHWITH COMPLY WITH THOSEL ATE: LJX/1J�/H^2 er PUCAN WARNING: FAILURE TO SECURE WORKERS' COMPENSATION •VERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN OGOITON TO THE COST CI '1011nENSA RON. UAMjGES A5 PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST .ANS..TTCANEYa FEES. CONSTRUCTION LEPDIP'E AG?NCY I HEREBY AFFIRM UNDER PENALTY OF F 31JUh! THAT T'ERE 'S A CONSTRUCTION LENDING . AGENCY FOR THE PERFORMANCE OF THE WOdF FOR WHICH THIS PERMIT 15 ISSUED (SEC.3097. LENDER'S NAME • LENDER'S Anniarss 1 CERTIFY THAT I HAVE ,,€oo TARNS A°PLI'AT"JN MJ STATE THAT THE ABOVE IN. CaMnrION IS CORRECT. 1 AGREE TO CUMO,Y WITH (AU, CO( AGD COUNTY CRDIF'ANCES AND SCATE'PWS REUTNG TO BUILDING C0NS'RUCTO;: A.1D IEREEX AUTIOP?E R:F.TLSENTAD'VES OF THIS COUNTY TO FNTER UPON THE AG-M_NOONEO PROPERTY FOR INSPECTION PURPOSES. Job Address: 1 City of Newport Beach Building Department PO Box 1768 Newport Beach, California 92658-8915 HOAG DR Bldg: 1 Floor: Inspector Area: 7 Code Edit: 2001 Owner HOAG MEMORIAL HOSPITAL Address: 1 HOAG DR NEWPORT BEACH CA 92663 Phone: 949-574-4488 Issued Date: 11/02/2004 Processed By: Suite: Legal Description: Contractor: Address: Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: Permit Counter Telephone (949)644-3288 MC CARTHY BUILDING CO 20401 SW BIRCH ST#300 SUITE 300 949-760-5580 411173 08/31/2005 BT00021561 03/31/2005 ELECTRICAL Permit No: E2004-2184 Inspection Requests/Telephone (949)644-3255 Description of Work: ELECICANOPY B2004-2357 Inspector Notes: New Construction Residential Multi -Family: 0 $0.00 1-2 Family. 0 $0.00 Service 0-600V up to 200A: 0 $0.00 0-600V over 200A: 0 $0.00 Over 600V or 1000A: 0 $0.00 Receptacle/Switch/Outlets Receptacles/Outlets: 0 Fixtures: 23 Sep Circuits: 0 Signs Branch Circuit: Each Add Circuit: Time Clocks: 0 0 0 TOTAL: $57.94 $0.00 $23.95 $0.00 $0.00 $o.00 $0.00 FEES Motors/Transformers (HP/KVA) 0 to 1 HP/KW/KVA: 0 $0.00 1 to 10 HP/KW/KVA: 0 $0.00 10 to 50 HP/KW/KVA: 0 $0.00 50 to 100 HP/KW/KVA: 0 $0.00 Over 100 HP/KW/KVA: 0 $0.00 Piggy Back/Temp Power 0 $0.00 Temp Power Pole' 0 $0.00 PAYMENT: $0.00 BALANCE: Temp Underground: Sub Panel: Record Mgmt Fee: Plan Check Fee: Investigation Fee: Issuance Fee: Supplemental Fee: $57.94 0 0 0 0 $0.00 $0.00 $0.00 $0.00 $5.00 $5.99 $0.00 $23.00 $0.00 ED CONTRACTORS DECLARATION ereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions code, nd my license is in full force and effect. se No 411173 Class: Date: Contractor: MC CARTHY BUILDING CO WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following dedarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the labor code, for the performance of the work for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Section 3700 of the labor code, for the performance of the work for which this permit is issued. My workers' compensation insurance prner and policy number is: Carrier: ARCH INSURANCE CO Policy number:51WC13594800 Expire Date: 04/01/2005 (This section need not be completed if the permit is for one hundred dollars ($100) or Tess. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that i( I should become subject to the workers' compensation provisions ction 3700 czt. lab de, 1 shall forthwith comply with those provisions. Date: / U lo2`IO� Applicant sh Signature : ateing: ilure to secure workers' compensation coverage is unlawful, anEshall Slgnatu an employer to criminal penalties and m Ines up to one hundred thousand dollars (5100, 0), in addition to the cost of compensationpamages as provided for in Section 3706 of the labor code, interest, and atiorney's fees hereby acknowledge that I have read this application; that the mfomulion given is correct; and that I am the owner, or duly authonzed agent of the owner. I rgrel to comply with oty and state laws regulating construction; and in doing the work authorized thereby, no person will be employed in violation of the labor code of the data of California relating to workmen's compensation insurance. Perrnittee Name (Print) Signature of permittee: j� C\jM(Z—.. Address: Date: 11 J 2 log Approvals Grounding Electrode Underground Under Slab/Floor Rough Conduit Walls Rough Wiring Ceilings Rough Sevice Temp Power Utility Cornpany Notified F:nal Inspector/Date PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.