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APPROVALS DATE COMMENTS OM.tsBuildr D..lmlio I h.rcby afnm unda po.lry of pdjury lnar I o .xmp lm in. C6!h.toB Lic6!. ljw fo! rhc followin3 r.Gon Ga.?03 I 5 Bsin* and Prof$ioi Cod.) Any City or County which (quirq a p.mn to construcl, alt.r, impovc, dnolish or !.p!ir dy llrucl@, pnor !o irs irsudc., lho r.quir6 lh. applicant for such p.mn b fit ! si8n.d slarcnâ‚¬nr ihar hc o. lhc ir licctucd pududt lo tn. Fovisions of tc Contradors Liens.d Llw (Chip|c 9, Comndcjne wi$ Sccion 7000 oa Divirion I oa rh. Busind Md tor6iois Codc) or rr,at hc d shc t .rnpr rhd.frcm 4d ttu b$i, fd fi. .ll.s.d cxmplio .Any viol.tim of Scclion ?03 I 5 by dy appli@t for 3 p.mn &bj.d! th. spplicdr to acivil p.i.lt, of.ot 6oE h& fivc hurdr.d dolla (1500) _I, 6 ownd of rh. FoF.ty, d my cnployd virh *aB6 6 thct sol. compc$ation. wiu do rh. *o.k Md thc imct(c i5 not inr.nd.d or ofiftd fo s.l. ( SE 7041. BusinBs Md Prcf6sios Cod.r Thc Coolador's Li.d.c L.* rLâ‚¬ n6r .prl, lo e o*no of lhc proFrty qho builds or improvs lhccon, d vho doB !ucl' wort hiruclf or hddl d rhrouSh bis o. hd oM cmploy.c!. provid.d rh rlch imprcv.ocnll de not inrod.d or of.r.d ad r.1.. If, how.v!r. d. buildin8 or inprovmcnt t sold wilhin on. yd of complclo, $c Omr-Builda*il, hrr. rnc burdo ofproring thar h. or 3h. norblild or impmvc ftr ln. purps. of sal.) _1,6 ow..r ofrh. prcp.lty, m qclusiv.ly conrrscrin8 with liccnsâ‚¬d conlr&toB ro consltuct rhc poj.cl ( Se. 70,4a, Bsin6! ed Prof6sion Cod.r Thc ConEaciol s L'ens. Law d6 not apply lo e o*ncr of Plop6ty *to builconrrac$ tor cuch prcj.c.r pio a c@rr&ro(, li@.d pu6@r io rhq cohhdori Lic. . LlB ) _l h .x.mpl und.r Sdtim loaKEEtlout[lsallox_uEcL6lAuad I h.r.by,ffim undcr p.nalty ofFrjury on. ofthc iollowin8 dcla.lio.s: _l havr ud vill naintrin a C.nifi@tc of Conlmt to S.lHnsurc for wo*6' compo$adon, s pEvid.d for by S.c on l?O0 of lh. Labor Cod., for th. pcrf@{c. of th. wdk fq which ln. pcmil is i$rcd _l hav. dd wiu mainllin ro16' conpchr{ion insurde. 6 rcquiEn by S.ction r70O of th. bbor Cod.. am th. pcrfom ccoith. *o'k for which rhis pmir is i$u.d My work6' conFntarioo insuEnc. ffia edpolicy numb.r uc Policy Numb..:-Erpl6 (Thiss.ctionn..dnorb.complc!.dillhcp.mtisiorOn.hundr.ddollmltlO0lorls, r{^,, u7.*" *i,t thrt in rh. p6fomsc. olrn. wod< fe vhich rhis imtr .cr ro lh. *ort.6 compcoeation las ofc.liaomir, d compdsa.ion prcvisio.s ofScclion 3700 oflh. Lalor Cod.,l shall, fonhvi J-o WARNNC Failurcro s.c ur. worlcE ' conp.n$tion cov.raSc ubj.d d cnployo to 6imii.lpcmltics ed eivil finB up to onc hund.cd lhoBdd dolls (ll00,O0O),in rh. L.bor Cod.. inr.ct dd dom.yk fc ddae6 6 prorid.d lo. $c Scction 10?6 of LICENSED CONTRACTORS DECLARATION I h6cby amm und.r p.nalry of pdjury th{ I m liccnr.d undd provision ofChapl.r 9 (@mm.nc wnh Sction 7000) of Divirioo 3 of d. Blrin6i &d Prcfdi@ Codc. ud ny licns. is in full foB ud !f[d. Li@ns.Clas Li@m. Nuhb.t I h@by afim uod6p.i.lry olp..jura th lhft h a coi5lructid i$u.d (S.. 309r, Civ. C) ofthc wrk t* which ftis rEmil is AIIUCAIrIDECIdBAIIAN D.holnion Pcftils-Arb616 Noificarior F.ddl R.8ul.1ior (fid. 40, PEI 6) _ R.quircd Lcn6 ofNotifiotid I c.nily dal th. a.dq.l rcsul .2,*,n^rn*.-^,n* 7-od'n-c6ud shk L$r Eldi aions r.srdins 6b6rs rcmoval dc tror application and rbr. th.t 'h. rocohply wnn all Crry md Counry ab.v. mcnrioncd prcp.ny for inip.clion purpss of rhb City sd Courty to .ira upon th. Underground Pole Bases Light Standards Spas, Pool, Fountains Signs (monument) Life Safety /Low Voltage Fire Alarm / Dampers Communications Cable Building Under Slab / Floor Bonding / Grounding / UFER Transformers Torquing Sub-Panels Air Conditioners Roof Top Equipment Factory Wired Unit Walls (Conduit) Walls (Rough) Ceilings (Hard & Soffit Rough Ceilings (T-Bar Rough) Meter Release FYPI E,trr\ Rough FEB =I 20ls Service Meter FINAL r,u, 9co, 66i Notes, Remarks, Etc. ELECTRICAL.INSPECTOR RECORD tD/srG. Site-Work ------T----t