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APPROVALS DATE ID/SIG.COMMENTS OMd-Buildd Dcclaado. <br />I hftby i6im uhd.r Fnrity ofFju.y lhal I M.x.hpt fom tt. ConE&loR' Lic.$. L!* for lh. followins Bn (5e.70r1.5 B6in6 <br />ud PrcfGiotr codc), Aiy City n County wti.I Equt6 . p.dn to coislrlct, altd, inprcvc, dmolish d rcpair ay sElcrur.. Fi ro iE <br />isu&c.. ako rcqune rh. agpli@r for suclr pcmn to filc. signcd st tmdr rhal h. or shc is lica$d pua@r lo$c Fovtids ol$. <br />Cortraclofs Lta.d Lrw (Clt.pta 9, CmD.o.inE wnh S.ction 7000 of Divirio. 3 of lh. BNi.6i ed Profasioos Cod.) or rhd h. d <br />rh. is .xopr th@from od ln. bais ld rh. s,l.gd dx.mplion Any violarion of Scclion 703 I 5 by &y agplicul lor a p.mir subj.cr! lhc <br />.pplisntro rcivil Fnalty of not moE th fivc hur.lr.d doll6 (t500). <br />1,6 owoc! of lhc pr@4ry, dhy cmploy.cs wilh wag6 d lhcir solc conp.nsaion, *ill do 6c worl and rhc sl,lctuc h nor imddcd <br />or oifacd for sal. ( Scc.?044, Busines ed Prcisiohs Codc Th. Conr&ror's Lic.ns. L.w do6 not apply to a own.r of ltc prcpcn} <br />ql'o builds o. imprcvE tho.on. dwho do6 srch *orl hitu.lf orh6clf or $roush hi5 or hcr own cmploycd. providcd th.l luch <br />implovcmols e nol in!.ndcd ot otrcd for ralc ll iowcvci th. buildins or improv.mcnl ii rold within oncyceofcomplcnd, thc <br />OvncrBuil'lcrwillhav.thcburd4ofprovinstlslhcorshcnolbuildorimprovcfordcpurrccofsal.). <br />_I. a own.rofu. prop.fiy, o cr.l6iv.ly cotr!-&ing *irh licctu.d conEacl* to con3lIucr rhc projer ( Sc.7044, BEi.6! dd <br />Profssion Cod.: Th. Co.!'&ror'r Lica. kv d€ not eply ro & oMaof propcry vho builds d inproyB fiatr , sd who <br />conr&$ for such projcll wnh r conl'{ro(, lhdr.n puEmr ro rhc Coituror's Liss. Lrw ) <br />_l d .xcmpl urdcr S.clion _,8 & P.C. fdl]lisr.Gon <br />]IOBKEBIIOIIEETSAIDITPECLAIAI@! <br />I h.reb, affim undcr p.nalry ofpolury on. olrhc lollowins dcclsarionsl <br />I h.v. Md vill mainuin ! Ccnifi@tc of Consmt to S.lf-lnsurc for wo*m' @mF.sarion. s prcvid.d for by S.c on 1700otlh. <br />Llbor Cod., for th. Frf@sc of thr wod. for whth lh! Fmn is i$ucd <br />_l hrvc dd vill mainhin pdk B onp.nstion iButu*, 6 @qun.d by S4tiof, l?00 oathc t bor Cod.. for thc Frfmu.. of$. <br />wolk fm whicn fik pdmn is issu.d. My wort6 @mp.6 io. ii!!m@ 6ic. dd policy nunbq dc <br />(Tha scction nccd not bc compl.t.d ifrh. pmn is ior On.hpdr.d doll4 lll00) or 16, <br />, , rn^*w6t,,6i"". <br />. Labor Cod.. I shall. loihwnn <br />doUs (ll 00.000).in rddiuon .bh.86 6 provid.d for $c S.clion 1076 of <br />I hcrcby affim und.r paalty ofp.rJury M lic4.d uida proehion oachaplo 9 <br />ofp.rjury thll lh@ is a conrEuctid l.ndjns Frf@rnc of <br />'h. <br />wdl lq which lhis pcmn i! <br />, Civ <br />APPL!CANT'S Df, CI-AITATION <br />Dcmohioi Pcmiis'Asb.sts Nolific.lioi F.ddl R.suhtior (Tnl. 40, pdt 6) <br />_ R.quircd L.l&r olNoriteli <br />4l'.,th. f.d.ral Egulalions r.gdding ab6t6 <br />I hav. rcod thn lrpli@ion dd rd.I asre ro comply wnh.ll ci9 u,l <br />odinmcq Md Strl. Lrws el.ting lo blildin! <br />!bov. m..rion.d pmFrty fd inrp.cti@ <br />Site-Work <br />Underground <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (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 />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release ENFIT rEo <br />Rough l-'.H - |IUtS <br />Service lvleter IAMC A.43 ?a <br />FINAL <br />Notes, Remarks, Etc. <br />ELECTRICAL-INSPECTOR RECORD <br />Pole Bases <br />Sub-Panels <br />L.nds! Addr6 <br />I