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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DF,L(]ARATION <br />I hqeb, amm undd Fshy o l pajury lhal I m .\cmpt fre6 lh. Conirtctou l,iccnE lrw fo. thc folhwing l@n -(S( 70l l 5 <br />B6in6s and PrcfNion Codc): Any C'ly or Cou.ly *hkh r.qun6 0 Fnil lo coslrucr, alld, inProve dqDolah or qan ey <br />slruduc pmrto ils i$u&., ako r.qric rh.4plic6l for such D.mil to 6lc a sisn.d siatdnol rhalh.orsh.ali.6kd pcu& <br />1o th. prcvisioB oa tnc Conrr.ro.s Lic.ns.d La* (ChaFd 9. Comn.ncrns wirh s(rion 7(ro of Division I oalh. BNincs'md <br />Procsn,ns Codc) or thd hc or shc i! .xcmpl lhdcnom sd lh€ bdc aor th. .ll.B.d cxmplion. Any lol.rion ot Scclion 701 I 5 ht oi <br />appli.r aor r p€flnil subjdlslh. ap?licdl to a.ivil pc.ahy olnor mot.th& fivc hu.drcd dollrs ($5Nr) <br />L s ow.6 ofih. !o!.n). or my oploy6 wirh s'asd s rh.t $1. ompdsslion. tr ill do rh. *od( .nd llE strlElu. n nul <br />inr6d.d or oFd.d for salc (Sc 7044, Busins md Profsio6 Cod.: ftc co.lr.cloir Licd. Lav do6 ft a9ply lo & o*nd of <br />rh. propdy *ho tiilds or iDpmr6lhq@n. ad ulF do6 such $* hims.lf or hmclfot thourh hB or hd o*n dwloy.6. <br />provil€d rhal such i,nFovmrs rc mt i a.H n ofis.d lor eL lt ho*ad, rh. buildiry or inpov.,El k $ld *irhin on. y@ <br />ofon'pldion. rlE Osr6 Buil&i wu hrv. thc &fd6 olFovins thal h€ or sh. did mr hiild or nnp.ov. lhc Foriqty ror tl€ purpoe oa <br />l. 6 oNnq oflh€ p.opsly. d cxclusi*ly oo.radi4 wirh li.ms.d conr,actoB io .oturtud rh. projcd (S( 7044. aB'nN <br />aid PNEsnn Cod. Th. Conlr.ctoa s Liccnse Latr do6 nol apply lo m ow.6 o f pro!.rly *ho blilds or inprove thsan. <br />and lho cont,acrs for su.h lr.j<ls wnh a conrmdo(, liccB.d p!6@l ro rh. ( onlr.clois Licdc La*). <br />-l <br />e.rmpr @da Sdlion-, B. & P.C. hi rhis lten <br />Driq Onrd: <br />roa6EEs:!a!u!!l Io!ll[cLa8aug! <br />I hseby allirm un&r Bnah, olFlury onc ollhc lollosms dcldalioB: <br />-l <br />h6v. and will @i.rain r ( cnificolc of Congt lo Sdf-l6w for mrlss' onrpcnsrnrn, s providcd aor by setion 1700 of lhc <br />l-abor Codc. lor th. patomdc. of (hc md for *,iich lhc pqmit is i$ual <br />-l <br />hav. sd will maimai wor*.r! compds!1rcn iBuancc. 6 r.r!n d b, S<l ion 1700 of rh. bb.r CDd.. tor thc pgtomecc oa <br />My wortda contE$rion iBuMc. .Mis sd riol,cy nudbd dc: <br />drtc <br />f(]/{llqII <br />I c.nirythoi in thc psloruncc of rhe wo.! lot$hi.hrhisFrnrn is issucd,I sh.llnor dlploy y <br />$ { lo beon. subjdt ro (h. qo,k6 comFNlio. la$ of Calilom'a dd .gc <br />'har <br />if I slFuld h.comc aubier ro dt. <br />Norl6 conpos(ion prcvisioBofScclion 1?00 otlh.lrnr Cod..I31Ell. fodhwnh comply silhlnos,trovilioN <br />IVARIINC ljailurc to Ku€ *ork6 corpo6arion covra!. is unlawtul. ud shrll subjdt e <br />hundred rhoMd doll6 ($100,000 <br />,rppriJn <br />I hftby amln u.dd poahy otpdjury thal I u lic.trs.d unds pmvBion ofCht$6 9 (comociry *ilh 5(| <br />of rh€ Ausin6s od Proreions Cod.. d ny licft. ir in tull for.. ad cfiar <br />ct\1eo\\\,) <br />coxsrBucuatrrEdDldcScllicl <br />I hs.by rIfiro unda pcnrlr, of pslury lhal rh6€ is a colrrudFn Ltdins a8ft, for thc psfollrrec of rh. work for ehich tht pcrn i <br />isu.d (56.1097, Civ. C ) <br />ATIUCANLDIiCI.AIAIIA! <br />I hod, affm uodd palhy olFrjury on. olth. fouowiq d(lmrion' <br />D.molirion Pmirs-AsbcsrG Notincatio. F.d6!l Rcgula ioa (Tnb 40. Pan6 ) <br />-R.'tuircd <br />l-.1t6 or Nld6caion <br />I cdiay rhar rh. Lddal r.Bulatio6 r.asdrna 6b<tos rooval r. nor +plicabl. to lh's pnj.(. <br />-l <br />cdlirylhal I have !@d th$ <br />ordinancB md Sktc La$ rcldins k) <br />6hvc Fdrn'n.d proFn, aor i6F.l <br />rcpr6dlativd o I rhis Cn '*1I1 <br />Appli(rnl or Ag€nl SIgn.lur. <br />Pemile mnE (prinll: .'14 <br />t *]1( <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor <br />Bonding / Groundinq / UFER <br />Transformers <br />Torqueing <br />Sub-Panels <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilinqs (Hard & Soffit Rouqh <br />Ceilings (T-Bar Rough) <br />Rouqh <br />Service Meter I <br />FINAL z/t//q .-.&-LA <br />Notes, Remarks, Etc <br />ELECTRICAL.INSPECTOR RECORD <br />Communications Cable <br />Air Conditioners <br />Meter Release <br />vr.r(J-L <br />l..n,id r A,itl,s <br />- <br />I <br />I