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APPROVALS DATE ID/SIG.COMMENTS OWNER I]UILDEX DI'LCAIIAI'ION
<br />I hcrchy rrfifln und.r pctrrl(y oi ncrjury thil I am cxcmB riom th. cbntrclom l,iccnsc L,a* lor rhc followins rca$n ISc.70ll5
<br />Itusircs o Profcsiotr Codc) Any Cir, or Counly shich rcqutcs ! Frnir h con{dcr. nlrcr inl9ii,vc. dcmrth or Nrrt rny
<br />lrfl.rurc. priq ro irs nsu(cc. aho r.guncs rh. rtplicdt for \uch pcrnn b fih r siSncd nalcmnr thal ltor shc h li.cnsd pu^uanl
<br />I0 rhc ,,rolisions olthc ContEcl{tr s Lienscd L.* (Chlplcr 9. Com.rncing wirh Scdion 7fix) ol oivkion I of lhc Busincss lnd
<br />Pn,,c$n,ns Codr) or rtur hcorlh. i\crcnpr rhocrromaid rh. h(sh lor rhcnlk8cdcrcnflt'n AnyviolalionofS.cli.iT0-1l5byotr,
<br />rpfli.trnr tur r r.i,trir sub)cclsrhc rpplica ro acivilpco,lrroi.ot morclhan livc hundrcd dolhrs {$50o)
<br />_1. rs o* lcr ol thc rrrorEny. rn ny dnth)ftr *irh {asrs 's rhct vrc .onr!.n\diotr. sill do thc work ud rhc sltrr!rc i\ Rn
<br />inr.ndcJ or offcrd f{, ul. (SN.704,{. Busi,rc$ and Ptufcssion( Codcr Thc Conra.kn s Licen\c Lrw d.cs nor {ntly io an oqrcr ol
<br />rhc pDrsry who builds or inDmvcs rhcrsn. and el.o d,trs \uch w* htnsclfor hc^clror rhoueh,ris.r hcr owtr cn{loyccs.
<br />nn)vdcdiharsuch imro\$ nh .rst inr.Mcd oroi|rcd for uld Il h(,Rcvcr. rh. buiklinBor impmlctrr.r t eld wilhin.nc llr
<br />ol dnrplcri,n, rh. Oancr Buildd will havc rhc hnrdcn of pmvinA rhql hc or shc did mr hild or improvc rhe pturdy fir rlr puno* df
<br />l. $ ownd orrh. !n,pd,, ancxclusivcly conhclirS with li.ctr$d contrldosr. c.6rd.r rtr por.r (Sec.70'1,1. Sunnc$
<br />und Pnlt$ion Codcr Thc Conhcrois l-iccnsc Lrs docs nor lrply lo !no*n.r orproItny who builds or nnFovcs thcrcon.
<br />nnd who snrrh ror such pmrcts wiih a Gnrrcdo(s) lf,ctrscd lunuM o rhc Conrrchls Li.cnsc liv).
<br />I rmcrcnr,, und.r S..ri
<br />lYoatrEBEglilSENsAIQN
<br />DLCIIISAIIO!
<br />I h.'chynflir rndcr FnalryofI,crjrryonc ofrhc fdb*nr8 &.lerrnrx:
<br />lhuv.nlwilliuinrtrindCcnifi. cofCos.nrhS.lfln\nr.f{trN.*d{.ompcnrdiotr.asrrovid€dlbrf,ySecrion-l7U)ofrhc
<br />l,atx, Gde, f( rhr p.rtumft{olrh. work for*hichihd pcrnir is ksu.d
<br />I h,vc and willmrn ,in wortcrs' comp.nsntion insur(ncc. rs rcquncd hy Sccrion]700 ofrhc Lrhtr C.dr. ror
<br />'hc
<br />ptrroamn.c of
<br />lh. work rd*hi.hrhi\ Fcmir is nsmd Myworkcr m,nFnslhn insurnrccstricr md plicynumbcrd.:
<br />Icc ily rhar ir rhcF f.nnarccofrhc work tu which rht pcirnil n hrucd.l shnllnor c,npl{,, rny pc^on i.a.y trr!.trcr
<br />\o Nro hcqxE sub]ed ro rh. sor\c c.mpctr\arion ln*s otCrlifomir. r d aarc rhai ill should hc.o.r suhrcl lonE
<br />w.rlcr'conf.nsarionlmvhionsotSccrior:lT0Oofrtcl-ntnrCod..lshdl.fonhs h..mrlysirhrh.{liovnion\
<br />WARNINC: liilurc lo scurc $orkc^ <,npcns kI covcrlsc i{ unh*tul. strd shall subrc.r tn ciryloFr lo nirlrinal p€mlrics lnd
<br />civil rine\ !p ro om hundrcd thousand dollars (Sloo.fixr). in addirion ro rhc co$ or conlcnsotnrnrdllNscs rs lrovid.d itr rhc
<br />6.
<br />6 $l rhc Lihor Codc, inrcrc( ndflrrorcy s tccs
<br />- /) -r / r,ept;-,r,
<br />DECI.AMIIA!
<br />I h.rcby !r,rm undo p.n.lry or pcijury rhd I em lienr.d undcr Fsrhfn of Chafl.r 9 (comdtuins eilh Secrion 7000) or Divisio. J
<br />of rhc B8itu$ aid Pmtc$annr C.d., 8nd n, li..{ n in tull ford ntd cficl.
<br />wa 6,-lL- I
<br />-l.cniryrharrhcrcdcnlr.sulurnrnsrcsddinra\bcsr,c'mval!rnor+pli.,blct'thisptuj.rr
<br />I ccniry rhar I hav. Ead rhis,ppliotion *d s.tc (har fic firw inforrdion ircoret.l a8re lo coryly sith aI Cny,od G,unry
<br />ordind.ccs srd Srdrct ws eliring ro building .onslru.rion. ,id h.9!\ddhorix rcEcqnraliv$ olrht Cilyand Coutrly ro cnrc. upon dc
<br />-\i.i,i*TrIffiliW::" &-t- *,. t ., z-, ?
<br />*^,r* * ,qa,,s, ' /t {1&z 6V LLALIA:,+4*
<br />Site-Work
<br />Underqround
<br />I
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Founlains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Groundino / UFER
<br />Transformers
<br />To rquerng
<br />Sub-Panels
<br />Roof Top Equipment
<br />Facto ry Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rough)
<br />lt/eter Release
<br />Rough
<br />FINAL 7-// - tz J)ctvt Gal
<br />Notes, Remarks, Etc
<br />ELECTRICAL-INSPECTOR RECORD
<br />Communications Cable
<br />Air Conditioners
<br />Service Meter ..,,-",.")dl/l-L
<br />CaISIBIJqIIONIEIIIIIC.AAEICI
<br />I hcrcby omnnudcr rE.$lryofpcrjury lhar lh* is ! qrnsltuclion kndiq,sct, for ihe p.rfo.mft. ofthc sork ri,r qtich liis pcmir h
<br />hsu.d {sa. 3{D7, civ. c.)
<br />tr ndc, \ Nrn.
<br />AITIICANfDECI.AMIIO!
<br />I h,y strm undcr pcn.llyof pcrjuryonc ollhe lollowins dcclaErions:
<br />Dcmlirion Pfimir! Arb. os Noliikalon F.d.ral Rc8ulario (Tirlc.10. Pd6)
<br />Rcrluir.d l.tr.r o, No$fi.dion
<br />I
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