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APPROVALS DATE COMMENTS oWN}:R BI'IIJ}EN DEII:AR^rll)N
<br />I hcrehy {fiirn undcr pcnalry ol pcrjury lnd I m crcnpr lmrn lhc Conr,rros l,rense Las lor rhc f{rhwing m$n (s(7011.5
<br />Busin*s ind Profc*b. Cod.)r Any Cny or Counry *hrh Eqri6 a p&mir ro .oNrud. alrq, improvc. dcmohh or Enln rny
<br />nrudurc. prix io ils Gsuancc. lho rcquncs thc {dkdtrr for such lErnrir ro lilc a siBn d srarcmnt thlr hcor rhc h lien$d pu.uanr.
<br />(o Ih. pmvhionr 6f rh. Contr.ror's Li.cn*d Lr* (Chtrprcr 9. Conmcking wnh Sc.ri.n 700{) ol Division I ollhc Businc$ 0nd ,
<br />Pmnssiotrs Cod.) or rhar hc or sh. is cxcmfl rhcrcrrom.nd rhc bdsit for rhc,llc8cd cxcq)lion. Atry violarion otSccrion 70:l I 5 h, un,
<br />applicanl for ! rermir subjccrsrhc apllicanr lo acivilr€nlltyofnor mrclhon fivc hhdrcd dollaF ($500)
<br />-1.
<br />as owrcr ot rh. poFny. or nry cnDloyccs wilh wia.r rs rhcn $t oml,tnelio.. lill do rhe work en llt srrudE n nor
<br />i'nctrdcd or orTcrcd lor sle I Sc 7{}44. Busin.s snd It fcs\bns Cdc Thr Conrador's Li.cn* tiw d.cs nor ,tdy ro .n owns ol
<br />thc nmJEny Rlx, hoilds or itrqnoEs rm.. anl who dm skh ui* hinrcll or hcGclf or rhmu8h his or her own cmplorcc\.
<br />pa'vidcdrhnr such iq,mvcmnc@mri cn& ororcrcd forsalc.It howcq. rhc truildins or iqmvcmnt issU*iiinorc Fd
<br />of coryldi'n. thc Owncr Buiklcr will haE thc Urtdcn olJrovin8 rhar h. or shc dil nol huiH .r nq,mvc lh. ,.mlsiy 1., rhc prqrs of
<br />-l-
<br />rs owrcr of Ihc pro!.ny. rn cr.tu\nrly conlnd in[ wirh liNnscd conractns t, .on{ruc' rhc prei.r (Scc 7(}:14. Bn\incs
<br />0d Pr.tss$ Codc Thc ConIr.cror's l-i.cnsc Law docs nor +tly h oqn.rofproFnyrhobuildsorirnpmvcslhcrcon.
<br />and qho conrmcrsnnslchrroicrs*irh a Conhdo(, liccnsql puslonr ro rh. Con,rncttr\ Licenrcris)
<br />-l
<br />trnrcxcml lndcr Scction
<br />-l
<br />hlvc ud will roinrrin ! Ccnificarc of Con\cnr ro Sclf ln{rc inr *orker' omprnsrion. u\ [nvided ro. by sdtion :t7tD or th.
<br />tihor codc. Ior rhc &rforroncc ofrhc "ort for which thc fsn h nsucd.
<br />_l hovc ana will mainrain w.rkcG co'npcnurn,n in\urrrcc, as .cquircd l,y Sccr ion -l7m of rh. tjbd Codc. ld Ihc pslonumc of
<br />rhc work lnrwhichlhis pcrn'ir is tslcd Mysorkcll mry,.tr\alion insurumc.!d.r ril p.licy nu'nb.rff.Aur iN\N(-fi F,/ L I;
<br />vAW1L9.1' 100 4 I'lrq
<br />I ccniirrhd in rhc Frfortun.e or rhc ,.rl ror shi.h rii pcrfri! is (\ucd,I shru.or cnUiiyr.yrccnn inrnyrnannc,
<br />R, 0s lo lrro'rc suhh.r b rhc wolknl omncn\dlnnr h*s or Cnlitomi!. lnd aarce rh[l if I sh,uld hconr sutirt h rrt
<br />lorkc6 onD(Norn r [oviriotrt ol Sccr ion ]r0o ol th! btt, Codc, I shll, lonhrith comfly w irh lho€ pmvi\nnN
<br />WARNINC Foilurc l. arlrc Mrrkcs omrcnsalion c.vcn-so n unh*tu|. md shsll subler an .nployr ro cimi.0l pcNllts lnd
<br />.ivil finc\ trr ro orc hlndrcd rhousand dolla^ (!lG).0001, in lddirion ro rh. .osr or.o p.n\srion. dnm8.s !s providcd for thc
<br />S..ri0n 1076olrh.lrlxrCod.. inr$c! rtrd onf,y s ri.ra/rz/t{
<br />OEII/8AIII}N
<br />I hcrcbyam undcr pcnahyof,rrjury lhll I am liccnEn urds pmvisisn otchaprs 9(commncing silh Sccrion70{D) ofDiv(ion l
<br />.f rhc Busift* rnd Ptuf.sio.s Code. Md fry liccn* t in fuu fom and clfccr.
<br />clol all c5)LL I 51tt 1L
<br />D"", L/I r / rf, ...,-",..
<br />APILIIANLIIEIIAAA.IION
<br />I Lrt{)y,]Im rodcr ptnahy ofpcrjury ok or rhc fouo*ins decharn i\:
<br />l)cmlilk,n Pcimils-Aslrsro\ Nolificstion FcdcalR.Eulari,)n\ ('lirlc40. Pd6)
<br />_R.qutcd Lcrrcr oa Nniff,:ian
<br />_l.cniryrhor,hr hdcrDl .sulrrh'r! rg&J'n! r!h.nu.,., \sls'. nrrq'nlrrhl. !n rhi\ pmr!
<br />adl (niryrhr IhNc rcrd rhtatpli. '.ndrlssrcrhrrrh.rbovcinnrnDlirniscorccl I a8N lo compl, wilh all ciry !
<br />.rdhokc! lnd Srtrrc trsc EhtrnS ro hu rldmB .onqrud nn. atn h.rcby.urh.nr rcprcsdorN.r ofthF
<br />atsvc mnhonct rr,Fn, f.r in.F<Dl!!,@x ./
<br />tcptr*r o, r,,e*rsrt*un 42'1L-4- - D.
<br />P.nt e*tuon"q, 7A t64€ *<.eP ct o
<br />l'x
<br />Underground zlalt4,.Outr1/
<br />Pole Bases
<br />Lioht Standards
<br />Spas, Pool, Fountains
<br />Siqns (monument)
<br />Life Safety /Low Voltaqe
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER fl ,9 7lz 4l(.(/t lfr/ $/t,/tc 3d(*
<br />Transformers \:/
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Rool Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soflit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Meter Releaseb\ gL rb rLAsrtfl-{4 t.b1rb €#4
<br />Rouqh ,/0/c.,?IJL6\
<br />Service lVleter
<br />FINAL '6/27/p,r\6r
<br />Notes, Remarks, Etc
<br />ELECTRiCAL-INSPECToR REcoRD
<br />tD/stG.
<br />B &PC lorihirrc,\on
<br />.ttaar!85t(autlNsarsN
<br />DES2TAAIIQN
<br />I turcby rr'ltn undd p.nrlrt oipcdury oit orrhc n,lL'trinB dccla,alion\:
<br />COUSAIJCIION.LENDINCICDN:I
<br />I hcrcby rffrm und.r Fnahy of Friury thd ihd. k s onnrudirn bndi.E lBcmy for $. pc.formm. of lh. sork aor which lhi{ Fmir i*
<br />isslcd (S.c. 109?. Civ. C ).
<br />Lcndcis Nlmc
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<br />Site-Work
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