|
APPROVALS ID/SIG., Own.PBuild.r Delration
<br />I h.r.byamrmunder penally olpdjury $at I ah exempl lom th. Co.ti.ctoB Lic.nseLrw lor rhe tollowiiS rcroi (*c 701I 5 Busin6s
<br />and Prolasioi Cod.) Any Cily or County wbich .equir* . pemir lo @nsta(q dl.r, improv., d.molish or repair dy srtuclue, pnor lo its
<br />is$.nc., rho r.qunes rh. aFplignr ior such p€rnir ro file, sisned srat.n€n rh.r h.orshe islic.tued puEUMrlolh.prcvisionsofth.
<br />Conricbr', Lic€nsd Law ((lhapte,e, Comm.ncingwnh Secrion ToooofDivision 3 of e Busine$ Md kore$ions Corlc) or lhd h. o.
<br />she is ex.mp! rhsefrom and !h. bask aor ih. allcg.d d.mpxon Any violario. olSedion 70rl 5 bv ey applicanr for! p.mir suhj.crs lhe
<br />applicrnr ro, civilpen,hy olnot mor.ths file hundrcd dolliB($too)
<br />I. as ownerofrhe propedy, ormyemploy*s wnh was.s rs thet sol..ohDens,tion. willdolh.work and th. srrucrur. is not im€.d.d
<br />or ollred for sale ( sec 7044, tsusinessmd Proaesro.s cod. The conrrcroisLicenseLa* do.s nor +ply h d or.er offielroper)
<br />uhobu,lds or improv.s the..o., rnd who does such u6rk hims.lforher.llorthrouEhhis or h.r own.mplovcer lroeid.d $ar ruch
<br />improvemcnts ar. nol int.nd.d or ofcr.d for sale Il howcvd,lh. building o nrpro!€me issot wnhinon.yeiroac.nplction,lh.
<br />OwidBuilderw,llhaveri.burd.nolprovinstha(neorsh€not6uilddrimFov.forrh.luryoscofsal.)
<br />I,sowe.ottheprop.rty,amqclosiv.lr.ontr.dngwithliccnsedcontractorsroconsrrucrth.proj{((s..70,l,1,Busin.*and
<br />PloresionCo'le'lh€ContaclofsLic.neLawdocsnotapplylos.ownerofpropdyphobuildso!improvesrh€..o.,andwho
<br />e.ric$ror n,ch projecrs uirh . Cont.rcto(, liceisJ pdsuantlo rhcConrracrort l-ic.ns.l-au )
<br />I rn, cxeni!r undcr Scdion ,R &PC forrhi\res.D
<br />WORl<ERS COMPENSATiON DECI,AR TION
<br />I he,eby,fiirn und.r penilry orp.rjury on. orrn. lollowins dcct,arions
<br />._rh.r.lndwillmintr.rccdin.ikolCotrs.nlloS.lf-lnslrelorwort€6conpensdion,bsprovidedrorbySerionrTo0ofrhe
<br />l,.bor con., lor rhc pcrfomlnc. oflh. qort aor shich rh. p.mn is ilsu.d
<br />I havernd will mainrain workerd comp.ns,tDn inrwance, as requned by Secr ion :1700 ol the Lrbo r codc, lor the pedomaDce oalhc
<br />worh aor which tht pdnn is i$u.d Mysorlte( compensation insu,anccca cra.d poli.y number ire
<br />(Tht s.clion need mr be compl.t.d irrne p.rmil h lor On. hundred doll.is l$r00| or l.s)
<br />I ceniry rhll in the p.rformonc.ofth.worllorwhich thi! pcmit n iisu.d,l all nor employany !.6on in.nyn,nner o arro
<br />b.ctne subjdl lo the workqs @m!.nstioh li*oacalirornu, and &sEc th.t ial should becon lubjct b rh. *orkdr
<br />compcnsarion provisions olsecrion :r700 olthc
<br />"^,. /-/: ?ttzz
<br />WARNING F ilur. ro *cur. wo .s comp.ns.rion covdaS. isunlrwrul, and shallsubj6l an employer to oimimlpenalri.s aidcilil
<br />lines up to o.e hundr.d rhoussnd dolhB ($1o0,000),in addirion rorh. cosl orco!+.nsalio!. damas.s is provided aor the s€crion 1076 of
<br />lhe l,bor Cod€, intcre$ rnd.Iorn.y s Les
<br />LICENSED CONTRACIORS Df, CT,ARATION
<br />I hcrcbyamrnr unds!.naltyoap.r.lurythar I amlic.osd und.r provision ofchaprer s (@nhencins lnh S*rio.7000) ofDivkion I oa
<br />!h.Ituslnessa.d Prol*sion3Oodc, and my License is in aull lorce md drecr
<br />/- /- ze
<br />CONSTRUCTION LENDING AGENCY
<br />I h.r.by amrm u.der p.hrlly ol perrury that th.r. is a onsrtuction l.nding ,geDcy fo, th. performsnc. ol rhc wolk lor whi.h rhi! p.rhir is
<br />tsu.d (Sec ro9?, ci! c)
<br />ATTLICANT'S Df, CLARATTON
<br />De66lirioo P.,nitlAsbestos Noriiic ion F.ds.l ReguhrioN (Till. 40, Pan 6)
<br />Rcqut d L.trer olNoLincalion
<br />I ccnily rhlL rhc fedcr.lrc3ularions reardina asbesror r.moval a.. nol applicable rorhisptujecr
<br />I cedily rhar I have rcad this applicalion MJ srare rhd rhr above inlormalion i! corcct I asre.to@mply snh ill CiryandCounty
<br />ordin,nces and sr.re Laws relrtins ro buildins constnrcrion. .nd hereby rurhorize rcpreFnrarives olrhis Ciry and Counry ro enter upun rhe
<br />Abovc nr.nrioDed tropeny lor i
<br />Permnre iahc (print)
<br />/:/:j4A
<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 / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<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 />lvleter Release
<br />Rough 4/34y'-'.i?ib.a &-/
<br />Service Meter ^\FINAL 4/e4/tc--4e/24 d) @)
<br />Notes, Remarks, Etc
<br />M\WPs1\Pormir lnspeclion Forms\Elecriel lnspeton Recdd d@ 03 31 06
<br />ELECTRICAL.INSPECTOR RECORD
<br />DATE COMMENTS
<br />Site-Work
<br />Communications Cable
|