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DATE tD/stG.COMMENTS OWNEN BUILDER DELCARA1ION <br />I hd.by amm und6 pcDalry ol prjury lhal I m .xempl fion the Co raclou l.iceM lrw for rh. lollos ins @on (5*.701 1.5 <br />B*ii6s and Prof6ion Cod.) Any Cir, or Coudy Nhich rcquts 6 p6f,n ro .o6rtuct, alld, improvc d.solirfi or r.p!n .iy <br />slruclur., prior lo ns isudc.. also r.qon6 $c applicd lor such Fmi to nh 0 si8n.d slalandt lhat n or sh. is lico$d pusuml <br />k, rh. FovisioB oflic Co.ra.tois Li.tucd tiw (Chapr6 9. Comc.cins *ilh S6tio. 7000 of Divilion I oaln. Buins ed <br />PoasioB Cod.) o, lhal h. or !h. ie .r.npt th6.6om d th. b6sir tor rh. all+ed .r6ption A.y violation oasElio. 701 L5 by My <br />applicanlfo!apennitsubjstslhc.pplic.n!loscivilp.naltrofnolmor.lhMfi!€hundr€ddolles(5500). <br />{.arosnr,.rrrrcpopcny.ormt.mplot6$irh$.sGsrF.tr$l.composr.n.r'udorh.\oRodrr€nMesnolfirod.d or {frs.d ror el. lsq 7o,lr. Bu5'n6! d Pro[6tioN Codq Ttu Contradocs Licd* rrw <106 .ot @ply ro o o\rd of <br />thc propgly rvho boilds or impmv6lhs@q and who do6 scfi srrl hi6s.lr or hmlf or rh,ough hG ot hd ost .nployc6. <br />provid.dthal srch improvddis m not intdd.d or oild.d aor el.. lt ho\vdd. lhc hiildifls or inpr!!ffi| is soB wnliin onc )€r <br />olconDldion, $. Ornd Buikb villharc $. hr,ot ofprovjq tha h. or shc did ful build or itpturc t pnpcry for rh. plrpr$ of <br />l. a oann of rh. propdy. dn .xclosiv.ly contBclinr \rith licms.d n,nt dou kr co.situcl thc projd (Sfr 70-14. BEinBs <br />ed ltll6sDn Codc,1h. aonrra.rois Li..ns. Law do* nor rfiily ro an ownd o f trop.ny $'ho builds or nnpro\6lh€rsn. <br />.nd who contracrslorsuchprojc-ls$irhaG.adon,[cos.dprEunrroihcConrradoisl,ic*.Ln*). <br />I m.rmpl !nd6 Sdion <br />,.'",r/za/A- - -x <br />I herby ailii,n lnder F.ahy oa rdjrry onc oatbe folloNi+ ddl&alioB <br />I ha!. and will nuinrain a C.nincale of Cocmr ro Selartuur. lor $0r[6 corFMrion. a Folid.d for by Sclion 3 700 ollhc <br />Lib.r Codq lor the r,6lom cc or lh. vork for which the pmil n isu.J <br />l ha\ e ...l will nrainiain $ork6 co'npens.tion iNu.r,c.. s rcqlted by sclion l?00 or rh€ lih, Cod., aor rhc tEloma.. of <br />lhe work Iu sh'ch lhis p.frir it i.sucd My \ orkd! compaslion insurdce cmE md poli., nunbd e€ <br />I cdlia, dal in rhe pedonmnce ol thc rorl lo! which Ihis panit is Gsu.d.I sfiall nor o.ploy any p.mn in uyndM <br />e d ro b6omc subjd ro rh. *0116 @mpdsnion laws orcrlironia. dd rtft rhd ia l shotrld b..om. sublc.l lo lh. <br />eorLds.omt6eri.nproli.ioBolsdioolT00ofrhckb.rConqlshalllodnsnhcomplrwilhthospmvisioN <br />DECIABAII(D <br />I hEby afirn rndd pa.lty o t pdjury lhal I o licr$.d und6 Fovision of Chapld 9 (ommocins silh S.(ion 7000) of Divirion l <br />of rh. Busina md PmfsioN Cod., ed ny licok L in aull aorc. ed.lTd. <br />CA!flAUEIIAIIEIDIIC.ACENCf <br />t hseby amm u.dr rEElty of Fjury lhal lhqc G a constoclioo lddins asdcy for lh. ldfoflnMc. of rh. { ork fo. $fiicfi lhis Fmn is <br />Gsu.d (56. 1097. Civ. C ). <br />APPLICANT I'ECLARATION <br />I h6cl,y a,tm undd p.ialiy of pdjury o.. oa rh. aollo* irB dclaar ionsl <br />D€,nohion Pgmits-Asb6tos NorificarioD F.dsal Rcsulariom (TnL 40. P6l6) <br />Rcqut.d L.!l.r or Notii@rio. <br />I cd iry rhal rhe icddal r.gularions Egdning abGror rcmokl d. nDr rp/icabl. to rhis prcjer <br />I c6liaythot I havcradihis.pplicalionmdst.lclharrh.aboveintonnarion iscor*1.I asGtocomplyl haU(ityand(ounrt <br />oldinoncG and Sr.re t.aNs rcklins ro buildins coBrudnrn, ald h6eby aurho.tc r.pr6crnariv6 orrhis cny6d Cornryro dtd upon th. <br />aliirc nmtnnEd propen, lor i * Ly'ay'nAppli.s ror Agr (Sig rrtrre - 7-7-Pnnrr* nrn. trrlnr,, /r.' <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 />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding / Grounding / UFER <br />Torquerng <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rouoh <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service It4eter <br />FINAL 2.-19 - Zo q,ru , o) <br />Notes, Remarks, Etc <br />Xio*o_,.o- CZz-- <br />ELECTRICAL.INSPECTOR RECORD <br />APPROVALS <br />Transformers <br />WARNIN(;: FailuE ro s{ue *orksC cohp<carion .ovsasc is lnlawiul. d.d sh,li subjd M cnplorr io cri,ninal p6uhi6 and <br />cnil n.cs trp ro onc hundred rhoMd dollm ($100,0(m). in addirion ro rh..on ol .onpcNtion. dznaB6 s prolid.d aor tlE <br />S. io. 1076 ul rh. LaLr Cod.. intdBr drl dblB ! I€:"-,i'/da- --:;; < m" <br />LICE NSE'CON I RAC I OR <br />- ---T------