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APPROVALS DATE ID/SIG.COMMENTS Own.rBuildcr Deldlid <br />I h.r.6y affim und.r p.ndiy oap..jury dut I m cxmpt f@ !h. ConlracroE' Li@ns. Law for lhc lollowins rcson Gd.7031.5 Busins <br />od Prol6ioi Codd, Any City c Co69 phicn Equi6 . p.mir lo co.srtuci rltd, imprcv., dcmoliih o r.p.i, dy n lcturc. prid ro i6 <br />istudc., rlso Equte rh! .ppli6l for 5ud p@n ro fil! . siencd sErm? rhar h. or sh. i! licn5.d pu6Et to th. provisions ofd& <br />Contactor's Lic.i*d L6v (Chafld 9, Cohnacjns vilh S.ction ,00o ol Divhi@ 3 ol thc B6in6s ed Profgsidr Co&) or rhar h. 6 <br />shc i3 d.mpt thcrcfom ed rhc bab fd lh. all.g.d dfrpliq Any violation of SEtion ?Ol L5 by &y lpplicet for ! Fmir ilbjccB rl'. <br />applicdt to r civil p.nllty oanol ndc lh& fivc nundrcd dolla (lr0o) <br />_i, s oma of rh. prcpsty, or my cmployr6 *id v.a6 s rh.t $1. compostion, will do (h. wo* Md tt. sd.la it nol intlndd <br />o. o,I6.d fo s.lc ( SE ?0a4, Buins od Profeid Cod., ftc Con@lor's Licatc Lap de rct ,9ply lo e oqq oa fi. pEFny <br />who buil& or imr(ovB lhfton, dd who do6 such wort hiruclf or hftdf d drou8fi hir d hd*n dployc6, Fovid.! 0' such <br />im!rcv.m.nts u. not int nd.d or o,Lr.d fd !.1.. lf, h*.v.r, lhc brildinS or improvcmat k sold vilhi. onc yco of co6pl*6. th. <br />Ownr-Build.r will nat. $. burd.i of p.oyi.E thtl hc or rh. nor build or imprcv. for 6c prrrd. of s.lc). <br />_1, G own.r of lhc prcp€riy, M dclusiv.ly conFacti"s vilh lic.ns.d contretoR lo cd5lrucl th. prcj.d ( Se. 704l auine ed <br />Prcf6ion Codc Thc ConEic|ort Lien* Lrw dl4 not pply lo u om6 of Plopaty who buil& s impoB lh@n , od *ho <br />contrclr ror such pbj.d5 with r Cdu&!o(, li6&d ,!6uar ro O. Co.hdofs Licc.sc L.* ) <br />_l m cxcmpl u.d6 Scclion _,B & P C ftr tht r.soD <br />YOAXEBS-CAMTENIAIIaX.DECIABAII9I <br />I hcr.b, alll m und.r pcnal ry of p.d ury on c of rhc fol lovins dcclmtions: <br />_l havc dd *ill fraiillii a Ccnifidc ol Co.sdr to S.lfJns@ for *ork6' @mp.nE6rio, a p,ovidcd tor by S.cti6 1700 of $. <br />Labor Cod.. ror rh. p?rfmd.c of D. wort lor vhich lhc pcmn b isu.d. <br />_l h.v. dd will m.in6in *trk6' @m!.N.tio i.su@cct B rcqlt.d by Sccrion 3700 oa tnc t$or Codc. for th. pdf(rucc of $c <br />wort for which $is p@n i! issucd M, wnLd cdnpdsation iniutu@ 6id dd policy runbq &.: <br />Policy Numb..-Expn ! <br />"^x,:,: <br />&-*" *i1." . <br />not b. compl.t.d if fi. pmn i5 for Oi. hui&.d done ltr0o) or lar) <br />rhc p.rromec. ofd.Nork for which rh6 <br />3 <br />workd @par.lio. covrasc it <br />ddollm (1100,000),ii .ddnioi ro <br />I harcby aflim und.r p.nalty of p.quy !h.t I M licascd u.dd provisioi ol Chap&. 9 <br />th. Busin6s ad Prof6sio6 lico$ is in full fo@ and cfccl <br />p.lury$ 6@isaconnruction <br />'h. <br />edk for which fiis pcmrt i! <br />Civ C. <br />APPLICA|{T'S DECLARATION <br />Dnolnion P.mils-A5b6bs Nodilotioi Fcdcral Rcguhri ois (Tnk 40, Pan6) <br />_ Rcquncd L.tl.r of Noifiqtio <br />I asrcc io cnply *ilh all ciry dd <br />abov! m.ntion.d prcp.ny fo. <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 />Bonding / Grounding / UFER <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 />Meter Release EX PIRED <br />Rough FEB -I ZUN <br />Service Meter <br />FINAL <br />Notes, Remarks, Etc. <br />ELECTRICAL.INSPECTOR RECORD <br />Under Slab / Floor <br />Transformers <br />L.bo, Codc, t shall. lonhw i <br />Lodat AddrB <br />- r -- <br />--------t------