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APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCARATION
<br />I h.rcby Nmnn u M.r ncn,h, oi I)c jury rh.l I an crcmpl from th. G,nlmclors Liccns l-aw for r,t trlowing rc.sn ( se ?0.l l.J
<br />Businc$ and Pmfc$ion Codcrr An, Ciry or Counly ghich rcqlirc\ a pcmir b ..nitu.r, rh.r, inProw. dcndth o! rcIl0n any
<br />nrucNrc. t ior ro irs hsuarcc- aho rcqutcs lhc apl,liclnr for su.h Fmir lo filc r sig@d natmnr th.t hc or shc h licnrd pu!$anl
<br />ro rhl pmvnioni ofrrr Conracttr\ Liansd trN (Chi!r.r 9, ComnEfrin8 $irh Scclion ?(x)O oI Dirtn'n I otrh. susiness anJ
<br />Pohsrn,ns Codc) or rhlr h. or shc s ercmfl lhcrcfronr {d rhc trsis for lhc llhScd cicmprinn. Anyvi.laiionofSsthn?03l5bytny
<br />applicanr for r pcnnir subjals rte amlic$r ro ! cilil pcaalry oa mr nnc rhan li. hunded dollr( (S5ur.
<br />-1.
<br />rs owncr of I hc pnrpcn,. .tr my emllotes *iln sll3cs or rh.i, rlc compcnsxrion. *ill du rlx wott afii rk {Mm is mt
<br />inrc h ororlcrcd for slc (SL{ ?04.,r. Brsiftrs and Piofcsio.s Codc: Th. Conta.k rLiccnscL.wdocs.ollpDlrrd'nouftrof
<br />rhc ,mp.ry wh. hoilds or inpmvcs rlIn)tr nd *ho dds flch s1,l hinscll or h.r*lf .r rhtulgh his .t hcr .wn cmtloyecs.
<br />plovidcd rhlt such nq,m(.r.h N mt inrcnd.n or oficNn ,ir elc ll- lnuri rhc t{ildinp or inlldvcmm is \.lti withir onc ,!3r
<br />of co4rLrion, rhc ONid Brilld srll hivc rhc bords oapmving rhd h or shc dil d build or irymvc rhc pmFny ,6r rlt nx4r* of
<br />l. Ds oekr ol ihc pmr.ny, r'n cx.lusivcly conhctnt snh li.ctrkd .orkr.k'n ro (n$lruct rlf, pruFcr (Scc 704.1, BxqiR$
<br />3 thncs\ir Codc: Thc Conlr0crors Liccnsc Low does nor olply to !n owncr orl,rolcny*ho huilds or nnFovcs rhc!co.,
<br />rid sho d,nrtucrs rar ruch pmirh wnh , conrmldi9lkrnrd ru^unr ro rhc Conrracrols Liccosc l.s,
<br />I rrcxcnu trndcr sc.rion . B. & P.C. iorlhi\ r s.r.
<br />l)ule: ()*n.r
<br />siotrtr[&t:(aufliNta.rl0N
<br />IIECLA.BtrI]ON
<br />I hcrcnyrlli.mnntlcrltdrlryol t)c'jurron.ol rhc lnlb$ing Jc.lrrrrnnrs
<br />lhr\rrxlwill'ninrsindc.nii.arcolCotrsnrtoscll.lnsurcfo.wo.kcnconll)cnsulion-arF,vidcdt{rbys.crio.l?0oofrhc
<br />Iibor Cr c. for rhc Frfortun.c of lhc w.rk for whi.h rh. pcrmir i\ i13uL{
<br />v^*rrtrdsill rdrIuolkcri coDpctrsurion insurnncc.i( rcquir.dhySc.rion:]?(X)olrhcljhor
<br />rk $r which rhn p.nnil s isu.d Myworkeri.omp.nsirio.insuEtr..crri.ra F,li.tiui$cr
<br />Gxlc. fd rhc prrlaflutr.c of/z*r./efz:a) t_U 2ct*
<br />-,*^',,',,7.f.?nR"!""?"7"*,?'t,.,&/*'-,,,'q, n\ t, h..om \ubjc.r k rh. ao&dJ .onqrn\.rion lrws .f Caliior.i!,
<br />wo*cri .mnt n\arn)n llrovnhnr of S(tiotr 1700 .a rhc hbr Cdc. I
<br />issu.d. I rhrll 60r crpLy dny F.mtr in rnymrnm.
<br />and uEc rhal if I sholld trotu lubicr ro rhc
<br />sh{ll. fonh$irh qnnply !irh rh)* ptuvisio.s.
<br />WARNINC ljailurc ro scurc Norkefi comFn\rrion cor.msc i\ unh*rul. xnd \hrll \ubjLtr dn cmpl(Dcr lo (rimi'ul pcMlrics and
<br />cnil ft'cs uD ro om hundrcd rhousrnd dollr\ (3100.0U)). in rddirn,i b rhc .o{ or.o Prn\ariur, drnurBc\ r\ Pn)vi{lcd lbr rh.::w#i::
<br />DECIdEAIITN
<br />t heEhy llfinn trndcr pcmliy of ncrjury rhrl I dm li.cn*d nndo pmvisbn oi Clut cr 9 ( contmncir8 wirh S(ii,n ?fi10) ol Division .l
<br />of rhc Burinc$a l'roiestN Codc. and nylicctrsc il ii rtll laft,nilcfta.r.
<br />czo /<s6 4 14 2/a
<br />7/1 7 g
<br />I h.rh, aflir'n und.r Fnrlryorpcruryrh.l 'hsc
<br />h o conddcrion lctrdi.8 ascocy for rhc psftnnln.c orrh. work lot rhich lhh le.mil h
<br />isucd (Scc lo97.Civ C)
<br />APPLI(]ANT DECLATATI(IN
<br />I tmtry altinn utulcr Fnaxt of trrlury oM ofrhc followin8 dNlarationsl
<br />OenDlirior Pc,nrih Asbcsro\ Nori6urtr FcdeBl Rcsllarion\ (Tirlc.t0. Pd6)
<br />Requncd lf, ncrof Norifi .ariJi
<br />-lccnifr-rhd
<br />lhc l.d.rrlr.srnrrnn,sr.grdi'rgr\b.noicnn,vxlx( ior xtltluhlc ki this Pnij..r
<br />_l ccn ity rhd I hrlc rcrd r,A aplliori($ drl {rr. rhd rh. rb\r ltrf(m tr is.onc.r.InSrer,'cornflywnhallCiryridCoutrry
<br />onlimNc\ Jtul Srrr.l:'*i rcLring t) huilding c.isru.rion. rtol hcrchrrurhorizc rc[c*.krivc( ol rhi\ Cily lnd Countt k' cnrcr uB,n rht
<br />$.vc nrnliorcl nrop.rly r'or inspe.'rion ***'b,
<br />,1...--
<br />r'l(tlr,
<br />/\opli.nnl or ,\t.nl Si*nnhr.e
<br />/Z/+? 7-r'bzzv 'tS:
<br />*
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Liqht 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 />Bondinq / Groundinq / UFER
<br />Transformers
<br />Torqueing
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilinos (Hard & Soffit Rouqh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service lVleter It
<br />FINAL llzt l18 2L-/trt^rl-lp-
<br />Notes, Remarks, Etc L
<br />ELECTRICAL.INSPECTOR RECORD
<br />lvleter Release
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