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APPROVALS DATE ID/SIG.COMMENTS OIVNER BUILDER DELCARATION <br />I h6eby amn! under p€nahy of pcrjury thlr I m ex lpr lrom rhe (tnta.rors' Lic.nse l,* for rhc follo*in! r.en (Sd 7011.5 <br />Ausins ann Profdion Cod.): Any Cily or Coum, whi.h r.rtuis r lErnil ro consltud. .h6. improve doolish o q,an ey <br />sttudu., Irror b ns is@... also ,.qun6 $c Agplic r lo! such p..nn to filc a sis.cd narod rhal h. dr sic is lics.d pufu&r <br />lo lh. provi3io6 oa0e Conlraclois Lic.nsed Lrw (Chafld 9, Condcncin-q wilh s..rio. 7000 of Divirion I ofth€ Busins ad <br />Prolessions Cod.) or thdl h. or sn is cxcmpl thdrfto,n ed rhc basi! for lh. allelrd.x.mplion. Any viololionofsElion 70115 byany <br />applicanlloraponitsubjelslh.applicanlloacirilpcnokyofnotmorclhefiv.hun&.ddollrs(t500). <br />l. 6 ow.d o lthc proFnr. or my .mplotc witb waB6 a rhcir $1. .or.p.nsalion. will do lh. $olt dd lhe slnrlrc t ml <br />inlodsj or oFded lor salc (Sc 704.1. Busin6 and Profsions Codcr'lh. Contidolr t-iccN Law do6 nol apply to 4own€.of <br />th. pmpdry vho hil& or n prov6 th6[ {d who do6 $ch s6d( himsclaor h.Blf or lhs Ah his or hd ow. cmploy.6. <br />prolidalrhar such imlrov@B d. mr iddddl or ofised f.r eL. lL IFNIE. th. h.ildins or ihpturd*d ir $ld lithin.n. ,a <br />ofconpLrbc lhc (lvnd Builds {ill hare !h€ hnlo of pmvins thd h€ or shc did m hrild or i'nFoE $. Flpdy for (he pnrpos oa <br />_1, N o*is orrhr Fop6ry, d cx.lsiv.ly codracrin8 *irh li.ryd coddtouro M$rud rhc ptujd (sd 7044, BGinN <br />a.d F\ot6sion Codc 1 fic Contrcro.3 Licflsc L.w do6 no! rpply to d osnd ol prcp.nJ" who builds or inFn'vca rhdon. <br />and $ho co Eds aor such,rojds wilh a ('o.hdo(r li(@d puBuer b rhe( onlroclols LiclN bw). <br />_I ddedfl unds Sclion_. B & P.C. forrhG r.sn <br />lo8r{r&r-.coltrEtialt0a <br />DCS43AU9! <br />I he.h, amm und.r Fnaxyoatsjuryon.ofrhr followi.s drtldariotu: <br />-I <br />havc ed wi ll mainhin a Cdincarc otco.sr lo S.lt'lNur€ aor su[e6 convenlrlion. e Fovid.d for bySdtio.]700olth. <br />L.bor Code ior lhe pgloflmcc oflhe wo lor vnich thc p6nit i! isued <br />_l h.r. and sill <br />'nlinrain <br />qork.r' .omt nsario. insuan.e. d r.qut d bySdlon lT0o oflh. bbor Cod., lor lhc pofoDdc€ ol <br />ptdir a isutd M, workfis <br />\ <br />n ituurd...mio rnd !$licy non'bd rc: <br />t <br />3r.uo\kvV?no>-I.7 <br />-l <br />ccnirylhal io thc pqiom,ncc ollh€ work lor which lhis pcmil is issu.d.I shallnor mpby any Pds.o i. an, mann6 <br />e 6 b bi.6m. subjer ro lhcMrk$ .onpcBation las3 olcdlifomi{ dd aerelhat ill shoold b.comc bjr_l toll'. <br />worl6 com!.ne'ionp(visidreofs.lion J700ofrh. rrlu C.de,I shrll.lodh$nh comply $nh rho$pDlisio6 <br />WARNIN6: Failurc to s(uc workcE .o rpdsarin &\qsse is unlaNful, dd shall suhj.d .h onployer ro dminal penaltis and <br />.ivil nn6 up ro onc hundrcd lhousmd doll6 ($100,000). in add ion ro rhc con ol .onrrcnsriotr,tu +;5"'ia"a t""r. <br />S*lion 10?6 ofrlE L{bor Codc, inr-6ldd6flofty'3 ts. <br />loa "teqN0v2018 <br />coNl]a.lcuQlrENllllclcE Cr <br />I h*by arm undd F.nahy of psjury thar lt* is fl olnrudiob Lndins agmcy aor rhc ldfolfucc of lhc erl lbr \\,lich this Fmh is <br />issu.d (S.,1097. Ci C ). <br />ATTUCAILDECIAAAUQX <br />I ndd, atr m Mdd p6any oaFjury oi. oath. aollo$ins ddltrdioa <br />Dnnoliion P€mn$Asb61os Nolificario. Fcddal Resulario.s (TnL 40, Pan6) <br />Rcqutcd ldler olNotiai€io. <br />I .dil, rh, rh. f.ddrl r.gulltioN r.gdding abebs r@oral d nor .pplicabL ro this pojct. <br />UGcniry rhat I havc @d rhis omli.dioo &d $arcrhat rh. abov€ inlomarion is corer.I {sr€ ro.onrply*ilh lll c(rand ('ounl, <br />ordinanc.s ind Slrr.l N\ rlditr! h btrildins (.nsrtucri.n.otturur r€F6mdn Ls ofrhis Cnted Counry to srlc ulrtr llE <br />ahrve 'norioned <br />ploFny aor iosp.ction <br />ADplic{nl or ,\sd'l Sknatu.e <br />Prrnile nim.(prlnl): <br />lt0I/r520ls <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 />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Roush) <br />Ceilin gs (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough <br />Service Meter <br />FINAL .-rn <br />Notes Remarks <br />ELECTRICAL.INSPECTOR RECORD <br />,",", 1,10y152_0t8 <br />I h*h, silrn ondd peah, of pdjxry ihd I o lic.mal ond6 Foli.ion of ChaE6 9 (ommd.iflB $ilh S(lion 7000) of Divirion l <br />of rhc Busin6s and Ptuf6iotu Cod.. dd iy 1i.tu. is in tull lo.c. od clr6r <br />I <br />Etc.