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APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DET-CARATION
<br />I h.rchy 0nhr undn ,cnolly of Frjury rhat I am cxcm,,r riorn lh. (t)ntmcron Liccnsc La* rbr ihc lollowing rcaei ( S( ?O.l l 5
<br />Busincss ond Proiession Codc) Any Cily or Coutrly which rcqutcs a ,smil to consrdcl- alrcr. nnP,o!t. dcndi\h ot rcplt an,
<br />srDcrurc. p orloits issuone, olw rcqutcsthc otrpliclni for sucn pcrmir ro fih! sisncd shrcftor rh he6r shc i\ li.dhql pursuanr
<br />lo lhc rovisions ordh conractor's Licctrsd tiw (Chlpi.r 9, Conmcn.in! wifi Sc.lion ?uro ofDivnion I oflhc Busincss and
<br />Prcfe$ionsCo!c)orrharlEorsh.kexcmprrhcrerromandrhcbasisrorrhe0llqcdcicnrflion.Anyvi.lari.nofsdrio!70.115byat
<br />fti; ;;;d.ffiffi.ffi;;ffiffi ;-;;*ff Hi.H,
<br />lhc ptrrtEry who bxilds or inpn,vcs thehnr aid slx, dfts e.h m* himq.lfor hcsclfor thrcuBh his or hcr owncmpbycc\.
<br />F,vidcd rhar such i'npovcEnrs re mr inrend q o{Er.t lor s.h I L houcrcr. rhc huildiu or inlmrcmal h v,ld wirnin on. ,!or
<br />oa conDlerion. rlE Owmr lruiBe, *ill h.w ltr budcn of povitrB rh{l hc or rhc dil mr 6uiu o, iq,mvc lhc ,rolgry for r,E ruqms or'
<br />L rsoemroirhc popeny. a'nciclu\iver, conrracrins $irh liccnsed conrxcn,n b con(tud rhc tn,j..r rscc. ro{. BnsiN-
<br />!*l lhfL\\ir. Cbdcr Thc C.ntbctr-s Lic.nsc Ln* dd\ nor apr ly k, Dsncrolptupcnyqhobuildsornnprcr.slhcrcon.
<br />rn.l sho cotrrncts lirr \uch pnjccr\ rirh a Conrrick,(, licctrscd pur${nrro rhe Conrractr's Liccn{ Il*)
<br />-l
<br />hrlc md will nEnrlain 0 Ccnilrcarc of Conscnt lo Scll.lNuru lbr wortcff (,npcns ion. us flovklcd lor by Sdin :r7u) or rhc
<br />Llbor codc. ior rhc pcrlornmncc ol rhc work lor which $c pmil is Nucd.
<br />Ih,krnd$illtrri' 3i', sork.rr conrc srri{r iNLraN.. a\ rcqtrtcdhySccri(n.17firofrh.t;$.rCldc.lbtrhcpc omu{coI
<br />rhc work ld uhi.h rhkFnnir i\ i\{cd ltr, tr.rkc^ .o'npctrlrrn,n nrurn.cc(ricr u Brlt.y iunrL\rdc
<br />P,,hr Nun,l-r' F.t.i,,.
<br />/l& ,,, " * *"'.,"*,"*,,., ,h.fq, ,,.h.uc,,.,{u,n,{
<br />/ * ||L.u,-" -rr;.,n- q,c,. nimrn.:',, r$sn.crro,,J. r d.,!n. rhi, r
<br />",,[.. ., -F-.",.r, ",* n\' si,rtr-, rii,il rhr l Jh .t{.. 1 \h,'l h rli\ h..{
<br />cnpn,r,n,I].rsonhdnyn ftr
<br />sloxld h..om subjNt lo thc
<br />nply wnh tho* pmvkions..
<br />;*lUffiA ion, dnnuecs .s providcd lor rhc
<br />I lrrcby rftrnrundcr piMlryol'Frjury rha' I an li.cn$d nr rvi(ion olChanrcr I (.omnEncirp
<br />ol rhc Bu\i',cssaftl Pmli$knNCo c. &J hy liccn\c is i'r
<br />Li€cnsc Class,
<br />-
<br />L icc nsc N!nb.r:
<br />Conlmclor:
<br />CA!EIA!]CU!]NIENDIA!{iENq
<br />I hcEhy allirnr undcr lrtraltyolI)c jurylhol lhqc h o.otratdcrion h ins ascNy for rhc pc,fornuncc orrhc*ork torwhi.hlhis p.mir i\
<br />issucd (Scc.1097. Civ C.).
<br />xlnicrlrr rl[lirr. nnnr tu otr iscord I lEe tosmplyqirfi allCiry r
<br />,\pplacnnl or,\xrnl Sixnnlurr ; dli;I()
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Lite Safet y /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Under Slab / Floor
<br />Bonding / Groundinq / UFER
<br />Transformers
<br />Torqueino
<br />Sub-Panels
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />Ceilings (T-Bar Rouoh)
<br />Rough
<br />Service ltrleter
<br />FINAL fi-Lil9 )Ntu
<br />^.lql)Notes Remarks \7
<br />ELECTHICAL.INSPECTOR RECORD
<br />It/eter Release
<br />EtC.
<br />(-dni.1
<br />tJrd.r'. AJdc$
<br />ATILICANLDECI,Af,AIION
<br />I herc-by altim undcr penslry ol perjury orc ol lhc followin8 d(laElions:
<br />Dc'rclition Pcrn h.Asb.{os Notificlrion FcdcBl RcBul{tions (Tillc,10. PM6)
<br />-Rcqurcd
<br />Lcttcr of Norirc ion
<br />rcgrln,g r\hcdn\ .ctrk,vrl JUxi rmlicrhlc n) rhis pft)jc.r
<br />I
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