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APPROVALS DATE tD/stG.COMMENTS OtrT.FBuildcr D.claaion
<br />I h.rcby afllm uidd p.n.lty of pdju'y lnar I m !x6pr fom rhc conF..!oE' Liqcn6. L.w ior tI. lollowlns rc.sof, G...?ot L Cdins
<br />dd Prclgsion Cod!)r Aiy Ciry d Couily whth Equir4 5 pmit ro conlr.,cq alt6, improv., dooliih or tcp.ir &y tl.!dE!. paor ro iB
<br />ts!&@, alro '.4uiB rh. lrpliot ao such pcftn lo fih . sisn.d slaldor dsr hc o, sho t licascd puEu r ro rh6 pevirioni ot lhc
<br />CoiE&to.s Ltas.d Llw (Ch+r{ 9, comcDdir sirh S*rioi 7000 of Dvidon 3 of $c Bsii6 dd rrof.slio5 Codc) or thd h! d
<br />shc t dmpl $@!iDn ed rhc bdis fd rhc :llcscd qdpli@ Any violario of serior Tot l.5 by sy.pptic&r tor ! pcmit iubj..l! thc
<br />applicdtro. civilp6.lty oinor morc thu fivc hundrcd dolld (1500).
<br />_1, 6 ownd ol $! rropcny, o my mployc6 wiri *a8c! s $.ir rolc compcEario, will do !h. wo! ed l]1. sruchrq ir not irrond.dq otrad f6 r.lc ( S.c 70{, Buinor &d Pror6doM Cod.: Th. cdEs.ior't Li6& L.w &6 ,ot lpply !o u oMd of tho proPqly
<br />who build! d ioFovd lna@, e.l who doa luch wdt nimclf or h6df or lhrcl8n hn or hcr own dploy4, prcyid!.d ln4 luqhimprovm66 & nor i ad.<t or offd.d fq !alc.Il how*d, rh. buildi.Bdinprovmdt is sokt wi6in onc y6 ofcohptaio., tho
<br />Oq6-Build< will hlvc dE burd\a of provin8 thrt hc or rh. nol build q inFov6 lor lh. purpdc ot sal.)
<br />_1, { ohn of $c prcp.ny, e qcluiv.ly @nrrcriig wi6 liccns!.!cdr!&rou ro conlnact urc proj.cl ( Scc. 7044, Bsinc!5 ud
<br />Prol4ri@ Cod. Th. Cont&rorl Limlc Ls* &q! nor lpply to M oM6 of propaq who buitds or improv4 thE.oi , sd who
<br />mF&!t for such proj.d! vnh I conE&to(, ltdscd puEu4t !o rh. coitra.rofr Lic6e L.w ).
<br />_l m cxhpt und6 S.cdon
<br />WORKERS COMPENSATION DECLARATION
<br />I hcrcby affim und.r pln.lty of pctury on. of th? followi.! dccl&rions.
<br />_l havc dd *iU nrinllin. Cfiifiqr. ofConrmt lo Scll.l.surc lorworlis,comp.nsalion, s povtdcd for by Scdion j70o ofrhc
<br />Labor Cod., for rh. Pc.fcmanc. of th. *o* for which L\. psmit h is6uqd
<br />_l h.v! ond will h.irl.in wo*.ni cohp.ndion i.suMe, s cqui$d by S.ctio! 37oo of$. Lahor Codc, ior rh. pc.fffiec? ofdr.wdl fd whth lhir pmir k ir$.d" My w6kd' cmpo$adoi iftufl.c. sid ed policy iurnbq e.
<br />Polic, NLmb.r _E\Dre(Tit Ecrion n..d nol bc corplcrcd ilthc p@n i5 ao, Onc hundcd dottd {tloO} or 16,
<br />_l cadry d'a! in rhc pafom&@ of $e wnl fq vhich $is p@ir is issuid, I sMll nd.nptoy ey p.son jn uy mond io s lo
<br />b.@q lubj.d ro thc wnt4 ' co6p@di6 l.s of Cslifoni4 &d lsre d1d ir I should b.@n. slbjer ro !h. wdt6'
<br />compctustion prcvisioru of Sarid 3700 ofrh. I-3lor Codc, I shalt, lonnwilh compty with rh6c lrovisions .
<br />WA.RNING i.ilw lo r@urc wdt6' coop.ns.rion @vd.gc ir lillwful, 6d ihdl sqbjcct d frployF to eioin.t podri6 ed citlfin6 up ro onc hundrcd lhousd doll6 (t 100,000),in .dditioi lo rh? cNl of @mFBsrioi, dMosq s prctd.d f6 th. S€ction 1016 of
<br />l]1. L.bd Cod., inro.sr ad anmoyk fcc!.
<br />LICINSED CONI]L{CTORS DrCI-AX"{TION
<br />I hftby amm uDda p.f,.lry ofpojury rt I.h li@n*d u,!do provisio, of charia 9 Gommacins wirh scclion Tooo) ofDiviiion I of
<br />th? Buin6! sd lrofsiw cod., sd my limr. b io fuu f6c. Dd afr@r
<br />CONSTRUCTION LINDING AGENCY
<br />I hcrcby !fid 6d6 paalty ol paJlry thd t'6 k r @n!r&ri6 lodins .s6cy for !h. pdfffi&@ oi $. w@l fd which $i. pmn ir
<br />i@.d (S@.3097, Civ C).
<br />APPIICANT'S DECLAIIATION
<br />D.molidon Pmil}Aibslos Norificaioi F.dqnl Rcsutatiors Onk ao, pan 6)
<br />_ R.4ui!?d Lrtc, ofNorifidion
<br />_l ccnit $!r ihc f.dd.l EsrlarioB c8rdins sb6r6 mov.l dc iot applicabl. lo dis prcj4r
<br />_ I c.fliry $ar I hav. rc.d thir lpplic.tion dd srrr t.! rh! lbovc i omarior ia @r@r r .88 ro cohply wirh . City dd Couiry
<br />odinu.6 Ed SEr. tret Eldin8 rr brildinS cdr!.d6, ed hd.by aultlni& rc!.€dtsliv6 of rfiir Ciry Md Cou y ro@t6 upor lhc
<br />.bov. ndtidcd pbFty id iup@d6 puQd6.
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Li ght Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />LiE Safaty /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor
<br />Bond ing/Grounding/UFER
<br />Transformers
<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 Ro ugh
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />Rough FEB 0 I 2019
<br />Service Meter
<br />Notes, Remarks, Etc.
<br />trY ,IPtrN
<br />FINAL
<br />.*-.o ,/o K
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