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APPROVALS ID/SIG.COMMENTS OWNER BUILI}ER DEI]CARATION <br />I hdcby smm lndd p.f,olly oi pstu,y rhot I m d.'npr 6on rh. Conrhcro* Lic.i!. liw for rhc lollo*i.g r@n i sd ?0.1 1 5 ' <br />BBin6s Md Prol6sion Cod.) Any Cily or County shich r.qut6 a ,6nir ro con!tud. .lrd, improvc d.nolth or r4arr oy <br />3'tude., Fioi to irs i$umc., aLo Equn6 th. rpplicst fo. sucn Fdi ro 61. ! si8f,.d slaImol lhd lE or $c is licntscl pGua . <br />lo rh€ !.otisioN of rhc Contretoa! Lic.nsd kw (('lupl6 9. Comdcncins *ith S<tion ?000 ol Divilion I oflh€ BBrnN sd _ <br />Prof6siotu Codc) or rhll hc or lhc is .rcnF ihacfton a.d rhc b8i5 for rh. a1l.8.d d@plion. Any violal ion olsalion 70.r I 5 by uy <br />applica for r pamir subjals (h. appli.ao(toacililp.6altrofnotnorclhelilchundr.ddoum($500). <br />_1, .i ow.d 6f rh. F6Fny. or ny mplo'6 wirh *ag6 a rh.n $E .omp.Mrion. wiu do lh. "oll dd ltE srniclE i! rt <br />inldd.d or olTdcd for s6l.1Sc.?044. Buin6 ed Prcf*iom Codcr li€ ConrGdor s l,ic€@ Llw do6 .ot .9plt lo e osnd of <br />rlr. tmrdy Nli, buil& or ifrpmr6 ths6n, ad *ho d6 su.h srl him.laor h.elf or lhrol8h his or hs own cmploy.B. <br />porid.d rhar su.h inp.ovd,E!5 E. en inrd(H 6r ofld.d for s]. ll h.*-6. th. trildi4 or ir.?r.v€1ffir is sld {ilhin on. )€r <br />ofcompldio( lh. O"trd Builds pill havc lhc hrda ol provins lhd tE or shc did el hri! or i,nlnu. th. pmpcly for th. purloE ot <br />-1. <br />sowF oflhc Fopgrx .xclsi!.ly contBclins $ith licgsd conlmtr6 ro.odtud <br />'h. <br />prcjer (Sd 7oa4. UGD$ <br />drl Pslission Cod.. Th.Cotrr..clors Licms. riw do6 nor rpplyro mown6olprop.nrwho builds or inprov.s rh6o.. <br />and rvho co.lEcts ror such Foj..rs wirh a Conttur{'(s) licd.d p6M ro lhc Conlroclor's Lkmc l,w). <br />l oncr.rhfl und.r serio. ,8 &PC lor rhis rc&)n <br />}AAXESC.COI4IENTAIq! <br />DECI.ASAI]AX <br />I hoeby afiim unda p.nrlr, oaFjry o.. oalh. aollowing dal,r.rioN: <br />-lhar€e'dsillmainrainaC6riic.ofCoBanrosclf-lBurclorworkfil@nrp.nelion,sFovidcdforbySalio!3700oalh.I ibor Code lor lhc potonluffc of lhc $orl tor which lhc p6mil is isu.d <br />Ih,r.rd*ilIm.inlrinwork.ricomp.BatioDiBr...dr.qut.dbySdior1700ollhcInborCodc.lorrh.pdfomMccof <br />rh. sorl lor q hilh rha pc{mir ir i$ud MrAo'16' .ompdNdron iburuce sno od F <br />,^", . "7-\ )ri ( l.,-^ <br />i6 <br />-l <br />c€nirylhat in Ihc pslomnce orrhc {o,k ror *hich llris p€rmit is,rsued, I sh.ll nor dnplo, <br />$ 6 lo bdon subjet to th. wolk6 comFlelion hws of Caliaomi.. and asr e lhal il I should b*orc subj..r ro rh. <br />M.l6' comF&tiod polisioB ol Sdlion l?00 oirh. tibo. Cod., I slull. fonhwilh comDly wirh lhoe l)rev6io6 <br />wo.k6 co'nr.nsaxon co <br />tl IQ <br />ul1].t!tara-! <br />I hocbr rlh'n trtrdrr lr.nrlr) ol t{ru,\ rhd I d li.c {n u a(a rno\a(nr f l ( h.,1! ( 9 *nh SKrion 7000) dlDirisiob l <br />ol lhc Rusin6s d Plol6sions Codc. ud my licose $m tull <br />b,c l0 1 <br />I holby amm undq FraltyofFjury rhal $6.is. oierucrion k dins aS@cy for ln. p6fom c.ofth.wo tor whi.h Ui5 pann i <br />issu€dlSa. 109?, Civ. C.) <br />I cdia! lhar th. aeddal rcrllat ioN rcB ding fll trc not appl@bl.ro rhlq pmjd <br />-l <br />c6liSlhat I havc rcad lhis appliol infoma(ion is en(r I agetu.ornpl, * <br />odman.6 and shlcli(s re aulhorn. rclredd i!. oldis Cn, d <br />aho\.n6lion.d pbp.ny lor i <br />t <br />Applicinl or Ag€tri Sigml pv5gel,1 <br />/ <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Si gns (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Building <br />Under Slab / Floor A <br />Bonding / Grounding / UFER 7-27*t1 ) <br />Transformers <br />Torqueing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilin gs (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />Rough toLfrq-1-zz-t1 I ux) <br />FINAL g-77"t1 <br />Notes, Remarks, Etc er\t/ <br />ELECTRICAL-INSPECTOR RECORD <br />DATE <br />Communications Cable <br />Service Meter <br />AIILICAILIIISAAAIIII! <br />I @ atrm undd p.nahy of !sju., onc of $. followiis dclealions: <br />De,mlnion Pmtu-Asbclos Noti6c.tion F.ddsl R.sulalions (f nl. 40. P616) <br />-Rqun.d <br />Lal6 of Nori6cdion <br />t- <br />"HIfi-ff