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APPROVALS DATE ID/SIG.COMMENTS Ownd-Buildcr D@ld. o
<br />I hcEby 5fiim und.r p€ndt oaprjury rhat I m.rcnpt fom 6c ConticroE' Li@.r. L.w forth.lollowins rcad (s@.7031.5 Busind
<br />Md Prcf6ion Cod.) Any City * County which EquiB a p.mir lo colEuct, alt4, improv., d@oliih Ep.jr oy structur.. Fi* ro its
<br />isu&e, also r.qut6 thc.prli@t fo such p.mi ro lllc . siEilcd rrlrnol rh.lh. @ !h. t licqnr.d pu6uat to th. r@visioN oflnc
<br />Conhcrork Licms.d Liw (Cn6p&r 9, C6lHcio! wilh Sdlio 7000 of Diision I of th. Bsin6 ad Prof*i6s Codc) or ttrr hc q
<br />ih. ii q.mpl rh.r.from ud lhc bai, fs rh! su.scd cxmptio, Any violadon of Sccion 7O3l 5 by my eplicmt for r p.mn subjals thc
<br />applior ro r civilpc..lry of not horc the fivc hun&cd doua (5500).
<br />_1, 6 ownd ollhc propcrly, or ny.mploy.6 wid1w.g6 a rh.t sol. .omp.ns.rion, will do lh. wort ud lh. slruclu. is nor intdd.d
<br />6r offotd ior sir. ( sd ?o,u, Bulird ud Prof6lions Cod. Tnc CntBcrot't Lic.6. Liw do.! not aPply ro .r ownd of ttc p,op.n)
<br />vhobuil& or impbvd th.rcn, ed who dcs such wort hitr.lf or hdlf ot through his or hcr o*n cmploy.6. providcd th.l luch
<br />improvcmcnb ec.or inrad.d or olIo.d forrat.Ia, howcv.r. th. buildin8 or imprcvd.nr is ioldwnhin on.y.rofcompl.uo, $.
<br />OwnB-Buildd {illhavc thc burdo ol provinS $dt hc or shc nor build or inprovc fo. rhc pu.psc oftal.)
<br />_1,6 owncr ofdE arcFrty, m *clBivcly coir&ting wilh li ccnscd .ontacrds to corutrud fi. projat ( Sd.'7044, acin* ud
<br />Proasion Cod. Thc Con!_..roa! Lic.olc Liw do6 noi .pply ro u owoa of prop.ny who buildr or imprcv6 tha@ , sd who
<br />c6ftd5 ao' such Ploj*rs pith a conlla.lo(, lkd.d pusuut ro fic cortrnclor's Licdc L5w )
<br />_l m .x.mpt und.r Setia _,S. & PC. ftr lnis rc6on
<br />WORXIRS COMPENSATiON DECLARATION
<br />I h.r.by amm und.r pcnalty of p.O!,, oi. of ihc follNinB dcd-rd@:
<br />_l h3vc ud vill nsintair a C.rlificat of Consc.l lo SclfJB!rc for yorkcs' @mposri@, d prclidcd ior by S.crion 3700 oft.
<br />Labor cod., for d. pc.fmdcc of Oc work for qhich thc pcmir i3 isiucd.
<br />_l havc ddwillmai.uii sdt6 @Flsaioi iswacc, a rcqui..d by S@tion l?00.4d. L5brCod., for$c F,fom&c orthc
<br />woi{ ftr which rhh p6mi i! i$ucd. My wortc6' conipqrstion iniuacc @i.r dd policy numb.r &.
<br />Poli.y Numbs: EIpn6:'x:::,:
<br />u6".. -L.u . o.
<br />bc @mrleEd if fi. pmn ir fo, On. hlndrcd douas Itl00) or ls)
<br />pdollruc. of th. volk ls which
<br />'his
<br />Dmit
<br />wrtlB complMtioi laws of Calii@id, Md
<br />T0Oofrhc L.bor Codq l ihall, fnhwitfi
<br />6
<br />WARN'INO Failur o sccurc work,s' @mFnsarion covclasc t
<br />fin6 up Io onc hundr.d lhoaMd.lollds (rlO0.00O),in addinon ro
<br />rhc Labo! Codc, int.r6t ud altomc) I f.6.
<br />I hncby aflia uida p.nrlry of p.rjqry th{ I m liccosd uda protision of Chalt r 9 (cing wnh S.crion 7000) ol
<br />th. B6in6s od PDl6si@r Codc. edmy lic.nsc
<br />'t i. full forc. dd.fLcr
<br />o ?o
<br />I h4by.inm und.r pn.lty ofp.rJuryrhilha. i!, @.rtuctiotr I
<br />i$u.d (S( 1097, Civ. C)
<br />APPLICAlT'S DECL RATION
<br />Dnolilion Pcmib-Asbslos Noti66rior F.d.Bl R.guhtios Onlc
<br />_ Rcqutcd Lcro ot Notiilcrtio
<br />_,,y lha' t. f.d..al ..Sulalions r.gdding abslos
<br />lnd I hav. E3d lhis ipplicalion dd cdplrvirh lll Ciry ud Counry
<br />ordinu.e dd Sul. L.es rcla ig to buildiiB this Ciry dd County to ola upon thc
<br />abov! ncntioncd propcny for itup*lion 3-B
<br />Site-Work
<br />Underground
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Building
<br />Under Slab / Floor
<br />Bonding / Grounding / UFER
<br />Transformers
<br />Torquing
<br />Sub-Panels
<br />Air Condrtioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />Meter Release
<br />lFtFa
<br />Rough
<br />FEE -lmrc
<br />FINAL
<br />Notes, Remarks, Etc.
<br />_. ..-._ v_o, <vu, 556,667
<br />ELECTRICAL.INSPECTOR RECORD
<br />Pole Bases
<br />Communications Cable
<br />Service Meter
<br />Dst.. O*no
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