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APPROVALS . DAIE COMMENTS OWNER BUILDT]R DDI,CAf, TION
<br />l hcrcby afiinn u.d.r r.n y of Frjory rhar l an qcmlt ironr thc Co.tacroF Liccnsc ljw for rhc rollowing o0$n ( s.. 70:l l 5 a
<br />Busincs md ltoicssion Cdc)r Ary City dr counry whi.h Equircs n F mir ro con{tucr. alter. im!'rovc. dcmlhh or El,n ony
<br />strucrurc- ptior lo ns hru.ncc.0L$ r.quncs lhc lpplicotrl rbr such pcrmr h nl.0 silmd sr,leeor !ha! tEorsllc n liccn*d Nruanr ,
<br />lo rhc prcrhions .r tlE Conr,erols Liccnsd ti* (Chapr.r 9, Commckihs wirh Sccri{,n 7000 ol'Divhion 3 ofrhc Businc$ md
<br />Pn,icsions Codc) or rhd hc d she ir er€ntr rh.r€f.om md rh. tusis lor rhc,llcgcd cxorytion Any vnrkrnriofs.crion?0115 byany ,
<br />applicont {or o pcrnrir subjc.a rh. nptli.anr ro s.irilp.n0lryoinor mrc rhan five hundren dollafi ($500)
<br />-1.
<br />as owncr or rhc l(,rrnt, or fry .nDkrrccs *irh woacs rs thcn $lc (onllE.er ion. will do th. wolt alld rh. (rurE is trot
<br />inrcndc{ or ontred for slc (Sa 704a- Busircss ond Prorcsnrns Cnlc:1'h. C.nrrttr\ Li.cns! Ijw d@i tror ot'tlyro nnown.r ol
<br />rhc Impcny wll) boilds or ir0mB rtEmn. lod *ho dds skh won himsclfor h(slfor rhmlah hn or hcro*n emtlolecs-
<br />n.ovidcd rhrr srch in rovcnrnh u intcndcd n ollcEd f.r eLr ll hoscw. rh. f ikling or iryDwnr n sU *irhir otrc ,rmof6q,lcrhn, IIE Ow.cr Builld will havc rhc hordcn ot pnNin8 Ihal h. or shc dil tror bnikl or inDrovc ihc pn]Fiy ror rh puqr,s or
<br />L xso*ncrolrhcpopcar. amexclusilclyco.tractine wilh li.ctr{d c.nrrror\ ro con{tucr rhc EtI$r (Scc 7(xl, Btrnncs\
<br />lnJ Btri6sih cld.r Thc codracra s Liccn\c lie docs nol mrly lo rn oencr ofptup.nt who huitdr or nnpmvcs rhficon.
<br />and ,ho conhcts for su.h pn,jc.R wirh, Co.rEcron, lietr\cd puru0 ro rhc C,nk(cro* LtcnE tiw)
<br />lr$drcnr|n ln,lcr Sccr(tri . B & PC hr rhn,cr$,
<br />Dotc: Orne.
<br />WORKFRS' (:OMPFNSATI{IN
<br />DEgI.AMIIO!
<br />I h.r.by rfllrn xndc. pcnalryolFrjuryoneofrn i{nhwintd(lMrio r:
<br />I hrvc rlsillmi rinrCcniif,lr.olC.nscnrioScll.lnsurcrttrworkrG.onlncn\irion,r F,vnhd i{rhrSccrd.]?00ofrh.
<br />ttrtr, Codc. for rhc IcrfonBncc ol rhc so lbrwhirhrhcp.nnir is isucd
<br />.Y,-(ml willn:rinrdii work.r\'.onpcnsrrbn irsurrncc.0r rc{Dircd hySc.tiotr STmoflhc l-ahorCodc. for rhc inf(r m..of
<br />ywortcr' comrcnsotion insumrrc.lricra lri.ynumb.r m:L
<br />5
<br />I.cdify rhlr ir lhe p.rhrnnneolrhc worl fur shi.hrhi\ pcrnir is issucd, t shallnor cqrkryanrlr.non in "nynruncrso $r. tr.o:B shj.d ro rh. wo*cr $np.Nrriotr ltrus ofcrlifoi0i,. and n!rcc lh iil dn,uld tr.onr subic' t'llr
<br />workc^.oiD.n$ri('nnrovii,nsofSecrionl?00ofrhctitrrCodc-lshrll.tonhqn[complywnhrh,$ptuvnids..
<br />WARNINC: faihrc Io (rur. workfJ.omtcnsarion oecmec is unhstul- lnd !h.ll slhjd nn cmplotcr
<br />'o
<br />aimimlpcMlri.s rtul
<br />citil ljncsunro trc hunnrcd rhousnd doll&s lsl00.0{x), in rddnioi t, rhc co\tnlcompcnsolion, dimrscs !s rmvidcd lor rhc
<br />::::;r;ii"u-
<br />I hcthy rlnnntndcr pcntrllyotpcrjury lhalI r licc.*l u.dcr rft'vnn rofChtrl,d9(co'nntrcinAsirhSccrionT0O0rofnivi\i,n.l
<br />of ihc Ru\i'rcssrtrd Proicssions Codc.0ul nrr licc s. is in liilltur.r ul claN--r
<br />dD
<br />*E//s
<br />CONSTRIICTION LENDIN(: AGENCY
<br />I ncrcby lltrm uRl.r pcn,[, ol p.riury rtnr rh(. is ! onsrtucr iotr lcnding oScmy ror rhc pcrfornEtra oa rhc work for wfiich rhis Fnnn is
<br />issucn(Se :1097. Civ C.).
<br />AIIIrcAITDqCI.AAAIION
<br />I hcE6y altinn undcr p.nally or Frjury oft or rhc r'ollowinS d$hrat io.sl
<br />D.turirid. Pcrdill^sbcsros Nolificolion ltdcrol RcBuhriotr* {Tnh 40. Pd6)
<br />Rcquncd Lxrrcr oI NorifEarion
<br />I(M'r.!rl rrho rrdrrrltguh ir)D\ rgrnlDE r\h.{.\rcrk,vntJr trrrxt)ftrrtr( k) rhis |n)j..r
<br />-l
<br />ccnilylhd I lurc rcad rhis,f|rli.,rir,n mlitrrclhnr rhcrtrvc i n naridr ir.unccr lllgrNk,.ompl
<br />ordimmcs !trd Srarr hw\ rhrii8 ro building consrrucri.n. rnd hcrcbyi horiz. rclrc\cnfurilcs.lrhir Cir
<br />utbv.
<br />'tunrn,ncd
<br />popcn) for irspcctiqr turpo{>*?4-/'Appli.{nl or Agcnl Six.!luE
<br />y*irhrllciryrn (iiuny
<br />v trd ('{nnvro cnld trtirirlk
<br />z/.t,/z./ /'
<br />Underground
<br />Pole Bases
<br />Li ht Standards
<br />S pas, Pool, Fountains
<br />Signs (monument)
<br />Life Safet y /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Buildinq
<br />Transformers
<br />Torqueing
<br />Rool To ut menl
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rouqh)
<br />Ceilings (Hard & Soffit Rouoh
<br />C eilings (T-Bar Rough)
<br />It4eter Release
<br />Rough
<br />Service I\4eter
<br />FINAL gl)ltg 'M?r)
<br />Notes, Remarks Etc.I I
<br />ELECTRICAL-INSPECTOR RECOBD
<br />ID/SIG.
<br />Site-Work
<br />Under Slab i Floor
<br />Bondino / Groundinq / UFER
<br />Sub-Panels
<br />Air Conditioners
<br />( a7?93
<br />t ndf s Addrcss: _
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