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Owu-Buikla DelratioE < <br />I hslby rtrm ulds poany of pcjuy tbat I u q@p( br thc CoDErcloE' Lir@ Lv for thr followi!8 tEe! (s.7031.5 BuilcSr <br />ud Profasioa Co&): Atry Chy or Couily which rcquiro a pcait to orutsuc1 alts, inprovq dmolisb or rcpair ey structug Fior to its <br />issuarc, dso rcquiE tbc rpplicam for nc.h pqEit to 6lc s sigDod ststcMt thar h! or rhc b licoscd Fmur o thr prcvirioa of thc <br />Cortrelor's Licdod IJw (Chrpia 9, Com@iry with S€1iou 7000 of Division 3 of tbc Buinqs ud ho&ssioq Codc) or that hc or <br />sh€ ir a@p tbstfon ud thc bGsis for rh. alcgod a@piotr .Any viol,ilio[ of Sctio! 703 I .5 by uy ryptiar for s psait sbjrts r]c <br />ap,pli@t to a civil paslty of rcr mrc the 6vc hu&cd dollas ($500). <br />_1, a ow of thc pmpcty, or my oploye with wagc u thcir rclc compasatioo, vill do thc worl ud thc $ructe is mt ilt@dld <br />or offacd for salc ( Se.7044, Buire rad Profesbu Co&: Thc Coatrrcor's Lic@ I:w do6 @t 4,ply to e ow of rhc prcpqty <br />who buildr or improvo thao4 ad who doc swh work hiwlf or hdf or through bis or ha ou oploye, providcd thm such <br />iEFov@@ts e Dot iarodcd or offqcd for salc. If, bowwc, thc buildiag or improvoat is rcld withil orc yq of omptaioo, tbc <br />o1vtrE-Buildg will brvc thc hrda ofproviag thar hc or rbc rct build or iEprovc for thc purpoe ofsab). <br />_I, s ow of th. popaty, u mluivcly @ltra&iog with licasod otrE-etoB to @Btruct th! trojer ( Sa. 7044, Buils ed <br />Proftssbq Codr: Thr Codrsaaor's Li@ Ilw do6 rct spply to e ow ofpropcty who builds or imFova tbsoa , aod who <br />@!rrast! for sch projeB vith s CotrEelo(s) licoscd pwwt to thc Coatrador's Lic@ kw.). <br />_I u aopt uoda Sction <br />-B. <br />& P.C. for thir reu. <br />Datc: <br />WORXERS COMPENSATION DECLARATION <br />I hscby 8ff 8 udq poalty of pajury orc of thc following deltatiou: <br />I bavc ard will uinain 8 Cdifcrtc of CoMt to Sclf-Ilsw fot rcrl6' @Ep6satioD, s providcd for by Sctio! 3700 of tb! <br />hbor Codc, for tbc psforc of thc wort for which tbc pmit is isucd- <br />_I bavc ul will nrinrcir worke' ompeatio! igurrac, 6 rcquncd by Setioo 3700 of thc Labor Cod€, for thc pqfoIme of tbc <br />worl for which this psmit is issucd My *orko' @Ep6satio! iruue@ ffiiq ald policy !ub6 uc: <br />r"rrx-u-, TcoooofScl3lll **, 7/Z/lz- <br />Cfhis rccbr !.cd mt b. @rylacd if lh. pqEh is for Ooc hundrcd doum (3100) or hs) a <br />I EtiS, tbrt b $. Fforc of tbc mrt for which this pgmit is isuc4 I sbs[ Dt -Tby my p<rco ia uy @ $ s to <br />beuc $bj6t to thr stt6 ' @Elnetiol la*s of Califonir, md agre rh{ if I sbould b6o@ subjcd to thc wott6' <br />@Epastb! pmvisiou of Selbl 3700 of thc L:bor Cod., I Eb8[, fonhwith omply with lbos trovisioB.. <br />.t <br />WARIIIING: Faihre to sm workc' oryanaiotr sveagc is ul8wfrrl, aod sball objct u oplolq to sinirsl paELica ald civil <br />6!6 up to oE hlldcd tho"-"d dolbc (S100,000),i! additioo to thc s$ of @Epastio4 ds@ge u povidcd forthc Sctbn 30?6 of <br />thc kbor Codc intqrd ad anomcy's fs. <br />LICENSED CONTRACTORS DPCLARATION <br />I hslby atrm ulds poa&y of pajuy that I u licancd undc pmvisioo of Chapa 9 (omcing with Sctio[ 7000) of Divisiou 3 of <br />tbc Burim rad ProftssbB Codc, ed Ey lic@ is h firu fore aod cfi61. <br />c LiwNuobs <br />Ddc: <br />CONSTRUCTION LENDINC AGENCY <br />I hsrby EffiE uds paalty of pqjuy tbat t[6c b a coEtructioa lcodiag agrey for thc psfome of tbc work for wbicb this pqDit is <br />issucd (Sc. 3097, <br />ladq's NEc: <br />Civ. C.). <br />lrodq's Ad&s: <br />APPLICA,IYT'S DECI,,/\NANON <br />D@olibn Pmirb.Albcstor Notificrbo Fcdml RrgdrtbB Ghh 40, Prt 6) <br />_ Rrquircd lrtts of Notification <br />I 6tiry thlt th! edssl rcgulatiou rcgudiag rbctos roval rc oot applicsbtc to rhi! Fojet. <br />_ I ccti! that I havc ud this applicatioo 8d starc thst thc abovc iafomiou is cons1. I agc to cooply with dl City ad Couty <br />sdiM rtrd Stlaa lrys reJtiag to hrilding oDsauctioD, aDd h@by authorirc rcprmtativ6 of lhir Chy Ed Couty to @16 uIDa thc <br />abovc matioocd propaty for pupos. <br />Applirot or agot sig. <br />P@ine@(prirt): <br />APPROVALS DATE ID/SIG COMMENTS <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type l! Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />1r <br />Rough Mech.3 il)l lt rl,u> <br />FinalTest t -[ <br />Meter Release lt <br />FINAL 1A r /lt ,ryk <br />MECHANICAL-INSPECTOR RECORD <br />"*," 6zcfrr* [J,*]fa"r.c^l