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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS OMs-Build.r D@lrrstion - i <br />I hcrcby rffm unda pmlty of psjury thlt I m acmpt form thc Coilntron'Liee lrw for tho following rootr (re.7031.5 Buinot <br />Ed Profsrion Codc): Any City or County which rcguils r pcrmit to oEtruct, rltcr, improvq dcmlirh or rcprir uy tlIuctuo, prior to itr <br />isrune, also rcquir* thc rpplient for ruch pmit to fila r ligncd s6tcmcnt thlt hc or rhc ir li€Ncd punwt to thc proviriou of the <br />Contnctor't Lieruad hw (Chapta 9, Comcncing wirh Swtion 7000 of Divirion 3 of thc Buinq ud Profariou Codc) or tlrt hc ot <br />rhc i! cxcmpt thoro&om rnd thc bs!i! for thc sllcgcd fiomption ,Any violation of Scction 703 1.5 by uy rppliunt for r pcmir tubj€cu tho <br />applioil b r civil pculty of not morc than fivc hudrod dollm (S500). <br />_I, N oucr of thc propcrty, or my omploye with ugo u thcir lolc @mpcMtioq will do thc work ud lhc rtruduc i! oot itrtodcd <br />or offcrcd for salc ( Se.7044, Buin63 [d Profqrioil Codcr Thc Contruclor'r Lieuc hw do6 not rpply to u ow of tho propdty <br />who builds or improvs thcr@r\ ud who do6 ruch work himrclf or hdlclf or through hir or hc om cmploya, providod thet ruch <br />improvcmcnts uc not inrandcd or ofrcrcd for slc. I{, howcvcr, thc building or improvcmcnt ii told within onc yd of@mplotior\ thc <br />Omcr-Builda will havc thc burdca ofproving tlut ha or shc not build or improvc for thc purporc of rrlc). <br />_I, u omor of thc proparty, Em qcluivcly @ntr8cting with liccrood ontrsctorr to srotruct thc proj*t ( Sw. 7044, Buinqr ud <br />Profsion Codq Thc Contrraor'r Liee bw doB not rpply to u oma of propaty who buildr or improva thq@n , ud who <br />@ntrsct! fo, lucfi projcd! with r Contrrclor(t) li@od puEBnt !o thc Conuactor't Li@Nc lrw.). <br />_l m acmp uda Sc.tion <br />-8. <br />& P.C. for thir ruon. <br />Datc: <br />WON,KERS COMPENSATION DECI.{R TION <br />I hocby rfrirm undcr pculty of pcrjury ono of tho following dchntiou: <br />_l hrvc ud will mitrtrin r Cclifiot of Corent to Sclf-Iuuc for mrksr' ompcBtio[ s providcd for by S.ctiqo 3700 of th6 <br />l,bor Codo, for thc pcrforrucc of iho work for wtioh lha pcmit ir irrucd. <br />_I havo mrl will roitrtrh worktrr' smpcution iilurucc, u roquirod by Soction 3700 of th6 Lbor Codg for tho pcfot]ru* of thc <br />work for which thir pcmir ir iuucd. My workm'iruwcc wia and policy trumbd srcl <br />Policy €V lz- t-rfl <br />(This scaion nccd not bc if thc pamit is for Onc hun&cd dolbs (t100) or lu) <br />_l ccnify $st in thc pcrformne of thc work for which thir pcrmit ir issucd, I sh8ll not cmploy any pmon in rny mMcr so u !o <br />bcemc subjrct to thc rcrk6 ' @mp3nstion hwr of Crlifornirn rnd rgle thst if I should bc@mc rubjcct to tho worlcr' <br />compcnBtion provilionr ofS6'tion 3700 ofthc hbor Codg I shrll,provirions. <br />-1fl--01 <br />WARNINGT Frilurc to rroc workan' ompcMtion ovcngc il ud rhall rubjet u mploys to riniul peuhis rnd civil <br />@mpcnutior\ dsrogs s providcd for lhc Setion 3076 ofIino up to onc hundrcd thowd dolbo (1100,000),in sddition to thc colr <br />thc hbor Codc, intsct Etrd rnomay't f6. <br />W <br />I hcreby rfrirm undcr poulty of psjuy t}l!t I m lierocd unda provirion of Chapta 9 (@mcnoing with S6tion 7000) of Division 3 of <br />thc Buinc$ rnd Profqrioro Codq ud my liccuc ir in full forc ud cfrct. <br />Liccroc Liccnrc Numbcr <br />q <br />W <br />I h6cby amrm und€r pcuhy of pcrjury tlil rhcrc is s @Ntruction lcnding rgcncy for thc pcrforunrc of thc work for which thit p6mil ir <br />iruod (Se. 3097, Civ. C.). <br />Lcndq'r Nrmc: <br />Lcndcr'r AC&sr: <br />APPLICANTIS DECLARATION <br />Demolirion Pcmit!-fubcltor Notifi{tion Fcdml Rcgulrtiou (Iitlc 40, Psfi 6) <br />_ Rcquircd lrn6 of Notifiotion <br />I @friry rhrt thc fcdml ragulrtiou rqgsdiag ubotos rcmnl uc not rppliqblc ro thit prcjet. <br />_ I eni& thlt I hrvc rqd thit rppliotion ed ttrE th8! thc lbovc informtion ir @rc(r I rgre to comply with rll City rtrd County <br />ordioncq rnd Stetc lrw rslrting to buildhg ouEucrior\ rnd <br />abovc mcntioncd <br />Appli6nt or rgcnt <br />Pcrmittcc mmo <br />ruthorizc rcprsctrtrtivo ofthL City rod County !o otq upotr thc <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 ll 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 />Rough Mech.L't?, I )/Y1/1,/ <br />FinalTest <br />Meter Release <br />FINAL (,/?-l )W <br />Forms\Mechanic€l"lnspsctor R€cord.doc