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IUItrUrlAIYILAL.INDl"trU I U}( KEUL|KU vt-2- <br />APPROVALS DATE ID/S!G.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation 9 lat '7,/?-ff 5-. <br />Smoke Detectors lnstalled lv <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 tl <br />Above T-Bar 5 At 7L Dt.tflO t a+Xa <br />I v <br />Rough Mech. <br />FinalTest <br />Meter Release IZ- <br />FINAL *67 <br />Notes, Remarks, Etc.U <br />()\\ \t R lll_rt.lrl.R t)t..1.(,\R..\ I l()N <br />I hcrcby atlurn unda luralty ofptrlury tha I an cxqnpt fiom thc ('onus(rors' Licmre La\y fbr lhc tolloving reurn (Srr 7011.5 <br />llusind and Profcssion Codc): Any City or County uhich rcquirs a gnmit lo congrucl. rlt6. irnprovr. d(rJlBh oi Ei,ir m! <br />slrucluc. Fbt lo its issucc. also rcquir6 lho applicail lbr such pdrnit ro filc ! sitnsd slalqMt thu hc or shc s liccud prrsuau <br />to lhc proyisioN of thc Conlractd's Liccnsed LaN, (('hapler 9. (-ornmcncing wilh S6lDn 7000 of Division .l oftlrc Busios ud <br />PlofctioruCodclo.lhathcorstrciscxcmptlhscfronrmdthcllosisforrhcallcgqlcremgxion. AoyviolationofsedionT0.ll.Shynny <br />applicantforapennitsubJcrlsthe applicsnltoacivilpcMhyofnorrmElhmlivchundraldollars($500). <br />-1. <br />6 owrcr of thc prcpny. or my cnrploys wilh weg6 s lheir $lc omposstion, wi[ do thc wo* ed thc selur b mt <br />inlsdcd orofleredforsale(Sc.7044.Businwmdl'rofruionsCodc:Thc('ontractor'sLi{rreLarvdosmtarplytoilno\vnsof <br />thc p,apdly who builG or imfmvq thsqn. ud who doq srch rvork hinrclf or ho$ll or throu!,h his or hcr om enrplolcs, <br />ptovidcd that luch improvq&a(s N rol iilmdcd or ofibrd fq sle. lf, horqq, tlr hrikling or tnlnrvorcnt ir rcld within one ya. <br />trfcompktion. thc Owns Builds rvill have thc hrdor ofproving tha he or she did mt build or irqrove rhe popa.ry for lhc purlxrs of <br />slc) <br />-1. <br />6olvB ofthe lropqty. rn cxcluively contrrcting with licoscd codrxtots to coBnd rhc frojd (Ss. 7044. &dt6 <br />md PtofeixCodc: IheContractor'sLiccnELarvd6notapplyloeownqofptopfiywhobuildsorimprovetheoo. <br />aod who sntrcrs fer Juch projcrs wirh a Contrero(s) ltwd puEuen to lhc ContEc.tq's LiccN Li* ). <br />_l ill e\qopt uodcr Sqtion_. ll. & P C. for lhis r6)n. <br />Date: Orns: <br />woRlil:Rs, coMPINSA iloN <br />DE(]l.lRATION <br />I hcrcby alfirrn untler pcnalty ofpcjurl onu ofthe following d$leationsl <br />-l <br />havc od will ruintEin o CalifNltc of Conscnl to Sclf-lNurc for *orkerr' conrpenstrtiou, rs ps\ idc,J for by Scction -l700 o f tlrc <br />Labor Code. for lhc pqftrnnmcc ofthc wo* for rvhich the pqrnii b ssued. <br />f,t havc and u ill mainlai[ workc,s' compeNdion iNrarEe. 6 requircd b] Setion -1700 of the Labor ('odc, for the pcrlbrnucc of <br />thc rcrk for which this Brintr G issl. My workas compcMion imurmc canio and policy nurnbct ac: <br />Zurich American <br />tblicy wcss1373106 10t01t2020 <br />-l <br />sqlify lhal in the Jxrfornrance of thc work for rvhich lhis permit is srucd. I chall not cnrploy auy Jxrson in any rnanncr <br />so o to &roorc subjwl to lhc rvorkcs' cornlrcnqtion larvs of Calilomia, ud aUN lhar if | lhould bccotne subjst ro the <br />wortcrs'conr;reoutionptovisionsofSccliotrlT00oflhcLsbor(lodc. lshall.forthwithcornplywithtlro*provisiom.. <br />WARNINGi Failurc to wuc workcrs'cornlsrstion cove&gc is unlawful. atrd shBll suhilrt an crnploycr to rirnin{l tmdlris imd <br />cNil liil6 up lo onc huodrcd thousdrd dolles ($1m.06r0). in ddition to thr co$ of cornpcnmtioo, donogcs as prrrvidcd lirr thc <br />S61Dn 1076 oflhe kbor Codd. itrtsBl aod snorruy's fues.t4t27t2020Christine Van <br />LI('ENSED CONTIIACTOR <br />DfI'IAILATION <br />I hauby alfirm unda pcnoltyof lujury tha I m licerccd unde polision of ChaFq 9 (comruncing wilh Sslion 7000) of l)ivision 3 <br />of the Buruo ard Pmfsioru Codc. ed my licw is in full forcc and cffqt. <br />B 753428 <br />r)rrr 4127 12020 (.(,ilrr:r(,or Crew Builders lnc <br />,,.,,. 412712020\- <br />CONSTRUCNON I ENDIN(:,{GEN(Y <br />I hocby affrm uodcr pu'ulty ol pqjury thal th6c s a co6ttuLlion Loding agmcy ftrr thc pafoll@cc of thc wrl for shich thi, fEnli b <br />iryed (Scc. -1097, Civ C.). <br />Lcrxirr's Nrnle <br />l-cnder's Adries: <br />,APPT.ICAN'T DI'CI-ARATION <br />I hotbyaffmuodo penalty of pcjury onc of thr following dcluaions: <br />Dstrolition Permit&Asb6tos Norificatiou l'edsal RqgulalioM (Tillc 40, Part6) <br />-Requircd <br />t.dts of Nolification <br />X I .otify,h", ,t <br />" <br />f",ltral r$guhltnts rcSaduu sb€slos rcmovsl&s fin opplicrblc ro this projd. <br />X t coriry rh8r I havc red thb appltarion ud statc that thc above informabn b cffi. I rgle ro comply wiih ,ll City snd Counry <br />ordwmG ud Statc tiws relding lo building condMtion. uxl lvcby autlrrrizc r.p.ffitdiv6 of this Chy ard County lo at6 trpon rh. <br />ahovc nmlioocd propcny for iroperion purF)s6. <br />Crr.rt4fir,\.(, Va*wAppliciltr or AgcnI Signaturci <br />p.*ire ildnc (lx.iil) _ehfisti nellan- <br />Jzl\nrn- <br />0lu'l'7,/) <br />('ris