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MECHANICAL.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG -COMMENTS OWNER BUILDER DELCARATION <br />I hoeby aflim undo p<u.lty of pcrjury $ar I m cxmpt ftom thc Contractors' Liccnse law for thc following rcen (Ss.7031.5 <br />BsitrBs and Profsion Codc): Any City o. County which require a pamit to conslruct, alts, improvq dcnolish or rcpair uy <br />structuq prbr to its isumcc. also requit6 the applicet lor such pennit to file I signed stdmot thd hc or shc b licrucd pwuut <br />to the Fovisios of tlE Conractor's Licensed hw (C.haptq 9. Comenchg with Sction 7000 of Division 3 of the Buine md <br />Prcf*iotrs Code) or that hc or shc is cxmpt thqefrom ed thc b6is for the allegcd exmpion. Any violation of Setion 7031.5 by uy <br />applicantforapmitsubjctsthc applicanttoacivilpenaltyofnotmorethmfivchundrcddollos($500), <br />-1. <br />u omr of the property, or my cmploye with wage a their sole compcnsalion, will do fie work ild thc struc1w is not <br />intodcd or offscd for sa.lc (58.7044. BuitrN ud Profsiom Code: The Contrsctor's Licce kw do6 not apply to m ow6 of <br />the pmpqly who builds or impovs $oo& ed who do6 such rort himclf or hcmlf or thrcugh his or hc om mploye, <br />providcd that such imFov@ols rc not intqd€d or ollqcd for sb. l[ howao. the huilding or inpovmot is sld within one ]w <br />ofcomplelion, thc Own6 Buildq will hsvc thc hudcn ofproving tha he or shc did not tuild or irnprcve thc prcpoty for th€ puposof <br />salc). <br />-1. <br />c omo of thc prcpaty. m cxcl$ivcly contmcting with licscd contractoBto consbuct the project (Ss, 7044. Buhw <br />md Proftsbo Codc: Thc Contrsctor's Lictre Law doe not apply to a owna of propcrty who builds or improvs thsan.ud who contracts for such proj6ls with a ConrEclo(s) licmcd puEwt to thc Conlrrctor's LiceN taw). <br />-l <br />m cxmpt uodo Setioo . B. & P.C. forthis rmon. <br />Date:_ <br />TVORKERS' COI\IPENSA'I'ION <br />DECLARATION <br />I hereby alfirrt under penally oflujury one ofthe follorving dcclarations: <br />-lharemdrvill <br />mainlainaCdificateofcoNenttoSelf-lnsureforworkers'conrpensalicrn,c providedftrrbySstionST00oflhe <br />tabor Code. for the perfonnance oflhe s'o* for $hich the pfinit is i$ued. <br />-l <br />have and will nraintain workers compcruation irourance. c required by Setion .1700 of lhe Labor ('ode. for (he ptrfomece of <br />thc work for rvhich this pennit is issue<1. My workers' compemation insurmce cariq ad policy number tre: <br />Policy <br />-l <br />cdiry that in the p6fom6ncc of the work fo. which this pemit is issucd. I shall not oploy any pc6on in my mm6 <br />m a to beome subjat to thc workffi' compcosation laws of Califomia" md agr that if I should becomc subjet to lhe <br />wort6' compcwtion provisiom of Seclioo 3700 of thc tabor Codc I shall, fonhwith comply with thos provisio$.. <br />WARNING: Failurc to scue workss'compmation covmgc is unlawful. md shall subjrct m qnployq to qiminal perultie ild <br />civil finc up to one hundred thoussd dollm ($100.000). in addition to thc cost of compcwtion. dmag6 I provided for thc <br />S6tion 3076 of the kbor Code, intqBt ed rftomey's fm. <br />LICT'NSFN CONTRACTOR <br />DF'CI,ARATION <br />I hrcby affm undc pmlty of pcrjury that I m licmsed undu prcvision of Chapta 9 (com@cing with Scction 7000) of Division 3 <br />of thc Buine md Prcfsioro Codc, md my licruc is in full force ad effet. <br />LicreClas: licaqNmbc:- <br />CONS I'RI]C'TION LENDING ACEN('Y <br />I hoeby aflirm under penalty of psjury that thoe is a conslruction lending agocy for the psfommce of the rvork for which this psmit is <br />issued (Sec. 3097. Civ. C.). <br />Lender's Name <br />Lender's Addrss: _ <br />I hoelry aflinn undcr pmalty of pc{ury one oflhe following declarations: <br />Denrolilion Pcrnrits-Asbeslos Nolification Federal Rcgulalions ('Iille 40. Patt6) <br />-Rqluired <br />Ldler of Nolification <br />-l <br />cstiry that the fedoal rcgulatiom rcguding obctos rmoval ue not appticablc to this prcjet. <br />-l <br />cediry that I havc red this application md statc that thc above inlomation is corct. I agre to comply with all City and County <br />ordintrcs md Statc laws rclating to building comtruction, ed hseby authorize repremtativB of this Cily md County to mts upon thc <br />above mmtioned prcpsty for inspeaion purposs. <br />Applicut or Agmt Signahrre: <br />Pmite @c (print)i_ <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh 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. <br />Final Test <br />Meter Release I -\a^ -.-\) .-y', <br />FINAL (/I <br />'/-a ,ytl )71*{ o r <br />Notes, Remarks, Etc.rl ru <br />Date:_ <br />I <br />I <br />I