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M ECHANICAL.!NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />lrlisc. 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 Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />FinalTest <br />Meter Release <br />(tr-)FINAL 2-zg'2n2o Jdctrt <br />Notes, Remarks, Etc <br />Bu\incss tnd l)rrrlcssion Codc): Any City or (i)unty s'hich rcquircs a g-_rmit Io conslnrcl. allcr. intprovc. dciln)lish or rcpnir rnY <br />npplicilrxli)rapcrinitsuhjcclslhc applicxnltorcivilpcnnllyolnolnxrrclhlnfivchuntlrcdtlollars($500). <br />_1. r\ (trvncr ol'thc pr()r-tly. or trry ctrrpk))cc\ s'ith $rgc\ as the ir solc cotrrpcnsali()rr. q'ill(lo thc sr)rk rrxl thc slnrlurc is iri <br />ulc). <br />-1, <br />as owncr ofthc pmpcrty. am cxclusivcly contracling with licenscd contracton lo conslruct thc projccl (Scc. 7044. Busincss <br />ard ProfssbnCode:ThcContractor'sLiccnscLawdesnotapplytoanownerofprolEnywhohuildsorimproveslher@n. <br />and who contmcts for such projects with a Contmctor(s) liccnsed pursunl to thc Contrsctor's Liccnse hw). <br />I amcxcmDt lt..c. for <br />7 <br />I hcrchy undcr pcnulty of pcrjury <br />-l <br />havc ud will mintrin a toSclf-lnsurcforworkers'compcnsation.as providedforbyScclion3T(Xloflhc <br />t bor Code. for thc Frforrorce of for which the pcrmil ir issucd. <br />_lhavcundwillmaintainworkcrs'compensationinsurancc.as rcquiredhySeclk)nl?0OofthcLuborCode.forthcperformanccof <br />thc work for which this pcrmit is issuc{.comJrcnsation cmier and Jnlicy ue:,f <br />Policy <br />-l <br />ccrlify thal in lhc perform-mcc is issucd. I shall not 8ny in any manncr <br />so astobccomcsubjecllolhcworkcrs'conlpensalionlawsofCalifornia.andagrccthiltifl hccome subject to lhc <br />workers' compcnsalion provisions of Seclion 3700 of thc Latnr Codc. I shall. forthwith comply with tho* pmvisions.. <br />WARNING: I;uilurc to rccurc workcrs'compcnsalion covcBgc is unlawful. and shull subjcct an employcr to fiiminal lEnaltics and <br />civil fincs up to hundrcd thousa[d dollus (Sl lo thc cost as lrrovidcd for thc <br />Sc.li(nr 1l)7ar ol inlcrest snd attorney's <br />I hcrcby {ffirm undcr pcnolty of pcrjury Ihut <br />DECI.AMIIQN <br />under provision of Chapler 9 (comrcncing with Section 7fi)0) of Division 3 <br />of thc Busincss lnd Pmfcssi(,ns Codc.is in full lbrcc and clTccl. <br />Licensc <br />??;*w74L <br />I hcrcby affirm IEnallyofperjury lhal thcrt is a lcnding agcncy for thc pcrformncc ofthc work for which this Jrcrrnit is <br />issucd (Scc. 3097. Civ. C.). <br />hndcr's Namc: <br />l.cndcr's Atldrcrs: <br />APPLICANT DUCLARATION <br />I hcrcby allirm utr(lcr pcilalty of pcrjury o0c of lhc li)lk)wing dcclarat i(ns: <br />l)cnrliliotr Pcrnlit\-Asbcstos Nolificalion l:edcrnl Rcgulalio0s ('fillc 40. Prrt6) <br />-Rc(luircd <br />l.cllcr of Nolificnli(nr <br />-l <br />ccdify lhat thc fcderal rcgulations rcgtrding asbcstos rcmovul arc nol applicablc to this projccl. <br />_l cdify rhar I have rcad lhis applhation and slalc lhat thc above inforrolion is c6sl. I alrc to comply with all City and County <br />ordinunccs and Slatc hws u[nn lhe <br />abovc nrenlioncd propcfly for <br />or Agcnt <br />nililrc <br />construction. and of this City rnd lo <br />t7 <br />l- <br />-trAt- <br />7