Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE !D/SIG COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />fi/isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh 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 />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL 2-Zc-?22,//.tN"(rr) <br />Notes, Remarks, Etc. <br />OWNER BTJII,DI:R I)I'I,CARATION <br />I hcrcby aftirrn undcr pcnllly of Frjury thill I am cxcnlpt lionr lhc Contrilck)F' Liccnsc kw lbr thc tblkrwing rcason (Scc.70-11.5 <br />Burincss and Proltssion Codc): Any Cily or Counly which rcquircs a lrrnlit to conslrucr. allcr. improvc. dcnmlish or rcpair anv <br />slruclure. prior lo its issuailcc. also rcquircs lhc applicanl li)r (uch Frnlit nr filc a signcd st0tctftnt thill hc or shc is liccnscd pursuant <br />lo lhc provisi(nrs of lhc Conlrrcbr's Liccnscd l-aw (Chilplcr 9. Cornnrcncing with Scction 7fiX) of Division 3 of thc Busincss and <br />ProfcssiolsCodc)orthallrcorshciscxcDrpllhcrcfromandthcbasislorlhcallcgc(lcxcmptk)n. AnyviolationofScclionT0-ll.5byany <br />ilpplicnnltbrapcrmitsuhjcclslhc afplicanltoacivilpcnilltvofnotm)rcthil[llvchundrcddollar\($5U)). <br />-1. <br />as owner of thc pm[Erly. or my cmployes wilh w8Scs as lhcir slc ompcnsalion, willdo ltE work ad lhc stnr-tw Ls mt <br />intendcd or offcred for sle (58.7044. Busincss and Professions Codc: Thc Contmctor's Licenw bw d@s nol apply to an owner of <br />thc prcJErry who builds or inprcvs themn. ard wln des such mrk himself or herslf or thmugh his or her own cmployces. <br />providcd lhat such impmwmnts m ml inlendcd or offcrcd for slc. lf. tnwcvs. lhc builditrg or ir{,mwrcnl is $U within orc }ts <br />of cotr{,lction. t}E Owner Builds will ha!€ the burden of prcving thd hc or shc did mt huiH or inqmvc orc pmJuty for thc purlbs of <br />ele). <br />-1, <br />as owncr of lhe propcrly. am cxclusively contrsctin8 wilh licenrcd conlraclos lo conslruct thc fmjcTl (Scc. 7044, Busincss <br />and ProfsskrnCodc:ThcConltactor'sLiccnscLawdoesnolspplyloanowncrofpropcrlywhobuildsorimprovesthercon. <br />and who conlEcls for such pmjccls wilh a Conlmcto(s) liccnscd pursuanl lo thc Contraclor's License Law). <br />I am cxemDl undcr Scction . B. & P.C. for lhis reason. <br />Owner:_ <br />]YQBIEIIII;OMTINSAIIQN <br />DECI ARATION <br />I hereby alJirm undcr pcnalty of pcrjury onc oflhc followilg dcclarstt)ns: <br />t-rl$r C(xlc. li)r thc pcrlbtrnrr(c ol thc $rrk lirr whieh thc pcrnril i\ is\uc(|. <br />-l <br />have and will maintain workers' compcnsatbn insurancc. as rcquircd by Scctkrn 37fi) oflhe lahor Codc, for lhe performancc of <br />thc work tbr which lhis pcrmit is issucd. My workers' compcnsation insumncc canicr and policy numbcr rc: <br />Policv Numbcr: Ernircs: <br />-l <br />ceftify lhat in lhc pcrformance of the work for which this pcrmit is issucd. I shqll not ernploy sny pctson in any manncr <br />so as to bccom subFct to lhe workcrs' compcnsation laws of California. and ogrcc lhat if I should bcconr subjccl to lhc <br />workers' comFnsation provisions of Scction 3700 of lhc Labor Codc. I shall. forthwilh comply wilh lhose pmvisions.. <br />llARNING: Failurc to scurc workcrs'coilrpcnsalion covcragc is unluwf'ul. {nd shull subjcci an cmploycr lo oiminal and <br />civil fines up to onc thousand dollars ($lm.Un). in co\l ()f li)r thc <br />Scct )n 1076 I-atxrr intercst and allorrcy's fccs. <br />I hercby allirm undcr pcnBlty ofFrjury that I am <br />of the Busircss and Pmfcssions Code. ard my I <br />of Chaplcr 9 (comrcrcinS wilh Scction 70OO) of Dilisbn 3 <br />in full forcc and cffcct. <br />Liccnse <br />I hecby affrm under pmalty of perjury that <br />issued (56. 3097, Civ. C.). <br />aScncy lhc JrcrfornEncc ofthc work for which lhis JErmit Ls <br />Irnder's Nanrc: <br />Lcndcr's Addrcssl <br />APPI ICANT DECLARATION <br />I hercby afiirnr undcr pcnally of pcrjury onc of lhc folk)wing dcclarations: <br />Denx)lilion Pcrnrils-Asbcslos Nolification Fcdcral Rcgulation\ ('l itlc 40. l,at16) <br />_Rcquircd [,cttcr ol Notilicalion <br />_l cenity lhal thc fcdcral rcgulations rcgarding astEslos rcnx)val arc nol applicablc b this pmjcct. <br />_l ccnify that I have rc0d this application and slatc that thc otnlc inlormuliul is I Bgrc lo comply wilh oll City and County <br />ordinrnccs and Slatc Lrrvs <br />above ,ncntioned propcny for <br />Applicant or Agcnt <br />Pcrrnilcc nrntc <br />ol this City rnd ulnn thc