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MECHANICAL.!NSPECTOR RECORD <br />APPROVALS DATE lD/slG COMMENTS OWNER BUILDER DELCARATION <br />I h6cby affim und6 poalty of pqjuy that I m exmpt &om thc ContrrtoB' Licmsc lrw for thc fotlowing r@n (Sc.7011.5 <br />Busines ud Profsiou Code): Any City or County which rcquiro a pomit to congruct. alta. improvc. dmol(h or rcpai; m.v <br />srucl[q prior to its isumce. also rcquirc thc appli@t for such pcmit to filc I sigocd sratmmt that Mor she b licrucd puNar, <br />ro thc provisioN of th€ Contretor's Licmscd law (Chaptr 9. Commcing with Setion 7000 of Divisior3 qf the Bsins and <br />PrcfesionsCodc)orthathcorshciscxmptthqefrommdthcbssisforthcallcgcdaoption. AtryviolstionofSctionT0Sl.5bymy <br />spplicet for I pfinit subjets thc applicet to a civil psnally ofnol mor€ thm livc hundrcd dollds ($500). <br />_I. d om6 of the Foperty. or my cmployc with wag6 6 their sle @mptrdion. will do the wort ad thc structue is not <br />intmded or offscd for sle (5@.7044. Busine md ProfesioN Codc: Thc Contnctor's Licce Law do6 nol apply to m owns of <br />the prcp€rty who builds or imprcvc thmn md who doc such work himself or hwlf or thrcugh his or ho om employee. <br />providcd that such impovsnmts rc not intqdcd or offqcd for sle. lf, howws. the building or imprcvmt is sld within one )6 <br />of omplaion, thc Ownq Buildq will hsvc thc hrdo of poving tha he or shc did rct tuild or imgrove 0rc popcty for the purpos of <br />ele). <br />_1. c omo of the propqty. m crclGivcly contracling with licscd contracloBto coBlruct the prcj<<t (Se. 7044. BEins <br />md Profesim Code: The Conlractor's l-icensc Law do6 not apply to m own6 ofprop€rty who builds or improvs thqsn. <br />and who contracts for such projeds with I Contrac,lo(s) licqscd puN@t to the Contractor's Licmc Law). <br />I m excrnDl undd SKlion P.C. for <br />D.t", llzblll <br />I hocby affim unda pqaltyofpdjury one ofthe deltratioB: <br />_l have md will maintah a Csdificatc of Commt to Sclf-lBure for workos' compwtion, o povidcd for by S€tion 3700 of thc <br />tabor Codc, for thc pqfommcc of the work for which thc pmit is issucd, <br />_l havc md will maintain workc' compcruatioo imumcc. s required by S*tion 3700 of thc t bor Codc. for thc pqfonmcc of <br />the uork for which this psmit is iscd My workc' compo'uation imumcc cuic md pnlicy numbo rc: <br />p"ri.y N,,b*, ? k'trttDl <7OG I lc. l-Expire: <br />_l cenify that h thc p€rfomcc of thc work for which lhis p6mit is issued, I shell oot mploy any pmon in any mone <br />rc o to baomc subj*t to thc work6' compcnsdion laws of Califomia ed agre thal if I should beomc aubj€t to thc <br />workc' compostion prcvbioro of Setion 3700 of the kbor Codq I shall. foahwilh comply with tho$ prcvirioru.. <br />WARNING: Failurc to wue work6'composation covmgc is unlawful. ud shall subjct m mployo to siminal penatiG ed <br />civil fines up to one hundrcd thousand dollm ($100.000), in addition to thc cost of compereation, damagcs as provided for the <br />Sfition 3076 of thc Lrbor Codc. intqst md attomcy's fc. <br />LICENSED CON'I'RACTOR <br />DECLARATION <br />I hoetry alfirm under psalty of perjury that I an licmsal under prl)vision ofChapts 9 (comrnencing rvith Scrtbn 7000) of Division 3 <br />of the l]usinss and Proiessions Code. and rny licmse is in full force md ell*1t. <br />1tz12LLicenseNumbs: <br />I hereby affirn undo pnalty of perjury that lhqe is a conslnrclion lcnding agency for lle po forililce ofthc work {irr rvhich this prrnit is <br />issued (SN. .1097. Civ. C.). <br />lrod6's Nam.: <br />Igrds's Ad&es: <br />APPLICAN'I' DECLARATION <br />I horbyaffmn undo penalty ofperjury one ofthc following dalaations: <br />Demolition P6ftils-Asbctos Notification Federal RcgulatioN ('l itle 40, Part6) <br />-Required <br />lata of Notificatiod <br />-l <br />cdiry thr, thc fcdoal rcgularioro rcgrding obetos rmovd uc not appticsble to this prcj€t. <br />-l <br />cdiry that I hsve r@d this application ud stdc that the abovc infomation is coffcct. I agre to comply with all City and County <br />ordinacB and Stale Laws relating to building corutruction. ild hscby authorizc rcprcmtarivs of this City md County to mts uJnn the <br />above menlioned property for <br />Applicilt or Agot oa, l\zul t1T -r- <br />Pmite nane (Frinl <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 />Rough 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.6'Zb-P?fr ft2 7 <br />FinalTest <br />Meter Release <br />FINAL 5--25-zoz,) E,A gtt:€.zzt s a 7 <br />Notes, Remarks, Etc. <br />o.r,, l lzulll <br />o"",1lzull-