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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.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 <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 />Tvpe 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 />Roush Mech. <br />Final Test <br />Meter Release tl I .. /^t <br />FINAL (0 uu) I 'x ,nAu_*67 <br />Notes, Remarks, Etc.I trr <br />OWNER BUILDER DELCARATION <br />I hseby aflnn unda peulty of pcrjury that I m exempt from the Cohtractors' Liccnse law for thc followiog r@n (Se.7031.5 <br />Buinss and Profsion Codc): Any City or County which requirG a pqrnit to congruct, altc. improvc donolish or rcpair my <br />structuc, prior to its i$umce, also rcquirs the applicilt for such pcmit to file a signcd statmmt that hc or she is licereed pumuat <br />to the FovisioB of the Con[actor's Licensed t w (Chapt6 9. Commencing with Setion 7000 of Division 3 of lhc Busine ud <br />Prcf$ionsCodc)orthatheorsheiscxmptthqcfromadthcbasisforthcallegcdermption. AnyviolationofSdionT0Sl.5byany <br />applicmt for a pcmit subjats the applicmt to a civil penalty of not morc lhm fivc hundrcd dollus ($500). <br />-1. <br />c omr of thc propcrty, or my cmploym with wags r thcir plc competsation. will do tlp wod< md the stnrctw b oot <br />intodcd or olTscd for slc (Sc.7044, Buins ud Profasioro Code: Thc Contractor's Licere lrw do6 trot apply to s oM6 of <br />theprcpcrty whobuildsorimprovethmn adwhodossuchwrkhimselforhffielforthroughhisorhoorvoemployes, <br />providcd that such imFovflmts e not intmded or offsed for sle. If. howwq, $c building or improvmt is sld within one )s <br />ofcompldion, thc Owrs Buil&r will havc the hrda of proving thal hc or shc did rct build or imprcve thc ptopoty for thc purpo* of <br />ele). <br />_1, 6ows of the prcpqty, m exclsively coilracling wilh licsed contmctoE to construct thc projccl (Sc. 7044. Busins <br />ad Profosion Code: Thc Contrrctor's Licrue Lew do6 nol spply to e own6 of prcperty who buil& or improvB lhq@n, <br />ud who contrads for such projecrs with a Contmcto(s) licrued pusuilt to lhc Contrrctor's Licffe Law). <br />-l <br />m crmpt uds Sation-. B. & P.C. for this r6on. <br />Dal(:()N ilcr. <br />rvonkrrrs' t olu,t,;ls,rlt<lt <br />t)lt( l,AItA I loN <br />onc oIthc follo* inu clcrlar aliorrs:I hseby affirm unds ponlty ofpajury <br />-l <br />havc md will maintain I Cqtificate of CoNmt to Self-lBure for workers' conrpensation, r providcd for by Sstion 3700 of the <br />labor Code for thc pqfomilcc of thc work for which thc pannit b issucd. <br />_lhaveandwillmaintainworkers'cornpcnsationireurmce,u rcquircdbyS6tion3T00ofthcLaborCode.forthepqfonnoceof <br />the work for which this pmit is isucd. My workeru' compsstion i$urmce wio ad policy numba ucr <br />Policy Nurnbs: Expira: <br />- <br />_l ccrtify that in thc perfomruce of the rvork for which this pmit is issued, I shall not mploy any pmon in any mmnr <br />e 6toberomesubjettothcworkm'compmsationlawsofCalifomia,mdagrethaliflshouldbecomcsubj6ttothc <br />workc' compamtion provisioE of Sdion 3700 of the trbor Code. I sh8ll. fonhwith comply with thos provisios.. <br />WARNINC: Failure to secue workers'compeosation covoage is unlawful. md shall subjat an onployr to qiminal pqraltie md <br />civil fins up to one hun&ei thownd <br />Sction 3076 ofthe Lebor Codq intoBt i <br />($100.000). in addition to the cost of compemation. dmages o provided for the <br />md ''s fe.,**{ to- lt <br />I hrcby affmundr paallyof psjurythal I m licmed mdr povision of Chaptq 9 (comocing with S€tiotr 7000) of Division 3 <br />of thc Buho ud PrcfsioN Codc, md my licce is in full force ard cffet. <br />License Nurnbs: <br />o"t", OY <br />I hrcby affrm under penalty of pcrjury coosruction loding ag6cy for the pofommce of thc work for which this p6mil is <br />issued (Se. 3097, Civ. C.). <br />Lender's Name <br />Lender's Addr6s: <br />AIEI.JCANLDEC!.ABAITAN <br />I ha*y aftm undo poalty of pcrjuy onc of lbc followitrg dckations: <br />Demolition Pmits-Asb6tG Notilication Fcdml Rcgulations (Title 40, Pan6) <br />-Rcqutcd <br />trtto of Notificarioo <br />that the HodrcgulatioN regildin8 Bbetos rmoval{e not applicable to this prcjrct. <br />I hare read this thal the above infomation is concct. I agre to comply with all City and County <br />Laws hseby aulhorte reprBmtativB of this City md County to st6 upon the <br />t <br />above <br />or <br />propsty