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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS 0\\'NI1R BU I I,DER DEL('ARA'I'ION <br />I hqcb affm unda pcnalty of pcjury that I m qmpt from thc ContEcloB' Liceroc [:w for thc following twr (Se.7031.5 <br />Bwiass urd Profcarion Cod!); Any City or Couay which rcquiro a pcmit to coBtruct. ahc. imprcvc doolish or npair uy <br />srucluc. pdor ro its isue, also EquiG thc applicmt for such pcmit ro 6lc a signcd statmat tha hc or shc b licqrcd pssaa <br />to thc povisiom of thc Contrctor'! Liccnscd L:w (Chspr6 9, Comdcing with Sction 7000 of Division 3 of thc BBiB ed <br />Prcfeions Codc) or thar hc or stE b qmpt th@from ud thc bssis for thc allcgcd aoption. Any violuion of SErion 7031.5 by 8ny' <br />applicmt for a pomit subjcls thc tpplic&t to s civil p@hy of rot morc th8 fivc hundrcd dollm ($500). <br />l!. u oma of thc Fopcrty, or my mployc with wag6 a thcir slc compesarion. will do tlr w* ad thr $rudrc is mt <br />iatardod or offccd foi slG (Sc.7044, BBiB ud Prof6sioB Codc: Thc Conlnclq's Liccrc taw do6 trot ,pply to u ow of <br />rhc prcpqty who bilds or improu thmn ad who do6 sh wrk himrclf or hmlf or thrcugh his or hcr om cmployccs, <br />prcvidcd tha uch improvqmt! c mt intadad or otH for eb. l[, how, thc hiklitts or impmwmrt is old within onc ]a <br />of orpl*ioa tltc Oma Builds will h8rc tbc hrdo of provirB thd hc or shc dil ot hiE or inprow thc popcry for thc prpo* of <br />sb). <br />_1 c omr of thc p(op6ty, m cxcluivcly ontracring with tienscd contraclon to snstsuct the Eojet (Sc. 7044, Build <br />ad Proftsim Codc: Thc ContnAor's LiccN Lrw do6 ml spply to m own6 of propqty who builds or imprcB lhcmtr. <br />sd who ontsrt! for such Foirls with a Contracto(s) limscd p$@t to thc Contrrctor's Lic@ [ry). <br />-l <br />arn exempt under Section-. B.P for this <br />Dere: Oi *l uorlo <br />I hercby alfirm under penalty of perjury one of the following <br />_l have and will maintain a Certificate of Conseflt to SelGksure for workgrs' compensation! as providcd for by Section 3700 of the <br />Labor Code, for the performance of the work for which the pernrit b issued. <br />_I have and will maintain workers' compcnsation insuranc€. as required by Section 3700 of the L:bor Code, for the pcrformance of <br />the work for which this permit is issued. My workers' compqsation insurance carrier and policy numhr arc: <br />Poticy Number: ExPires: <br />Et certiry that in the performance of the work for which this permit is issued. I shall not employ any person in any manner <br />so as to become subject to the work€rsr compensation laws of Californiq and agree that if I should become subject to the <br />wortcrs' compe$ation provisions of Section 3700 of the Labor Codq I shall. forthwilh comply with thosc provisions.. <br />WARNING: Failure to sccure work€rs' compensation is and and <br />cMl fines up to one hundred thousand dollars ($100.000),to the <br />attorney's fees. <br />LICFNSED CONTRACTOR r <br />DECIABAIIAN <br />I hereby affrm undgr p€nalty of perjury thd I am licensed und6 povision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />License Class: License Number: <br />('o rt I racl o t' <br />CONSTRUCTION LENDINC AGFNCY <br />I hEcby alfim unds paulty of pcrjury tha ilEc i! I ons(ruclb! knding agmy for thc pcfomc of thc wtk frr which thb psmit b <br />isucd (Sc. 3097, Civ. C.). <br />Lender's Address: <br />I hercby affirm under penalty of perjury one of the follorving declarations: <br />Demolition Permits-Asbestos Notil-rcation Federal Regulations (Title 40, PaI16) <br />-Required <br />Lrtter of Notification <br />-l <br />certi& that the fedcral regulations regarding asbtos removal are not applicable to this project. <br />ffil-t ccrti$/ that I have read this application and state that with all City and County <br />and County to enter uPon theordinances and State Laws relating to building <br />above mentioned property for inspcction purposes. <br />Applicant or Agent <br />Pennitee name <br />and <br />o*,otfz-ol zoz- <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. <br />Final Test <br />Meter Release It lt ./2 <br />FINAL )lal?{r|t oDfr/u4 M <br />Notes, Remarks, Etc.I I <br />Section <br />ll.r 1... <br />Datc: <br />/ <br />**nt k Naanext