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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Appliances <br />lVleta! Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[t/isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room I Clothes Dryer <br />Residential Range <br />Other \ <br />Hood <br />Tvpe I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL ,-lv'h t- Ul >r'-t?J*5 w\Y <br />Notes, Remarks, Etc. <br />t <br />\. <br />\ <br />I hercby affirm undcr pcnalty of Frjury thst I m cxcmpl ftom lhe Conlrsclo$' Lhens Law for ilr following rcssn (Stc.7031.5 <br />Busincss ard Prcfession Codc): Any City or County which rcquircs o permir lo @nstruct, altq. impEvc. dcmlish or Epsir any <br />structurc, prior to its issusncc. d$ rcquircs the rpplicrnt for such lEmit to lilc I sigred stslercnt thsl lE or slte b lien$d puNant <br />lo the ,rrcvisions of tlE Cootractfi's Lhensd bw (Chaptcr 9, Commrcing whh Setion 7fi)0 of Division 3 of lhc Busircss md <br />Prcfcssions Codc) or that hc or shc is cxcmpt thwfrcm snd the basis for the ellcgcd ercmption. Any viol8tion of Selhn 7031.5 by sny <br />applicont for 8 pcrmit subjcrts ttE applicf,nl to 8 civil pcnslty of not mrc than fivc hurdred dollus ($500). <br />-1. <br />as owner of the prof,crty. or my employces with wages as thcir sole compensalion. will do thc work and thc strrcture is rmt <br />intcnded or offered for sah (Serc.7044. Busincss and hofcssions Code: The Contractor's Liccnsc [-aw docs not aPply to an owncr of <br />the proprty who b,uilds or inrproves thcrcon. and who drrcs such work himself or herself or through his or her own cmployees. <br />providcd that such improrrcnrcnts are not intended or offersd for sah. lf. howcver. thc building or inqnovenrnl is sold within onc )car <br />of conrpletion. thc Owncr Builder will have thc burden of proving that hc or shc did not build or improve the propcrty for the purpse of <br />sah). <br />_1. as owner of the pmperry. am cxclusivcly contracting with liccnsed contraclors lo conslruct thc project (Scc. 7W. Busincss <br />and hofesshn Code: Thc Contractor's Liccnse Law docs nol apply to ttn owner of propcrty who builds or improves thereon. <br />and who contracts for such projccts with a Contracto(s) licenscd pursuant to lhe Conlraclor's Licensc kw). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />I)tle: <br />WORKERS' CONIPENSATION <br />DECLARATTON <br />I hcreby alfirm undcr pnalty of Jrcrjury one of thc following declarations: <br />_l have and will maintain a Certificate of Consent to Self-lnsurc for workers' comlrcnsation. as provided for by Section 3700 of the <br />Labor Code. for the performance of thc work for which the permit ts issued. <br />-l <br />have and witl mainlain workcrs' compnsation insurance. as requircd by Section 3700 of thc labor Code. for the pcrformancc of <br />thc work frrr tlris is issucd. My workcrs' compcnsalion insurance carricr zuxl plicy numbcr arc: <br />_l certify that in the pcrformancc of thc work for which this pcrrnit is issucd. I shall ttot cmploy any pcrson in any manner <br />so as lo bccomc subjcct to thc workcrs'comJrcnsalion laws of California. and agrc'c lhal if I slxruld hccome subject to thc <br />workcrs' compcnsation provisions of Scction 37fi) of the Latnr Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure to sccure workcrs' compcnsation covcrage is unlawful. and shall subjcct an employcr to criminal penalticx and <br />civil fines up to one hundred thousand dollars ($100.000). in additkrrr to thc cost of cornpcnsution. damagcs os providcd for the <br />of L-abor Code. inlcrest and allorney's <br />LICENSFD C(IN'I'RACTOR <br />DFCLAR,\'TION <br />I hcrchy atlrrn under pcnalty of pcrjury that I am liccnsctl urrdcr provision ot'Chaplcr 9 (cotnnrcncing with Scctiott 7(Xru) of Division .1 <br />of thc lrxl c'll'cct.le3DE- <br />W <br />I hcrchy allirn uodcr lEnnlty ofFrjury thal thcrc is a conslruclion londing {gctrcy li)r lhc pcrl(trmilncc ofthc work for which lhis tf,,nlit is <br />issucrl (Sec. 3097. Civ. C.). <br />hndcr's Nunrc: <br />I-cnder's Addrcss: <br />APP, ,.ANT IrFCI {*..'.,* <br />I hcrchy affinn undcr pcnulty of pcrjury onc of thc following dcclaratiorts: <br />Dcnmlition Pcrnrits-Asbcslos Notificalion Fcdcral Rcgulations (Titlc -10. Parl6) <br />-Rcquircd <br />lrttcr of Nolilication <br />-l <br />ccrtily thal thc fcderal asbcslos removalarc nol applicable to this projcct. <br />_l ccrtify that I have rcad this is corrcct. I agrc.e lo comply with all City and County <br />ordinanccs and State [:ws ol'this City and County to cntcr uJxrn thc <br />,ru,",fl^l?-)a> <br />ahovc mcntioncd propcrty for <br />Applicant or Agenl <br />Pcrrrritcc narrrc <br />slllc thll <br />representativcs <br />Orvner: <br />frrfi-et/0hI <br />Fevc Ifue:J9)Q Applicant: <br />of,.