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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 I Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Fina! Test <br />Meter Release lt A' <br />u.frukAFINAL lll|slzo W\tu-]Llu 7Ul <br />Notgs, Remalks, Etc. ; / ,lt-A,tO, <br />tht<J/i pl{Luqttlryr hs,lsFrr / H UltJ 1il4(-/ <br />()}VN I.:R I} TI I I,I)I.:R <br />I hcrcby afiim urdr penslty of Frjury thal I m eremJ,l hom the Contrrctm' Lkrns tlw for thc folbwing ftamn (Scc.7031.5 <br />Buriness and Prcfession Code): Atry City or County which rcquires r Jrmit to @nstruc{. rlt6, itrprcrc, demlish or rrlah my <br />Btructw. lrbr to its issurec, als rcquircs tha spplicml for such pemit to lile 8 sigred ststemnt thlt he or shc b lieosd plN8nt <br />to lhc pmvisioN of tlt Contrcttr's Lienscd [rw (Chaplcr 9. Comrcing with Scclbn 7000 of Divisioo 3 of the Busircss and <br />Pmfessions Code) or thsl he q shc is €xerpt theGfrom 8td the bosis for thc rllegcd crcnpaion. Atry violdion of Setbn 703 I .5 by sny <br />applicsnl for I pemit subjc]s rhe spplic8nt to I civil pcBlty of mt mrc thsr liv€ hundrcd dollus ($500). <br />-1, <br />&! owmr of the pmpcrty. or my employees with wages s thcir slc compensstion. wil do the wort( 8d thc stlutuc ir mt <br />inteoded m offered fs sh (S6.7014, Buirc$ sd Prcfesrions Codc: The Contrrctor's Lkcns ky dcs mt spply to u owrcr of <br />lhe pmperty who boiu.s or inprcB tlson and who dm srch wrk hiroelf or hemlf or thrcugh his tr hcr own cmph,€es. <br />prcvklcd thal such inpmwnls @ mt irlcodod tr orfercd for sh. lf, howE thc buildirg or irprowreil ir sld uithio orc )qr <br />of strpletion. thc Owmr BuiHer will haw thc hlden of poving tlut he or drc di, mt huild or inprow thc pepqty fq thc pupos of <br />sle). <br />-1, <br />asownerof the property. amcxclusivelycontracting with liccnscd conlrectorsto construct thc project (Sec. 7W. Busincss <br />and Professbn Codc: The Contraclor's Licensc Law does not apply to an owner of propcrty who builds or improves thercon. <br />and who contracts for such projects with a Contracto(s) liccnscd pursuant to thc Contractor's Liccnse taw). <br />-l <br />am exempt under Scction- B. & P.C. for this rcason. <br />WORK EILS' CONI PENSA'I'ION <br />DECLARATION <br />I hcrcby affirrn undcr pcnalty of pcrjury onc of thc following dcclaratiorrs: <br />-lhavcandwill <br />nuintainaCcrtificatcofConscnttoSclf-lnsurctbrworkcrs'colrrpcnsation.as providcdftlrbyScction3T([ofthc <br />Lahrr C<xlc. forthc Jrcrftrrnmnce of thc work lirr which thc pcrmit is issucd. <br />and will mainlain workers' compcnsation insurancc. as required by Scction 3700 of thc l-abor Code, for thc Jrcrformancc of <br />work tbr this pcrmit issucd.insurancc carricr and plicy numbcr are: <br />J <br />Policy <br />'- l4rJZl <br />-l <br />ccrtify that in thc performance of the work for which this ;rcrmit is issucd. I shall not employ any lrcrson in any manner <br />so as to bcconrc subject to thc workers'comgrcnsation laws of California. and agrcc thal if I should be<orne subject to thc <br />workers' compensation pmvisions of Scction 3700 of the Labor Code. I shall. forthwilh comply with those provisions.. <br />WARNING: Failurc lo sccurc workcrs' compensation covcrugc is unlawful. and shall subjcct an cmployer to criminal pcnaltics and <br />civil fincs up lo one hundrcd thousand dollars ($1(X).0001, in addition to thc cost of comlrcnsation. damagcs as providcd for the <br />Section 3076 of the Labor Code, intercst and attorncy's fees.J-'At <br />o,r". I (-3 -k)1,.o <br />LICF'NSFN CON'I'RACTOR <br />DECLARTt'l'I0N <br />I hcrchy affirnr undcr pcnalty of pcrjury that I anr licenscd undcr pnrvision of Chaptcr 9 (conrrnencing with Scctiorr 70fi)) of Division 3 <br />of thc Busincss and Profc'ssions Codc. arxl rny liccnsc is in fbll frrrcc and cffcct. <br />72tt70 <br />Applicarrl or Agcnt ,,,". I l-3-Zo2€) <br />Pcrmilec namc tp,i^o, J fdy'4 s <br />Liccnsc Nurnhcr: <br />( 'onl r:rclrlr: -. rE <br />W <br />I hcrcby alfrm un&r Fnalty of pcrjury thal tlsc is I oNtruclbn lendhg sgcrcy ftr thc peIfoffie of thc mrk for whkh this Imil b <br />issued (56. 3097, Civ. C.). <br />lrnder's Nanrc: <br />lrnder's Addrcss: <br />^pH <br />,c^NT,r"u R <br />I hcrcby affinn undcr penalty of pcrjury onc of the tbllowing dcclarations: <br />Dcnrolition Pcrmits-Asbestos Notification Fedcral Regulations (Title 40. Part6) <br />-Rcquircd <br />lrttcr of Notification <br />-l <br />ccrtify thal thc tbdcral rcgulations rcgarding asbcstos rcmovalarc not applicable to this proict. <br />ccrtify that I havc rcad this applicalion with all Cily and County <br />and County lo enler upon thcordinances and State l:ws rclating to <br />abovc nrcntioncd property for <br />4 <br />l)ale:0wner: <br />WCooofvz O I Expires: <br />/? <br />G