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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 I nstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer ( <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type Il 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 />Final Test <br />Meter Release I I 1-- t <br />FINAL -7,1 9rD v\ry6' <br />II <br />,\ <br />-/ <br />I hsclry affm unda pcnalty of pcrjury that I m acmpt from the ContractoE' License lrw for th€ follorving IEen (Se.7031.5 <br />Buines od Prof*ion Code): Any City or County which requiG a pgrnit to coGtruct, alta. inprcvc dsrolish or rcpsir my <br />strucluq prior to its isumce also raquirB thc spplicmt for such pemit to filc 8 sigo€d starmot lhar hc or slE is licms€d plNut <br />to thc provbioN of thc Contretor's Licenrd t:w (Chapt6 9. Commcing with Sction 7000 of Division 3 of thc Busirc ad <br />Prcf*ionsCodc)orthathcorshcisqcmptthscfrommdthcbmisforthcallqcdqmption. AnyviolationofSelbnT03l.5bymy <br />applicant for a pcnnh subjcts thc applicmt to a civil pffilty of not morc the fivc hundrcd dollm ($500). <br />-1. <br />as owner ofthe propcrty, or my employees with wages as their sole comperuation. will do the work and the structure is not <br />intqrdod or offerod for sale (Sec.7M4, Business and Professions Code: The Contraclor's Licanse Law does not apply to an owner of <br />the propcrty who hrilds or impnoves thcroru md who does such wort himself or herself or through his or hcr own employees. <br />provided that such impnovarents dE not intendcd oroftrod for sale. I[, howcvcr. the hrilding or iryrovcnrent is sold within one ]€r <br />of complaion, the Orvner Buildcr will have the hrden of pnoving ttra he or she ditl not build or inprove the popcrty for the prnposeof <br />salc). <br />-1. <br />as owner of thc property. arn exclusively contracting with licemed contractors to construcl the pnoject (Sec. 7044. Business <br />and Proftssion Code: The Contractor's License Law does not applyto an owner of property who builds or improvcs thereon, <br />and who contracts for such projects with a Contracto(s) licenscd pursuant to the Contractor's Liccnse l,aw). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />l)qlo'Owner:__lue8KEis'corwrNsr -DECLARATION <br />one of the follorving declarations:I hereby affrrm under penalty of pcrjury <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as provided for by Section 3700 of the <br />Labor Code, for thc perfonnance of the work for which thc pennit is issued. <br />have and will maintain 3700 of the Labor Code.for the pcrformance of <br />work for which this and policy number <br />4 Itslzl <br />_l cerri& 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 bccome subject to the workers'compensation larvs of California and agree that if I should become subject to thc <br />workers' comporsation provisions of Section 3700 of the L^abor Code. I shall. forthwith cornply with those provisions.. <br />WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an onployer to oiminal paulties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of <br />Section 3076 of the labor Code interest and attorney's fees. <br />damages as provided for the <br />T TCENSFN CONTRACTOR <br />nrnLtrL{TtoN <br />I hercby affnm undcr pcodtyof ffiury tha I am licensad undcr provision of Chapter 9 (commancing with Scctbn 7000) of Division 3 <br />of the Business and Profcssions Code, and my license is in full force and effect. <br />Nunrber:C-eo <br />(lontraclor:3 <br />W <br />t hotby affim unda pcnalty of pajury tha th@ b I oonructios kding rg6cy for thc pqfoffic of thc wrk for which this psmit b <br />bsu.d (56. 3097. Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPI ICANT NECL^ RATION <br />I hor*yatrrmunder penalty of perjury one of the following declarations: <br />Dcmolition Permits-Asbeslos Notification Fedcral Regulations (Title 40. Pafi6) <br />-Required <br />Later of Notificaion <br />-l <br />certi& that the federal regulations regarding asbestos removal are not applicable to this project. <br />certi$that have read this application and state that the above informatit'rn is correcl. I agroe to comply with all City and County <br />rreptresentativcs of this City and County to enter upon theandStateLaws rclating building conslruction. <br />above rncntioned property for inspection purposcs. <br />Applicant or Agent <br />name <br />and hereby authorize <br />?-O o <br />Notes, Remarks, Etc. <br />Numrrer: qI-GA {QB I <br />(- <br />Applicant:1 <br />=