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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG GOMMENTS Om6-Build6 D*leadon <br />I hcrcby allim undcr poalty of pcrjury th8t I m cxmp fm thc Cfirstm' Limrc Lrv fd rhc followitrS Bo (s.7031.5 Buincss <br />and Prcfsion Codc): Any City tr County which rcquirc a pcmit to mstsuct slt6. impovc, deinolish or rcpair Dy structurc, Fitr to its <br />i$uocc, also rcquic thc .pplicmr ftr such pcrmit to filc a signcd ststmot thrl hc s shc is licmscd pummt ro thc prcvisionr of rhc <br />Contrutor's Lienscd Law (Chapts 9, Commocing uith Setio 7000 of Divisiil 3 of thc BuinB ild Prcf*ions Codc) or that hc or <br />shc is cxmpt thcrcfrm ud thE b6is fd thc rllcS.d qmpiion .Any violrtion of Sction 7031 .5 by ey rpplimt fa . pcf,it lubjetr thc <br />spplicat to I civil paalty ofoot morc thu fivc hundrcd dollm (S500). <br />_1, c owtra of thc p.opcrty, or my mployccs with w.tcs s thcir solc ompcnsatim, will do thc work sd thc strudurc is not intcnd€d <br />or offqcd fs salc ( Se.7044, Bsin* ud Prof6ifis Codc: Thc ConF&ts's Licffic Law dG noa apply to u own6 of $c p.opcror <br />who builds or impovc thcm, ud who dc such wqk himclf or hmlf o thrugh hi: r hcr om mployc, Fovidcd that ruh <br />improvmmts m not itrtcndcd or otrcrcd fs sdc. lf, howcs, thc building c imprcvmot is sold within onc ytr of omplction, thc <br />Omq-Buildcr will havc thc burdrD of proving that hc or she not build o improvc fr thc purposc of salc). <br />_1. a omr of thc propcny, m acluivcly @ntrrctin8 with licarcd cotrrctos to c@struca thc prcjet ( 56. 7044, Buinsi ed <br />Prcfsio Codc: Thc Cotnctq'r Licarc Lrw dG not spply to u oma of propsty sho builds q imFov6 thffi , md who <br />coarets fs such projcB wi& I Cotr*tq(s) lifficd Fmwt to thc CoEetor'3 Lircnsc hw.). <br />_l am exempt under Section & P.C. for this reason. <br />Datc: Own6: <br />W9RKERS COM PENSATTON pECLARATTON <br />I hereby alTirm under penalty of perjury one of the following declarations: <br />lhavcudwillmaintainaCcrtificarsofConsenttoSclf-lnsurcforwortm'compcnsation,r providcdfcbyScction3T00ofthc <br />3700 of the Labor Codc, for thc pcrformance of thc <br />policy numbcr are: <br />Policy t.K <br />(This scction complcted if thc permit is for One hundrcd tstoq or less)rnot <br />_l certify that in the performance of the work for which this permit is issued. I shall not employ any person <br />bccame subject to the workcrs ' compensation laws of California, and agrce that if I should bccomc subject to <br />in any manner so as to <br />the workcrsr I <br />compensation provisions of Section 3700 of the Labor Code, I forthwith comply those <br />a <br />WARNING: Failurc to seurc wortm' ompcnsation ovaagc is ulawful, ud shall subjet u mployr to eiminal pcnalric md civil <br />fina up to onc hundrcd thoMd dollm (S 100,000),in sddirio to thc 6t of cmpcnsstion, &magc u prcvidcd fa hc Scrio 3076 of <br />thc Lsbor Codc, inrffit ad anomcy's fce. <br />LICENSED CONTRACTORS DECLARATION <br />I hcrcby affim undo pcmky ofpcrjury that I m licmscd und6 provisim of Chagtr 9 (commcncint wirh Sction 7000) of Division ! of <br />the Business and Professions Code, and my liccnse is in full force and effect. <br />License License <br />Date. <br />CONSTRUCTION LENDING AGENCY <br />I hcreby affirm under pcnalty of perjury that there is a construction lending agency for the performancc <br />issucd (Sec. 3097, Civ. C.), <br />of the work for which this pcrmit is <br />Lender's Name: <br />Lender's Addrcss: <br />APPLICANT'S DECLARATION <br />Demolition Permits-Asbcstos Notification Fedcral Reguluions (Title 40, Pert 6) <br />_ Required Lctter of Notification <br />_tjFtliry fiat the fedml rcSuldiom rc8editrg ubcro moval rc not pplicsblc ro this projet. <br />tZ I ccrtify thlt I hsvc rad this rpplicaio Dd trrrc ihd thc $ow infmatio is mt. I .8re to conply with all City ud Cunry <br />ordinuc ud Sarte Lrvr rcluing o building onrructim. ud hcrcby ruhoriu rcpradtativcs of thir City ud Conty to amtcr upon rlc <br />Applicant or agent <br />Permittce niune (print): <br />inspection <br />20Y <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation <br />Smoke Detectors Installed <br />Rough Ductwork <br />Vents <br />Toilet Room / 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 />Final Test <br />Meter Release <br />FINAL <br />- <br />a Contractor: <br />a =