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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.a COMMENTS ()11'NI'llt ltt,ll,l)Elt l)l'll,CAR,\ l'l()N o <br />I hcrcby affrm undcr Fnalty of pcriury lhal I m crcmpt fDm thc Conrrclotr' Lbe[s lrw for th€ following emn (Se.7)31.5 ., <br />Bwincss 8nd Prcfession fuc): Any City or County which rcquircs a permit lo @nslrucl. alto. itr{rrcrc. dcmlish or rspsir any <br />structurc. Fior to its issuance. alm rcquircs the applicant for such JErmil to Iilc 0 si8rcd statcmnl that lE or she is liccnsd puMt <br />to th€ prcvishns of ilE Contrctor's Lien*d txw (Chrptcr 9, Commrcing wilh SNlion 7000 of Division 3 of thc Busimss and <br />Prcfessions Codc) or that hc or shc is cxcmrrt thercfrcm and the basis for the allcgcd ercmprion. Any violslion of Srcibn 703 1.5 by 8ny <br />.pplicant for I permit subjets the applicant to I civil penally of not mrc lh8n live hundrqd dolrs ($500). <br />_1. as o\r,ncr ()l'thc proprty. or tny cnlployecs wilh wagcs as thcir solc contpcnsiltion. s'ill do tlrc u'ork and tlrc struclurc is nol <br />intcntlcd or oll'ercd lor salc (.Scc.7Gl4. Busilrcss und ltofcssions C<xlc: 'Ihc Cotrtraclor's l,iccttsc [,arv does not ilpply lo an owner o[ <br />thc pnrJrcrly who builds or irnprovcs thcrcrrn. and who clocs such work hinrself or hcrsclflor lhrough his or hcr owlt cntplttyccs. <br />providcrt that such inrJ:rovcrrcnts arc not irrtcmlc.rl or olTcrctl lirr salc. lf. hos'cvcr. tlrc building or imJrnx'cnrnt is sold within ()llc vcar <br />9l'cgrnlllction. thc Owncr Buitdcr will havc tlrc burrlcn of proving that hc or shc did rrol huiltl or intprovc lhc pnrprty fbr thc pttrJxrsc ol' <br />sulc). <br />_t. as ()w,1cr ol'thc propcrly. arn cxctusivcly contracting with liccnscd conlrirclors lo c()tlslruct ltrc projcct (Scc. 7(X'1. Busiltcss <br />antt Pnlll.ssielCodc: 'l'hcConlractor'sl,iccnsct.awdocsnotapplyloanowncrofpropcrlyrvhohuildsorintprovcsthcrcon. <br />arrd whg contracts l'or such projccts with a Contractor(s) liccnscd pursuant to lltc Conlractor's l-iccltsc Law). <br />-l <br />am cxcmpt under B. & P.C. for this rcason. <br />l)ale:0wner:woRxr'ffiron <br />DEgI.ABAUON <br />I hcreby alf irmuntlcr pcnaltyof perjuryonc of llte lirllowing dcclaritliotts: <br />_lhavcandwill lruintainaClcrtificatco[ConscnttoSclt'-lrrsurclorworkcrs'cotnpcnsation.as provitlcdforbySccliott.lTfi)ot'lhc <br />t-ubor Codc. for thc pcrfrrnnance of lhc work lirr which thc pcnnit is issucd. <br />_l havcandwill lnaintainworkcrs'conrpcnsationinsurancc.as rcquircdbyScclion3Tffiofthcl-aborCodc.forthcpcrfonnancco[ <br />thc work tirr which this pcrnrit is issucd. My workcrs' cornpcnsatiott insurancc canicr and policy nutnbcr arc: <br />l'olicy <br />_l ccrtifythat in the pcrformance of thc work for which this Jrcrnrit is issued. I shall not <br />so as to hccomc subjcct to the workcrs'compensstion laws of California. and agrcc that if I subjcct to thc <br />workers' comgrcnsation provisions of .Scction 3700 of thc [-atxrr Ccxlc. I shall. forthwith comply with lhose pnrvisions.. <br />WARNING: Fuilurc to secure workcrs' compcnsation covcragc is unlawful. and shall subject an employcr to crilninal pcnalties and <br />civil fincs up to onc hundrcd thousand dollars ($100.000), in addition to the cost of compensation. damages &s provided for the <br />Scction 3076 of thc L,ittnr Codc, interest and attorney's fees. <br />LICIiNSIID C0N'I'RAC'tOR <br />I)ECI,AIL\'TI()N <br />I hereby affrm undcr pcnalty of perjury that I am liccnsed under provision of Chaptcr 9 (comnrncing with Sc'ction 7m0) of Division 3 <br />oI thc I]usincss alrd Profcssiolrs Cotlc. and nty liccnsc is in full forcc and cffcct. <br />( 'oltl rlrt'lor <br />W <br />I hcrcby allirm undcr fEnalry of Jrrjury that thcrc is a mtrsrruction lcnding agcmy for lhc Jrcrformmc of thc work for which lhis lErmil is <br />issucd (Scc..1097. Civ. C.). <br />Irndcr's Namc: <br />- <br />lxndcr's Addrcss: <br />ATI'.I':ANI.PE :I.ABAIIIN <br />I hocby aflm undcr pnalty of pcrjury orc of lhc followinS dslarations: <br />Dcmlition Pcrmits-Asbeslos Notificstion Federsl Rcgulslirns (Tide ,10, P8n6) <br />-Rcquircd <br />Lrltcr t f l{<rtifstion <br />-t <br />enify that thc federal rcgulations rcg&ding osbcstos rcmval8rc not applicable to this pmjcrct. <br />-l <br />ccfify that I havc rcad this spplicslion aod st8tc that thc aborc infomtion is coml. I sgrE to otrlply wilh sll City snd Counly <br />ordinarccs snd State Lays rclating to building construction. snd h€rcby ruthorizc Eprcsnt&tiws of this City 8nd County to cnls qnn the <br />aborc rcntioncd prcpcdy for inspcction purposcs. <br />Applic0t or Agcnt Sigmturc: Dsle;- <br />Psmilce nom (prinl)i- <br />Appliances <br />lVletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />JVlisc. Equipment <br />Duct Work <br />Pre- lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type Il 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 />Rouqh Mech. <br />Final Test <br />Meter Release I <br />FINAL tl't )c lbailn{a {rl <br />Notes, Remarks, Etc <br />Carrier:-