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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNf,R BUILDER DELCARATION <br />I hcctry aflim unds pmalty of pfijury thd I m qempt film the Contraclos' Licmc Law for thc following r@F(Ss.7031.5 <br />Buinss ild hofsion Code): Any City or County rvhich requir* a pemit lo construct. alt6. improvc. dmolish or rtpair my <br />structuc prior to its issumcc. also require thc applicmt for such pcnnit to file a signed statmql thst hc or drc b licosed pusant <br />to the provisio8 of thc Contractor's Licosed larv (Chapl6 9. Commencing with SEtion ?000 of Division 3 of the Busine md <br />Prcfsions Code) or that he or she is cxmpt thocfrom ed lhc basis for the allegcd crmption. Any violation of Sccrion 7031,5 by any <br />applicant for a pcmit subjets thc applicant to a civil pcnalty ofnot morc the tive hundred dollus ($500). <br />-1. <br />6 o*Ts oflhe propcny. or my mployc with waga r thcir rclc compostion. will do thc wck ed thc stnrlw b rct <br />inlodcd oroffqed for sle (Se.7044, Busins ard hofesiom Code: Thc Contnctor's Licmc law doc oot apply to m olvnd of <br />lhc pDpcfly who huilds or irnprcvc th@n. ed who do6 such $ork himsclf or h€rclf or thrcugh his or ho orw employe. <br />provided that such imprDvmB Ee rct intodcd or offqcd for slc. lf. howa.6. thc building or irnprovmt is mld withio onc )s <br />ofcompletioc thc Omq Buildq will havc thc hldo ofptoving that he or shc did not build or improvc thc prcpsty for thc purpo$ of <br />slc). <br />-1. <br />s own6 of the propsty. atr cxclusively contracting with licmsed conlractoE to consrud the projcct (56. 7044. BBin* <br />md PrefesionCode:TheContraclor'sLicflscLawdo6notapplytoanownsofpropeflywhobuildsorimprovesthq6n. <br />and who contracts for such projsts with a Contracto(s) licensed pursuilt to the Contractor's Licmsc Latv). <br />I anr c\cnrpl undcr Sccli()n . lt. & l'.('. li)r this rcason. <br />Owtrer: <br />WORKERS'COMPENSATTON <br />DECLARATION <br />I hocby affirm undo pmalty ofpcjury one ofthc follorving daluations: <br />-l <br />have ard will maintain a Ccttificate of CoMt lo SclfJNurefor workm' compmation. I providcd for by Setion 3700 of thc <br />L€bor Codc. for thc pqfol]rlmc of thc wo* for which thc pamit b issucd. <br />_l havc and will maintain -1700 of the tabor Code. for thc pqfomucc of <br />lhc uork for shich this od policy <br />p<rlt,..,|cq <br />Policy "u I <br />-,1 ceniry that in the psformmcc of the rvork for rvhich this issued. I shall not mploy any pemon in any manno <br />and agre thst ifl should become subjat to the$ G to bccome subjet to lhe work6'compcnsation laws <br />IYARNING: Failure lo ssure workss'compensalion coverage is unlarvful. and shall subjecl an mployr to siminal poaltiB and <br />civil fines up to one hundred thousand dollam ($100.000). <br />Sstion 3076 of the lnbor Code. inlsst and attomcy s f6. <br />in addition to the cost dmagcs re provided for the <br />.lc- lr <br />I hcreby allim unda pmalty ofp€rjury thal I m licoscd of Chapts 9 (comqcing with Scction 70(x,) <br />, <br />"rr}r, <br />Iof the Busin* dd Profsiom Codc. md rny licosc is in full force ed effect. <br />,EszstqILiccnsc Nunrlu' <br />(l^-} <br />I hcrcbr allirnr rntls penrlty ofgrcrjury that thuc is r <br />issu.d (Scc. l0r)7. ( iv. (.). <br />l.cnrlcr's Narnc: <br />a8ocy for the ptrfommcc of the rvork for rvhich this pcmit is <br />Lends s Addrs: <br />APPLICAN DI:('LARA'IION <br />I lut{r1 allirrn undo penally ofpojury one ofthe folk)$,ing de.larations: <br />DcnNlilion Permils-Asb6los Notilicalion lredsal Regulalions ( l illc 40. t an6) <br />Rcquircd Letts of Nolil'icalion <br />_l celifythal the lldqalregulatiore rcguding cbstosrmovalrc nol applicable to this prejcct. <br />-l <br />cdi$/ that I havc r@d this applicalion sd state that with all City and County <br />ad Countyto mt6 upon th€ordinancs and State lass rchting to building <br />above lnmtioncd prcp€ny for <br />Applicant or Agst <br />Pmitenme <br />Noe _*," - B-(6-(( <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation ql 9lV4 14 ,L.{tl c/l q) <br />lnsulation <br />Smoke Detectors lnstalled <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 />It <br />Roush Mech. q/< hq Phs'7-?>ury <br />Final Test tt - , ,f <br />Meter Release --n <br />FINAL ,1/77?t //.J;U @ <br />Notes, Remarks, Etc. <br />-+ <br />I)n(ei <br />A /e. <br />- fl-, <br />License('las: U <br />o",", . 81( 6r H (intrlctor !L <br />l