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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hoeby affm undq pdalty of pqjury thst I m exmpt fipm the Contractors' License lrw for thc following rcen (5(.7031.5 <br />Buins and Profwion Codc): Any City or Couty which requirB a panit to conslrucl, alt6, improvq dqnolish or r.pair ey <br />structue. prior to its isuacc. also rcquirc the applicmt for such pcanit to filc a sigDed stalmmt that he or slrc is licffcd pusuut <br />to the provisioB of the Contractor's Liensed Law (Chapts 9, Commencing with Section 7000 of Division 3 of the Businos ud <br />Prcfsions Codc) or that he or she is excmpt thqcfrom ud thc b€sis for the allcgcd exmption. Any violation of Scclion 703 1.5 by my <br />applicmtforapmitsubjatsthc applicuttoacivilpenaltyofnotmorethefivehundreddollus($500). <br />_1. a omc ofthc trop€rry, or my employe with wags re thch rclc comperoation, will do thc wrk and thc stnrctm is rct <br />intqdcd or offqcd for salc (Se.7044. Buine ud hofessiom Codq Thc Contrsctor's Licoc hw doc not apply to m oM6 of <br />thepropqry whobuildsorirryroGth@!LmdwhodoGschwrkhimsclforhmclforthrcughhisorh6oMmploy6, <br />providcd that such imFovmf,ts rc not intqdcd or offqed for sle. If. howwq. the huilding or impovmot is rcld wilhin one yw <br />ofcompt*ion. thc Owno Buildq will have thc btrda ofproving tha hc or slrc did not hrild or imprcve tlrc popoty for the purpos of <br />sle). <br />_1. o omo of thc prcpdty. m exclusivcly contracting with licrued contractoEto coNtruct the projccl (Sc. 7044. Buine <br />md Profission Codc: The Contr.ctor's Liccnse Law do6 Dol apply to m own6 ofpropfty who builds or improves ths@n, <br />ed who conlmcls for such projects with a Contmclo(s) licscd pu6@t to the Contmctor's Licw Law). <br />I m cx@Dt udq S6tion , B. & P.C. for this rmn. <br />Date:_ Owner: <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hoeby affum undo poalty of pojuryooe of the following drcluatioro: <br />_l havc md will mintain a Ceaifrcarc of Cosqt lo Sclf-lnsuc for workcrs' compenstioq o povidcd for by Setioo 3700 of thc <br />trbor Codc, for thc pofomce of thc work for which thc pamil b isucd. <br />**;;and will main(ain workers' comp.Nation iNuilcc. 6 required by Setion 3700 of thc Labor Codc, for the pdfomuce o[ <br />for lhis E workas'imurucc crio od policy numbo rc: <br />ZPolicy <br />_l cdiry that itr thc pqfomoce of thc work for which this pemit is issucd. I shall not mploy my p6son io ey muo6 <br />s dtob6omesubiGltothewori(s'amposationlawsofCalifomia,udagrrcthstiflshouldbcomcsubjGttothc /workc' compostion prcvisiom of Setion 3700 of the kbor Code I shall. fonhwith comply with thoe prcvisiore.. i <br />WARNINC: Failurc to wue workm' compmation covmgc is unlawful. md shall subjet m mployo to qimhal peflahiG ud <br />civil fines up to onc hundred thoMd dollffi ($100,000), in addition to the cost of compcMtion,dmage o providcd for the <br />Strtion Labor Code interGt @d <br />1^> <br />I ICENSED CONTRACTOR <br />DEC!.ABAIION <br />I hwby aIIm unda p<ralty of pdjury thd I m licoscd unda povision of Chaptc 9 (comsciDg with Scctioo 700O) of Division 3 <br />of thc BEine ed Profsio6 Codc, &trd my licw is in futl force and cfTcct. <br />CONSTRUCTION LFITDING AGENCY <br />I h@by affm ud6 pcnalty of pcrjury that thqc is 8 construclioo letrding ag6cy for the poformcc of the work for which this pamh b <br />issued (Sa. 3097, Civ. C.). <br />Lender's Namc <br />Lender's Adcbcss: <br />ABIIJCANI.DECI.ABAIIAN <br />I botby affrrn unds panalty of pajury oac of thc following d*letions: <br />D@otition Pmits-Asb6tos Notifi€tio! Fcdqal Rcgulatiors (Titlc 40, Pan6) <br />-Rcquircd <br />l;ta of Notificdiotr <br />-l <br />cdiry that the fcdfial regulatiore rcgoding rbetos rmoval re not applicable to this prcjcct. <br />futhatt havc red this application md state that the above infomation is corect. I agr6 to comply with all Citymd County- ordinmce ud Statc taws relating to building constructio[ ed h6cby authorizc repr6@tariv6 of this City md Couoty to mtq upon thc <br />above mmtioncd property for <br />Applicmt or Agmt <br />Pmitenmc <br />*,", \ [?4 rzl <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 / 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 />, <br />Rouqh Mech..rM6 <br />Final Test I t- <br />Meter Release t/\ <br />FINAL \4L-w F,liLl{,} <br />Notes, Remarks, Etc.u\)