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M ECHANICAL-I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Appliances Meta! Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Ranqe Other Hood Type I Hood ll- 17-?0 fZc o'3^)?A2, -Zrl Type ll Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release F!NAL /28-@ //Z Ctc.J c ?-a vZT " J OWNERBUILDERDELCARATION I hschy affrm undr pcnalty of pcjury that I m cxmpt ftom thc Cotrtmctots' Liccre Lrw for thc following lwo (Sc.7031.5 Busins and Profcssion Codc): Any City or County vhich rcquirc a pcmit to srstruct. alta, improvc rlanolish or rcpair my strucIw. prior to its iswcc. also rcquk6 thc applicer for such p6mit to 6lc 8 sigocd stalm@l thd hc or shc b licas€d pw8ril to thc prcvbioN of thc Contractor's Liccnscd Law (Chaptq 9. Commcncing with Setion 7000 of Division 3 of lhc Busins md Prcfsio6 Codc) or thar hc or shc b qcmpt thqcfrom md thc bcis for thc alktscd qmplion. Any violation of Sction 7031 .5 by my 8pplicstforspf,ritsubjcBthc applicanttoscivilpcnaltyofnotmorclhtrfivchundrcddollm($500). _1. as owner of the property. or my employees rvith wages as their sole compensation. will do the rvork ard the structue is not intended or offered for sale (Sa.7044. Business and Professions Code: The Contractor's Liccnse [aw does not ryply to an orvner of the propcrty rvho builds or improves theron. and who does such rvork himself or herself or through his or her own employees. provided that such improvanrcnts are not intcnded or oflbred for sale. l[, horvgt'er. the building or improvanent is sold within one ]car of complaion. the Orvner Builder will have the burden of proving that he or she did not build or improve the propctty for the purpose of sale). _1. as owner of the propcrty. am exclusively contracting with liccnsed contraclors to construct the project (Sec. 7044. Business and Profission Code: The Contractor's License Law does not apply to an orvner of property rvho builds or improves thereon. and rvho contracts for such projecrs with a Contraoo(s) licersed punuant to the Contractor's Liceose Law). -l am exempt under Section-. B. & P.C. for this rcason. l)ate: On trer: \\'ORKILItS' ('( )l\l l'l',NSr\'l'lON t)}.C1.,\RA'l l()N I hcrcbv affir'rrr urrrlcr pcrraltv of llerirrrv orrc of tltc lirllorvinu tlcclat al iotts: __lhaveantlwill rnaintaina('ertificateofConsenttoSelf-lnsurefrrrs'orkers'compensation.as providedforbySection-3700ofthe l,abor Code. for the po'fonnance of the s'ork frrr rvhich the pennit is issuecl. t have and s'ill rnaintain rvorkers' cornpensation insurance. as required by Section .1700 of the Labor Code. for the perfonnance of the rvork for s,hich this pennit is issued. My workers' cornpensation insut'ance carier and policy number are: Policv Number:l'rpir cs: _l certi& that in the performance of the work for rvhich this permit is issued. I shall not onploy any person in any manner so as to become subject to the u'orkers' cornpensation larvs of California. and rvorkers' cornpensation provisions of Section 3700 of the Lahrr Code. I shall.comply with those provisions.. WARNING: Failure to secure w'orkers' compensation is unlarv[ul.shall subject an onployer to crirninal penalties and as provided for the Section 3076 of the Labor Code.fees.ltlts/l< DI]('I,ARATION of tlrc l]usiness and Profcssions C'ode. antl my'license is in full force and effcct. 9 (L(3 License I iacnoa Number: I)nte:lc I hereby affinn under penalty of issued (Sec. .1097. Cir'. C.). lending agency for the po'formance of the work for rvhich this p,ermit is Lender's Address: APPLICANT DECLARATION I hereby affirm under penalty of perjury one of the following declarations: Demolition Permils-Asbestos Notification Federal Regulations (Title 40. Part6) Notes, Remarks, Etc. civil fines up to one hundred thousand Dete: ] l,ender's Nanre: