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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS ()\\ N l.:lt lltl I l.l) l.lt l) 11 l,(',\ R,\'l'l( ) N a <br />I hacf aflim unda pcnalty of pdjury that t m ucmpt from thc Contractors' Licens liw for thc following lwn (Ss.7031.5 <br />Buinss and Prcfwion Code): Any City or County which rcquire a pcfmit to congruct. aha, improvq denolish or rcpair uy <br />struclu€, prior to its isuucc, also rcquiE the applicmt for such Frnil to 6lc a sigocd statmot tha hc or drc b licosed puwt <br />to thc prcvisioB of thc Conractor'3 Lienscd t:w (Chapt6 9, Comacing with Setion 7000 of Division f of thc Buins ud <br />Prcfsions Codc) or that hc or shc is cxmpt th@from 8d thc bosis for thc allcgcd cxmpion. Any violation of Scrion 703 1.5 by uy <br />applicmt for a pemit subjets thc applicut to a civil pemlty of oot morc the fivc hundrcd dollm ($500). <br />I <br />_1, 0s owner of the property. or my employecs with wages as their sole compensation. will do the work and tlrc structuc b not <br />intendcd or offered for sale (Sec.7044, Business and Pr,ofcssions Code: The Contractor's Licensc [-aw does not ryply to an owner of <br />the property who builds or improves th€ron, and who does such work himself or hcrself or through his or her own employees. <br />provided that such improvanents are not intended or offoed for sale. If,, howwer, thc building or improvemcnt is sold within one )car <br />of complaion, the Orvner Builder will have the hrdcn of proving tha he or she did not build or improve the prcperty for the purpose of <br />sah). <br />_1. as owner ofthe propcrty. am exclusively contracling with licersed contractors to construct the projecr (Sec. 7044. Busines <br />and Profission Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon, <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's Licensc [aw). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />f)o ia.fl-nor. <br />WORKBRS' COI\I PI,NSA'[ION <br />DECLAITA'TION <br />I hereby alTirm under penalty of po'jury one of the following declarations: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' contpensation, as provided for by Section 3700 of the <br />work for which the pennit is issucd. <br />Section 3700 of the t^abor Code. for the performance of <br />carrier and policy number are: <br />u ( <br />/s12 2l <br />issued. I shall not employ any pcrson in any manner <br />and agree that if I should become subject to the <br />shall, forthrvith comply with those provisions.. <br />WARNING: Failure lo sccure workcrs' compensation coverage is unlarvful. and and <br />civil fines up to one thousand dollars ($100,000). in addition to the the <br />Section 3076 l.atxlr and attorney's fecs. <br />I ICFNST'N CONTRACTOR <br />DF.C| ATIATTON <br />I hcreby aflirm under poralty of perjury that I am liceruod under provision of Chapter <br />of thc Business and Professions Code. and my liccnse is in full force and effect. <br />9 (commencing with Section 7000) of Division 3 <br />License <br />o <br />W <br />t hcrrty affm undo paalty of pGjury thd thft fu 8 snstruclbr hoding aSmy for thc pqfotmcc of thc wrk for which thb pqmit i3 <br />isucd (Sc. 3097. Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />,r, ,c NT "EC, <br />.RAT <br />I hercb), aflirm under penalty of perjury one of the following detlarations: <br />Demolition Pennits-Asbcstos Notil'rcation Federal Regulations (Title 40. Part6) <br />-Required <br />Letter of Notification <br />r I certifr/that the <br />fuk*irytr,"t Ihave <br />federalregulations regarding asbestos removalare not applicable to this project. <br />read this application and state that the <br />ordinances and State l-aws relating to building <br />above mentioned property for inspection purposes. <br />Applicant or Agent <br />Perrnitee narne <br />the <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 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 />Openinqs <br />!nstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release I I ,l,l -, <br />F!NAL tLl'll u 2flvr57 <br />Notes, Remarks, Etc.I <br />\r) . <br />r^. <br />t' <br />_License <br />Dile: f Conlraclor: