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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION <br />t heby affm unda paalty of pa'jury tba I m qmpt ftom thc Contnctors' Licens law for thc fotlowiog ron (Sc.il31.5 <br />Buins aod Prcfeion Co&): Any City or County which rcquirc a pcmit to snstruct, aha. improvq danolish or rcpoir uy <br />strucluq prior to its ismcg ds rcquirG thc applicut for Buch pqmit to 6lc a sigDcd statqmt that hc or slE b licsasd pwust <br />to thc prcvbioG of thc Conurctor'! Liccnrd Lrw (Chaptr 9. Comocing whh Setiotr 7000 of Divisioo 3 of thc BuincS ud <br />Proftsiom Codc) or tllat hc or shc is acmpt th6c&om ed thc b6is for thc allcgcd qmption. Any viohion of Sclion 7031.5 by any <br />applimt for a pcrmit subjets th€ applicut to a civil pculty of oot mrc thn fivc hundrcd dollrs ($500). <br />-1, <br />B om6 of th€ Fopqty, or my mplolB with wag6 I thcir slc compcGarion. will do tlE vut Ed thc dn5lE b mt <br />inqdcd or offqcd for slc (Sc.7044. Buire 6d ProfqsioB Code Thc CoilnctG's Licae L:w do6 mt apply 1o m offi of <br />thcprcpcty whohuildsoriEp.oEthaoqodwhodoerehwrkhiroclforhclforthrcughhisorhcromoployc. <br />providcd that such irurcvorEls rc mt idadad or olEcd br sh. lf. how. thc hrildiog or iryrovuu* b old within onc )a <br />of conpl*bn thc Ovmq Buildq will harc thc hr&r of proving thd tc or she dil mt brild or inp.ow thc FoFty br thc prrposc of <br />$lc). <br />dt, c omq of thc propqty, m qcluivcly conracling with licmcd conttrtots to onstrucl thc proj6{ (Se. 7fi4. BciB <br />and Proftsrbn Codc: Thc Contr8ctor'r Licffi [xw do6 not apply to m ownq ofprcpcrty who builds or improvB th66rl' <br />md who contncts for such projals with r ContEclo(s) licoscd pmuet to thc Contrsctor's Licmc [:w). <br />-l <br />am exempt under Section-. B. & P.C. for <br />D,b,.2l luzg?9 <br />DECLARATION <br />I hereby affrrm under penalty of pojury one of the follorving declarations: <br />-l <br />have and rvill maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as provided for by Section 3700 of the <br />Lahrr Code. for the performance of the work for which the polnit is issued. <br />-l <br />have and will maintain workers' compcmation insurance. as rcquired by Section 3700 of the Labor Code. for the perfonnance of <br />the work for which this permil is issuod. My workers' compensation insurance carrier and policy number are: <br />Policv Number: Exoires: <br />Ul, certiry that in the performance of the work for which this permit is issued. I shall not ernploy any person in any manner <br />so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the <br />workers' compemation provisions of Section 3700 of the Labor Code. I shall. forthwith comply wilh those provisions.. <br />WARNING: Failure to secure workers'compensation coverage is unlawful. and shall subject an employer to oiminal perTalties and <br />civil fines up to one hundred thousand dollars ($100.000), in addition to the cost of darnages as provided for the <br />attorney's fees. <br />I ICFNST'N CONTRACTOR <br />DFCI '^ RATION <br />I hereby affrm under peoalty of perjury that I am licenscd under provision of Chapter <br />of the Business and Professions Code, and my license is in full force and effect. <br />9 (commencing with Section 7000) of Qivision 3 <br />License Class: License Number: <br />Date: Conlractor:_ <br />W <br />I hotby alfm unds pqulty of pcrjury thd th4 is E @nsruc{bn l@ding agcy for thc pqfotMc of thc m]t 6r wlilch this Fmi b <br />isucd (Se. 3097, Civ. C.). <br />Lender's Name: <br />l,ender's Address: <br />APPI ICANT NT'CT .ARIATION <br />I her€b}, affinn under p€nalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Federal Rcgulations (Titlc 40, Part6) <br />-Required <br />Letter o f Notification <br />I certifothat the <br />Vfr*rytnaIhave <br />federal regulations regarding asbestos rernoval are not applicable to this project. <br />read this application and state that the above information is correct. I with all City and County <br />and County to erter upon theordinances and State Larvs relating to building <br />above mentioned property for inspcction <br />Applicant or Agant <br />Pennitee name }\ <br />and hereby <br />*,",2,1D1 2O?g <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation <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 !l 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 />Rough Mech.lt -L/do R-{z 1 <br />Final Test <br />Meter Release ul ,^ <br />FINAL /24.rc)b /1l wrendv <br />Notes, Remarks, Etc <br />D <br />?hen