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APPROVALS DATE ID/S!G.COMMENTS Oma-Builda Dcclmtioo . ! <br />I bccby affim udc poahy of pojury that I u q@pt fom thc Coatrrcton' Liccre Law for thc followiag rcon (w.703 1.5 Buiacs <br />ud Profcsion Codc): Any City or Couty which rcquire a pmit to @struct, 8lts, iDprovc, &Eolish or rcpai, oy structuc, Fior rC its <br />isswcc, alm rcquiro thc lppli@t for sch p<mit to 6lc a sigtrcd rtEt@@t that hc o, sbc is licwd pmuut to thc provisiou of thc <br />CootrEtor's Lic6€d hw (Chryrc 9, Coreming with Sctioo 7000 of Divisios 3 of thc Buinas ud Profcsioru Codc) or thst bc or <br />shc is d@pt thscEoo udtbctosis forthc 8lcgcd q@ptioa.A!yviolatior of Srctioo 7031.5 by uy applicut for Ep@it subj*ts thc <br />appliut to a civil p€lshy of rct oorc tha fivc bu<hcd dotlars ($500). <br />1-116 oua of thc prcpgty, or Ey @ploye with wagc u thcir rclc coopoation, will do thc work md tbc stnciuc ir oot intadld <br />Fr offacd for salc 1 Se.7044, Bwils ed ProfBsios Codc: Thc Coatrrctor's Licce Law do€ lot apply to e omq of tbc prop<ty <br />who builds or improvc rhreq ud wbo do6 sh work hidf or helf or through his or ha om oploye, prcvidrd tbat such <br />imprcvoas rc aot intadcd or offqcd for salc. I{ howcva, thc hrildiq or inprov66t b $ld withi! ooc ya of complaioq thc <br />Or*ao-Puildq will havc thc budo ofprovilg that hc or shc Dot build or improvc for thc purfrcs ofsalc). <br />_1, a omq of thc propcty, u ecluivcly coatrrtilg with licdcd ontrrctotr to coEtruc't thc projct ( Se. ?044, BuitrB ud <br />Profssioa Codc: Tbc CoaEactor's Lic@c be doc aot apply to u ow of prcpay who builds or improvc thcon , md who <br />cootracts for sucb pojets with I Cootrrctor(s) licocd pusumt to thc Contractor's Licoc Law,), <br />-Ie <br />Setion P.C. for this roon. <br />/7 0b <br />I hocby affm unda poalty ofpajury onc <br />_l bavc ud will oaiataio a Cstificac of CoB6t to Sclf-IDsuc for worhc' compmioo" o providcd for by Sctioo 3700 of thc <br />labor Codc, for thc psfomucc of t[c worh for wbich thc pmit is issucd. <br />I hsvc ed vi[ @iltaia worka' @mp@tior i!Mc, s rcquircd by Satioo 3700 of thc kbor Codc, for thc pqfo@c. of thc <br />worh for which rhis psait is isucd My workm' coopcGatioD insuecc cmic ud policy nubc ucr <br />PolicyNMba: Exphd;_ <br />*-a <br />of 3700 ofthc tibor Codc, I sb8ll, fonhwith coEply with thosc <br />/J '06 ,4. a <br />WAf,NINGT Failuc to reuc worle' coopcsalion <br />fEa up to oe hu&cd thouod dollm ($100,000),in <br />thc Labor Codc, iataBt ud attomcy's f6. <br />covaagc is ua.lawful, <br />additiotr to tbc cost of <br />ud sball subja m oploya poahic ud civil <br />coEpcEatioo, daoagcs r providcd for thc Sdtioo 3076 of <br />W <br />I hacby afrm uda pcDslty of pqjury thal I u li@cd udE pmvision of Ch8pts 9 (comcncing with Setioa 7000) of Divisiotr 3 of <br />thc Buirc ud hofasioa Codc, ud Ey licw is in full fore ud cffet. <br />Lic6c CIN:_ Lic@c Nrb6 <br />Datc: Coatraau: <br />W <br />I h6ciy af6m uds poahy of pcjury that thqe is a cortructioo ladiog agacy for thc psfot@cc of thc worl for which this pmit is <br />Civ. C.). <br />t:nda's Ad&cs: <br />D@olitio, p@irs-Asbcstos Norificsrio' Fcdq, *ffiu <br />_ Rcquicd lrtt6 ofNotific.tio! <br />_l cdiry that thc fcdaal rcgulatioro rcgrdiag cbctos rooval uc Dot appl.icablc to this projet. <br />\A *r*vc rcid this applicatioa ed $atc that thc abovc irfomation is conet, I agre to cooply with all City ed Couty <br />Erdiruca ad Starc taws rclatitrg to bui.lditrg coEtructioo, ed hqcby authorizc rcprcatativcs of this City ud Couty to @ts upoo thc <br />sbovc E@tiotrcd Foptry for <br />Applicet or ag6t <br />P@hte Euc (priDt): <br />.0, 0 <br />Appliances <br />Metal Fire Place <br />Evap 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 />Rough Mech. <br />FinalTest <br />Meter Reiease <br />FINAL I <br />[.N[)1, <br />M ECHANICAL.I NSPECTOR RECORD , <br />1.06 <br />I