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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/S!G COMMENTS ()\t'NER Bt n.DER r)t:t.( ARAtl()N <br />I hcrchy afilrnr undcr pcnalty ot;::jury thh: l'an exeilpl liom thc (i)nlrnclors l-lcense taw for thc following rron (56.7031.5 <br />Busin6s ed Profsioo Codc): Any City or Couty which require a pmit to construct, alto, improvq dmolish or rcpair uy <br />structuc, prior to its iswca also requirc thc applicot for such pcmit Io file a signcd statmot thar hc or shc b licos€d pmat( <br />to thc provisio6 of the Contractor's Lienscd Law (Chapt6 9, Comencing with SEtion 7000 of Division 3 of the Buine ad <br />Prof6siom Codc) or thst he or shc is cxempt thgefiom ed thc basis for thc altegcd exmFion. Any violatioo of Setion 7031.5 by uy <br />applicantforapcmitsubj6tsthc applicuttoacivilpeqaltyofnotmorcthefivchundreddollds($SOO). <br />-1, <br />s ous of thc propqty, or my mploye with wage r their rclc compensation. wiu do thc wort ud tlE $rwtrc i not <br />intaded or oflqed for slc (Sc.7044. Busias md hof*ioro Codq Thc Coilractor's Licw taw doe not apply to m oms of <br />thcprcpsly whobuildsorimprcvcthsorlmdwhodoesuchrcrthimselforhasclforthrcughhisorhoomcmployco. <br />provided that such improvffib e rct htqdcd or offqcd for sale. li howd6, thc building or impovmat is rcld within one )urofomplliou thc (}lvna Buildq will havc thc hrdq of prcving tha hc or shc did mt buiH or improvc the propqty for the puposof <br />ele). <br />-1. <br />m orvno of thc popmy. an exclusivcly contracting wilh licmsed conlracton lo construd thc project (Str. 7044, BNin*s <br />and l'rtrfssionCodc:'lheConlractor'sLicensel-arvdosnolapplyloilownsofpropertyu,hobuildsorimprovsthaon. <br />and trho contmcts for such Froj(ts with a Contrado(s) liceNed puBuml to the ( ontractor's Licse [nw]. <br />_l &n exempt under Seclion_. B. & P.C. for lhis reoon. <br />\l oRI(ltRs' c()l\t PltNsa't t( )N <br />DECLARA'I'ION <br />I hcrcby affirrn under penalty ofpojury one ofthe lollowing dcclrations: <br />_l have md \r'ill lnaintain a Cenificale of Consml lo Self-lnsure for Norkers'compen$tion, a povided for by Sction 3700 ofthe <br />labr Code <br />l*""^,0 <br />for lhc pcfomacc of thc wort for which the pemir is issued. <br />will maintain workers' compcnsation imurance, ro required by Setion 37OO ofthe t{bor Codc. for thc pqfomucc of <br />the work for which this My workrs' colopoMtiotr ireurilce mio and policy numbo re: <br />Policy CLL' <br />-l <br />coairy that in thc pofomece of the work for which lhis ptrmit is issued. I shall not mploy any prson in any mmno <br />so retobecomesubjettotheworkas'compwtionlawsofCalifomia.edag@thatiflshouldbccomesubjccttothe <br />work6' compensation provisiore ofSectiotr 3700 ofthc t bor Code. I shall. forthwilh comply with thoe prcvisioro.. <br />WARNING: Failure lo suc work6' compcNalion is unlawful, ad shall subjst il to oiminal peraltiG ed <br />civil fincs up to one huD&cd thousmd dollm in addition to the cost of o provided for the <br />Setion of lhe Code. intqest <br />>.) <br />l)E( L\Ri\t toN <br />I hreby affm undc panalty of pojury that I m licersed undc povision of Chapto 9 (commcing with Ssriotr 7000) of Division 3 <br />of the Busho md PrcfsioB Code. ad my licme is in full forcc ed cff(t. <br />tLiceme <br />I hacby affirm undo penahy of p€rjury thar thoe is a coretruction lmding ag6cy for the pqfomace of the rvork for which this p6nit is <br />issued (Sec. 3097, Civ. C.). <br />Lender's Name: _ <br />Lender's Addrs: _ <br />I ho@ aIIm undo pmalty ofpojury one ofthc following drclrations: <br />Demolilion Pemits-Asb6tos Nolification Fedsal Regularions (Title 40, pff6) <br />_Required Lettq of Notification <br />cdiry that th€ federal regulatiom reguding cbslos rmoval ae nol applicable to this prcjst. <br />have read this application and statc that thc ak)ve infomarion is coreci. I agrtr to comply <br />fthis City <br />with all City and County <br />l-arvs upon the <br />prcpcnyabove <br />Agflt <br />to building comtruction, ad o <br />"1 <br />242b <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace z-1 <br />Compressor -/ ,r ,zl. r, y'ff4' <br />Misc. Equipment ?-1o-t? -[/.t-7v ?a 4,ZucA '/I <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 />Fina! Test <br />Meter Release <br />FINAL /o - rS'- t?J/odo{=-g <br />Notes, Remarks, Etc. <br />l)stc