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MECHANICAL.!NSPECTOR R ECORD <br />APPROVALS DATE !D/SIG,COMMENTS <br />Appliances <br />lVetal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />FinalTest <br />Meter Release <br />F!NAL ?2€-?2 J*8iilD<b <br />Notes, Remarks, Etc. <br />otvNt;R Bt;lt,t)uR t)Il,( ARA'iloN <br />npl)licrrl li)r r Nnnil snhjccls lhc ll)plicnrl l(l a civil pcilillly ol'nol nx,rc lhrn livc huf(lrc(l (l()lhrs lS5lx)) <br />l. xs otr ncr ol lhc Iroltily. or my cmployccs with wagcs as l hcit s()lc corrrpcil\ilt ion. will do t hc work lml thc slnrcturc i\ nol <br />lhcp[)pcrly whobuildsorimprovcstlrcKnr.rtrdwhodoc\suchurtrkhinl\clforhcr\cll()rlhrnrghhirorhrrowncrnpkrYccs. <br />snlc ). <br />-1. <br />as owncr of thc pmpcny. am exclusively contracting with licenscd conlraclon lo construct thc Fmject (Scc. 7(X4. Business <br />and ProfssirnCode:TheContractor'sLiccnsclrwd@snolspplylosnownerofpropcrtywhobuildsorimpmveslhcreoo. <br />and who contmcls for such projecls wilh a Contmcto(s) liccnsed pursuanl to thc Conlractor's Liccnsc Law). <br />-l <br />mexempt under Selion-, B. & P,C. for this rctmn. <br />lVORKERS' COTI PENSATION <br />DECLARA'TION <br />I hcrcby affirm undcr pnalty of perjury one of the following dcclarations: <br />_lhaveuxlwill mintainaCertificaleofConsnttoSclf-lnsurcforworkcrs'com;rcnration.&s pmvidcdforbySection3T0Oofthc <br />Labor Codc. for the lErformncc of the work for which lhe Fmit Ls issucd. <br />_l havc and will mainlain workcrs' comJrcnsalion insurarcc. os rcquired by Seclion 37fi) of thc talnr Code. for lhc fBforroncc of <br />lhc work for which lhis frcrmit is issucd. My workcrs' compcnsation insurarce caricr and F)licy numbcr ec: <br />Policv Numhcr: Exnires: <br />_l ccnify lhilt in thc pcrfortnance of thc work for which this pcrrnit is issucd. I shsll not employ any pcrson in any mrnncr <br />so as to hccom subject lo the workcrs' compcnsat ion laws of California. and agrcc thal if I should hccomc suhjcct to thc <br />workcrs'compcnsalionprovisionsofScction3T0OoflhcLahr(ode.lshall.forthwithcornplywilhlho$provisions.. <br />WARNING: Failure to sccurc workers'comfEnsalkrn covcr8gc is ulhwt'ul. and shall subjccl an crnployer to oiminsl xn(t <br />civil tlnes up k)huilJrcd thr)usilrd d('llur\ ($llo.(xx)). itr bl cosl oI compcnsation.li)r lhc <br />Scclion 3076 of iflercst and atfurncy's fees. <br />I hcrcby aflirm under penally ofFrjury lhat I am prevision ol Chaptcr 9 (cornf,rcncin8 with Scction 7Um) of Divisk)n -l <br />of the Busincss and Profcssions Codc. and my torce and effcct rffi73r <br />Licensc <br />I hcrcby affirm urxlcr pnahy ofpcrjury thal lherc lcnding agcncy for lhc pcrformncc of thc work for which this Jrcmit is <br />issucd (Scc. 1097, Civ. C.). <br />kndcr's Namc: <br />Lndcr's Addrcss: <br />APPLICANT DECI ARA'NON <br />I lmhy allim undcr pcnalty of pcrjury onc ol lhc [ollowing dcclar{tt)ns: <br />Dcnn,lilion Pcrrrits-Asbeslos Nolificalion Fcdcral Rcgulati(nrs ('titlc 40, l'!46) <br />-Rcquircd <br />Lctter of Notification <br />_l ccrtify lhal lhc federalrcgulalions rcgarding astEstos rcnx)v{larc not applicablc to lhis pmjccl. <br />_l ccnify that I have rcad this application eKl stalc that thc rtnvc infomalk)n is wilh all City {nd Co!nty <br />ordiilanccs ilnd Stntc Laws rclating <br />above renlioned pmpcny for <br />Applicilnl or Agcilt <br />l)crilrilcc nnnrc <br />I <br />l)ntc: <br />anrl lo upon lhc <br />\