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M EGHANICAL.INSPECTOR RECORD <br />DATE ID/SIG.COMMENTSAPPROVALS <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 />, <br />Rough Mech.9/E//t=AF[uo rr^h) / <br />Final Test t// <br />Meter Release , .lA\\\ttru ,l <br />FINAL 'rSil\tU \Mi$t0 t\h <br />Owncr-Builder Dcclaration <br />I heteby alTirm under penahy of perjury that I am excmpt form th. Contractors' Liccnse kw for thc following r6son (ss.7o3J .5 Bsi-Jss <br />aod Profesion Codc): Any City or Couty which rcquirc a pmit to co6truc1. altcr. improvc. dcmolish or rlpaFany stutui. prior to its <br />issuncc.alsorcquirethcapplicrnlforsuchpcmittofilcrligncdltatemcnt lhathcorshcisliccucd puBumttothcprcvbionrofthc <br />Conttactor's Licensed Law (Chaptet 9. Commencing wilh S.clion 7000 ofDivision 3 ofthe Burincs and Profagions Codc) or thst hc or <br />shc is cxcmpt thcrcftom and thc b8is for thc allcgcd cxcmption .Any riolation ofSction 70! 1.5 by uy rpplicant for a ponh subjccts thc <br />spplicant to 8 civil pcDshy ofnot morc th[ fivc hundrcd dollm ($500). <br />_1. u owno of thc propcny. or my cmployG with wag6 s thcir solc compcnsstion. will do thc work md lhc structuc is not intodcd <br />or offercd for sle ( Se 70,14, Busines snd Professions Code: Thc Contractor's Lic€me Law doe not apply lo an owner ofthc prcpcny <br />who builds or improvcs thcrcoo, and who do6 such work himsclfor hmclfor through his or her own cmploycB. providcd thrt such <br />improvcmcnts uc not htcndcd or offqcd for slc. lf. howcvq, thc builditrg or improvcmcnt is sold within onc ycr ofcomplclion, thc <br />Ornq-Buildcr will havc thc budcn ofproving thrt he or shc not build or improvc for thc purpose ofsElc). <br />_1. I owncr of thc propdy. am cxclwivcly contmcting with lic.D.d contrrctoB to coBtruct thc projcct ( Scc. 7044, Buincss md <br />Profesion Codc: Thc Contrrdor's Liccruc Lrw do6 not apply lo u owncr ofpropcny who builds or improvcs thcrcon . &nd who <br />contrrct! for such proj.cts with 8 Contractor(r) liccnled pursurnt to the Controdor's Lic.nsc Lrw.) <br />& P.C. for <br />Dste: <br />I hscby aflim unds pcn8lty ofpqjury onc ofthc follow <br />_l havc and will maint8in 8 Ccrtificatc of CoNcnt to SclfJnsure for workers' compensstion. ss provided for by S6tion l?OO of the <br />Labor Codc, for thc pqfomncc of the work for which thc pcmit is issucd. <br />_l have and will mainlain workers' @mpeMtion insumnce, as requircd by Seqtion 3700 of the kbor Code, for the pcrforroncc of thc <br />work for which this p€rmit is irsued. My workers' compenstion insurance orrier and policy numbs rc: <br />Policy Number:__-_ _Expircs: <br />- <br />(-l.llis sfttion need not be "o.pl"t.d if th. p*it i. fo, Onc hrrndrcd d<,ltaro-{$tOOl or lcss) <br />_l ccatify thsr <br />bccamc aub.jst l <br />in thc pcrforuncc of thc work for which this rs isucd, I shall not mploy any pcmn in any manner so s to <br />agree that ifl should become suhjet to the workers'Io the workers ' conlpengtion bws of and <br />compcnsation provisions ofScction 3700 oflhc t,abor sith those <br />WARNINC Farlure to secure workers'unlawful, and shall subj*l an employcr to criminal pemlria and civil <br />fitr6 up to onc hundrcd thouaod dollan ($l <br />the trbor Code. interest and atiorney's fees. <br />to lhe cost ofcompcnsation. damagcs s providcd for thc Scction 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hercby 8ffm und4 penalty ofperjury that I m liccnsed undo provision ofChaptcr 9 (commcncing with Scction 7000) ofDivision 3 of <br />lhe Busincss and Profcssiou Codc. md my liccnsc is iD full forcc md cffcct. <br />l.icense Class: License Nurnbcr <br />CONSTRTICTION LENDING ACENCY <br />I hcrcby iflirm unds pcnally ofpcrjury thal lhcrc is a construclion lcnding agcncy for lhc perfonnance oflhc rvork for which this psmit is <br />issucd (Scc. .1097. Civ. C.). <br />l-ender's Name: <br />l*ndq'3 Add.s: _ <br />APPLICANT'S DECLARATION <br />Dcmolition Pemhs-Asbcstos Notification Fcdqal Rcgulstions (Tillc 40. Pan 6) <br />_ Requircd kttcr of Notification <br />_l cdify thst thc fcd6.l regulstions rcgarding sbstos removal arc not applicable to this project. <br />_ I ccnit that I havc rcad this application md ststc th8t thc abovc infomation is concd. I 8grcc to comply with all City and County <br />abovc mcnlioned <br />Applicant or agcnt sig.: <br />Perrnitlee na!ne <br />to building and hqcby authorizc rcprcscntativcs ofthis City and County to enter upon the <br />MIWP5 1 \Permit-lnsp€ction Rocord.doc 03.31.05 <br />I)rlc ( (rrlr.r(lor <br />Je,%