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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hseby affmn undq paalty of ptrjury thal I m excmp from the Contraclors' License l*w for the following r.@o (Se.7031.5 <br />Bwines ud Profesion Code): Any City or County which require a permit to corutruct. slts, improvc, dmolish or repoir uy <br />structuq prior to its issumcc, also requirc the applicmt for such pennit to filc a signed statmf,t that he or she b licscd pusuilt <br />to thc provisioB of thc Contractor's Licensed Law (Chapts 9, Commmcing lvith Sfftion 7000 of Division I of lhc Buins ud <br />Prcfe$ions Code) or that he or shc is exempt thEefrom ild thc b6is for the allcgcd exmption. Any violation of S€tion 7031.5 by uy <br />applicilt for a pmit subjcts thc applicet to a civil penalty of not more thm tlvc hundrcd dollEs ($500). <br />-1. <br />6 oMtr of the propcdy, or my cmployB with wags 6 their sole compf,sation, will do thc work ud the struciqc b not <br />intodcd or offscd for sale (Se.7O44. Busines ad Prefasiom Code: Thc Contractor's Licme Law doa not apply to e omq of <br />the prcpcrty who builds or improvq th@n, ed who do6 such uo* himself or hmelf or thrcugh his or ho o*n mploym. <br />provided that such improvffits @ not itrtadcd or ofiqed for sle. lf, hows'q. the building or improvclmr is sH within onc )q <br />ofcompleion, the Owntr Buikls will have the hrd6 ofproving thd he or she did rct huild or imp(olr the propqty for thc purpos of <br />qle). <br />-1. <br />Bowns of the p(op6ty, m excluivcly contrscting with licrued contractoEto co$truct the prcjcct (56. 7044. BBins <br />md PpfesionCodc:TheContractor'sLiccnseLawdo6notapplytoeown6ofpropcnywhobuildsorimprovcslhcrcon. <br />and who contracts for such Fojects with a Conlmcto(s) licrucd puBuut to the Contractor's Licruc l2w). <br />_l u cxmpt unds Setion_. B. & P.C. forthis recon. <br />Date:_Owner: <br />IUQEKE8g,SAAIPINIAIIAT <br />DECLARA'TION <br />one of the follou ing delarations:I hueby aflim unda penalty ofpojury <br />-l <br />have and will mintah a Cstilicate of CoMt to Sclf-Ircure for workqc' @nrpens6lion, u providcd for by S{tioo ]700 of the <br />Iabor Codc for the po'fommce of the wort for which thc pqmit is isucd. <br />f havc md will maintain worlcrs' compcrualioo i6uancc. arcquird by S€tion 3700 of thc Labor Code. for thc psfomcc of <br />the work for which this po'mit is isucd My workers' compquation iroumcc cmia md policy numbr se: <br />CA DDSoR-e.tse0 Co <br />o 99 2-( ot oq ' s7 t7 z-oPolicy2 <br />-l <br />ccnify that in thc psfomance of thc work for which this pmnit is issued, I shall not mploy any pamn in any mano <br />so 6 to bccome subjtrt to thc wo*ffi' compcosation laws of Califomia. md agE lhat if I should bccome subjct to the <br />workm' compcnsation prcvisioro ofScctioo 3700 ofthe Labor Code I shall, forthwith comply with thos prcrisioro.. <br />WARNINC: Failure to scurc workm'compmalion covqage is unlarvful, md shall subj(t m mploya to qiminal pcnahiq md <br />civil fines up to one hundred thousand dollm ($100.000), in addilion to thc cosl of compereation, dmags o providcd for thc <br />S(tion 3076 of thc Labor Code, intdd od attomey's fe6. <br />DIJ('I,AR{I ION <br />I heby affm unda poalty of pajury thal I m licosed udc provision of Chaptq 9 (commcing whh Sccrbn 7000) of Division <br />of the B6ins ed Prcfessiom Codc, md my licw is in full forcc md effet. <br />Li"*ectas' ' 42o u".*rNu to. - ($?ryL <br />3 /t z12o 6on1.".1or.b{ HvAc- lrrf<.ff#tclr- <br />-\r <br />CONSTRUCTION LENUNG ACENCY <br />I brcby affrm udo poalty of perjury thar thse is a construclioo lqding ag6cy for the pGfomecc of thc work for which this p6mit is <br />issued (Sc. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Addrw:_ <br />I ho@ alfinn unda penalty ofpqjury one ofthe following dalaatiom: <br />Demoliion Psmits-Asbestos Notification Fcdqal Rcgutations (Tillc 40, Pan6) <br />_Requf ed LellE of Nolifi cation <br />-l <br />cEtiry thal lhe fedoal regulatiore regrding mtstos rmoval re not applicable to this prcject. <br />$rtify ml have red this application ed state thal the above infomation l <br />ordimcB ed Slate lxs relating lo builditrg coNtruction. ud h6cby authoria <br />is cor6t. I agrc to comply with all and Counly <br />ml6 ulrn lhe <br />above motioned propeny for inspetion <br />Applicilt or Agmt <br />Pmilc.me <br />reprdolativ6 of this <br />t/ D tzo <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled /^ <br />Rouqh Ductwork Mt$n <br />UI\J <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 />/,n\ <br />Rough Mech.4-t,u,ilLtA <br />Final Test u Il I <br />Meter Release I I le- <br />FINAL r.t L(t 7o aro"l <br />Notes, Remarks, Etc.\\I <br />-> <br />+'lLl-2, <br />)ltrn0 tn- <br />orr., ' thlb <br />Drlc:-L