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MECHANICAL.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 />I I <br />Hood I <br />Type I Hood lt lP <br />Type ll Hood <br />/l*1,/Grease Duct <br />{n, <br />IFire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />"l/ L // <br />Above Hard Lid <br />Above T-Bar <br />lr <br />Ir \1-Mrd f)Rough Mech.t) <br />I tFinalTest <br />I il-\ /IIt \Meter Release <br />FINAL <br />fr?t,Z <br />I hcrcby rfrirm undcr pcuhy of pajury thrt I m cxcmfl form thc Contncto['Liere bw forthc following rrun (rei03l.5 E]ris6r <br />rnd Profdrion Codc): Aay Chy or Couty which rcquirg r psmit to @uuu6, rltq, improvc, dcmolirh or rcpdr uy rtrustuq priilr to it! <br />issune, rlro re4uire thc rpplient for such psmit to fi16 E signcd tlrtcmcil thrt hc or rhc ir liocucd purrwt !o thc proviriom of thc e <br />Conrador'r Lierucd Law (Chaptcr 9, Comcncing with Scrion 7000 of Divirion 3 of thc Buinqr rnd Profsrioro Codc) or thrt ht or <br />thc it qcmpr thgcfiom rnd thc bq!i! for thc rllcgod acmprion .Any violation of S*tion 7031.5 by uy rppliont for r pmh subjccB Oc <br />rppliont to r civil pcmlty of not morc thn fivc hmdrcd dolhn (t500). <br />_I, u ow of thc propcny, or my cmploye with wrga D thcir tol! @mpcution" will do thc work ud thc truauc ir lot irt4dcd <br />or offacd for nlc ( 56.7044, Buins! ud Profo[iom Codc: Thc Cotrtrclor's LieEo lrw doa not rpply to u omr of tho propcty <br />who buildr or improw thqaq rnd who do6 such work hirolf or lurclf or tluough hL or ls om mploy€, providcd thrt rwh <br />improvcmctrr sc not intcndcd or ofrqcd for llc. If, howryq, tlrc building or improwrcnt ir rold vithh orc yw of omplctio4 thc <br />Oms-Buildq will hrvc thc budon of provitrS thrt hc or thr ool build or improvc for lha purporo of ulc). <br />_I, u omo of thc propsty, rm qclutivcly ont[<ring with lieucd onrrston o oEtruct tho proj€t ( Sc. 7O44, Buinss rnd <br />Profsion Codc: Thc Contnctor't Li@ruc lrw doo not rpply to u ow of propaty who buildr or improvc thson , ud who <br />@ntr.ct! for tuch proj€8 wih r Cont scto(r) lieucd pununt !o thc Conurdor't Lieuc hw.). <br />am undq Section &.thir <br />I hcrcby rffirm undcr pcmlty ofpajury onc <br />_I hrvc ud will mintrh r Ccniliqtc of Coent !o Sclf-IEurc for wrlc' ompcmtioq u providod for by Soction 3700 of thc <br />hbor Codq for thc pcrformnc of tho worL for which thc psmit ir i[ucd. <br />_I hevc ud will mrinuin worko' ompcution iruwn@, s rcquitod by Scction 3700 of thc hbor Codg for thc pcfomns of tho <br />work for which thir pomit ir isucd. My workor' ompcmtion iroumc oriq ud policy numbo uc: <br />Policy Numbrt: Expirq: <br />Ghh-r..tion * oi to) <br />I c.nify tht in thc porformno of tho work for <br />bccemc rubjcct to tho mrk6 ' ompaution Lwr <br />which thir pemit ir iluod I rhrll not mploy rny inuymaruto <br />ofCrlifornir, rnd rgrcc rhat ifl rhould boomc tho worko'a <br />ompcnution proviriont ofS6don 3700 ofthc lrbor Codq I with thorc <br />Failurc to s6urr worka[' compcEstion ov9ngc ir and cmploycr !o qimiill pcuhis rnd civil <br />onc hundrcd thouud dollan (S100,000),in rddition to thc mn drrogg s providcd for thc Sccion 3076 of <br />thc bbor intcr6t ed rdorey'r f6. <br />W <br />I hscby rffrrm undcr pcrolty of pojury that I rm lienrcd utrdor provirion of Chspta 9 (@mcocing with S61ion 7000) of Divirion 3 of <br />thc Businc$ rd ProfatioN Codc, md my liccuc ir in full fore ud cffct. <br />Liccre Cler:_L&:m Numba_ <br />DEto: Contnaor: <br />W <br />I lscby rfftrm und6 pcrhy of psjury thd thsc ir . oiltruction londhg rScncy for tho psfomne of thc wsk for which thir psmit ir <br />irgucd (S*. 3097, Civ. C.). <br />kndcr'r Nrmc: <br />lrndcr'! Addr6s: <br />AIEUCANT,S-DTCIAEAIIAN <br />Drmolition Pcrmii!.Asbcstos Notilication Fcdcnl Rcgulationr (Titlo 40, Psn 6) <br />Rcquircd Lcttcr of Notifi qtion <br />@nif] thlt thc fcdcral rcgulrtion! ,cgrrding ubctor remouluc not rpplioblc to thir projct. <br />thst I hrv€ r6d thi! sppliation rnd tulc thEt thc rbovc informrtion ts corcct. I rgre to qomply with rll City rnd Counry <br />and Stltc LH rchting to buildirg orotruaior\ ud hcrcby rcprscnutivs ofthi! City rnd County to cnt6 upon the <br />propcrty for <br />O <br />or rgcnt <br />Eme (print). <br />fr, Yotr <br />|t/Jt , <br />-ilt/-*l- t,7,r'tnr( HP <br />PAI(^. <br />t{,.Yn-z <br />A,I <br />' ll <br />\I rl 'l{