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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hacby aflim unda paalty of perjury thd I m cxmpt from thc Conlraclos' Licens hw for rhc following rc@n (Sc.7011.5 <br />Bwine and hofeion Code): Atry City or County which rcquire a p6mit to con$ruci, a.ltc, improva danolish or rcpair my <br />strucluc, Fior to its isumcc. also requirs the qplicot for such pcmit to filc a siSncd statmmt that hc or shc b licfficd pNad <br />to the provisioN of thc Contractor's Licensed kw (Chapts 9, Comcncing with S(tioo 7000 of Divisioo 3 of thc Bwitrs ed <br />Prcfruions Code) or that hc or she is excmpt thgefrom ud thc b6is for lhc allc8ed q@pion. Any violstiotr of Scction 7031.5 by any <br />applicilt for a pflnit subjcts the applicmt to a civil pcmlty of not morc thil fivc hundrgl{onA}($500). <br />-1. <br />I omq of the propcrty. or my emplo}l6 with wags s thcir $lc compcBation. will do tfre wort'md thc atructrc is not <br />intmdql or offred for sle (Ss.7044, Buitrs md Profcssioro Code: Thc Conlractor's Licmse Law do6 not apply to m omer of <br />thc pmpcrty who builds or improvc thmq ud who doc sch wort himself or hmelf or thrcugh his or hcr om mploym, <br />providcd that such imprcvmts Ee not intodrd or offgcd for salc. lf. howrys, thc huilding or improvmmt is mld within onc )q <br />ofcompllion, thc Ownc Buildq will havc thc hrdsr ofproving thaf hc or shc did not hrild or improve thc prcpoty for thc ptupos of <br />elc). <br />_1. uomq of lhc propqty, m eiclsively contractiog with licdEcd contractoElo coMcl the projc( (S{. 7044, BNirs <br />and ProfcsionCode:ThcContractor'sLic@eLawdo6f,otapplytouownoofpropertywhobuildsorimprovdth6oo. <br />md who contracts for such projars wirh a Contmcto(s) licqEd puEwt to thc Contraclor's Lic@ tlw). <br />-l <br />m crmpt uds Satioo . B. & P.C. forthis rmn. <br />WORKERS' COI\lPENSATION <br />DECI.AEAIION <br />I hoeby affirrn undr pqalty of pojuryone ofthe following d(lamtiom: <br />by Section 3700 ofthc <br />for the pofommcc of <br />q&1170Policy <br />-l <br />cqtiry that in thc pqforlruce of the work for which this pcmit is issucd. I shall not mploy ey pcrsn il oy mmna <br />s 6 to b€omc aubjet to thc work6' compqr$tion laws of Califomia od agc that if I should beomc subjct to thc <br />wo*6' comp@tion prcvisiore of Seaion 3700 of the lrbor Codc. I dull. fonhwith comply with thos prcvisiore.. <br />WARNING: Failure lo sue workm' compovtion covmge <br />civil fines up to onc hundred thousd dollffi ($100.000). in <br />is unlarvful, md shall subjet a mployo to qiminal pqraltie ud <br />addition to lhe cost of comp€Nation. dmg6 o providcd for thc <br />::::"t6i'iYTiT*- ;#"'5*'tl^ Gl,W <br />LICENSI'I) CON'TRACTOR <br />NF(]L{]LATI()N <br />I hereby aflirm undr pmahy of perjury that I an licoxd undo provision ofchaplq 9 (commcncing wilh Setion 7000) of Division -1 <br />of the llusinm ud Profssiom Code. md rny license is in full force md eff(t. <br />6 t9LiccreeNumbs: <br />Drle:lo t l5l l4 Conlrf,clor: <br />CONSTRUCI'ION T ENNINC ACENCY <br />I hocby aflim undr penahy of ptrjury that thqe is a construclion lending agmcy for the pafommce of the work for which this permit b <br />issued (Se. 3097. Civ. C.). <br />l"ender's Name <br />Lender's Address: _ <br />altttcAl.IJ)ectd8AuoN <br />I hcnty affinn under poalty ofperjury one ofthe following declaations: <br />Demolition Pqmils-Asbestos Notification Fedgal Regulalions ('t itlc 40. l'a(6) <br />-Required <br />[,clltr of Notilication <br />-l <br />cqtiry thd thc 6d6al rcgulatiore rcgudhg rbqtos rooval ue not appticable to this projct. <br />-l <br />coriry that I havc rad this appli€tion ad $atc thd thc obovc infomation is cor€t. I agrc to omply with 8[ City ed Comty <br />ordinmcB md Statc LM rclatiDg to building consffuc,lion, ed h6cby authoria rcprGqrldivs of this City ud Comty to otE upon thc <br />abovc motioocd prcpaly for <br />Applicill or Agot <br />Pmit@nme <br />purpos. <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 <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 />Final Test <br />Meter Release I <br />FINAL z/ttt '/ aO -r4 ry44{1 <br />(Notes, Remarks, Etc.( <br />*," [ol{!l I