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M ECHANICAL.! NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS <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 />Rough Ductwork <br />Vents rl rt t?.1 <br />\.Jtfi<Toilet Room / Clothes Dryer (/;7 <br />Residentia! Range ,l V <br />Other <br />Hood <br />Type I Hood <br />Type II 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 l, I .t- _ / <br />FINAL ll cl'u NI{o7 <br />Notes, Remarks, Etc.It <br />OWNER BUILDER DELCARATION <br />I hmby atfm undc poulty of pojury thd I m ump from thc Coflnc{on' Licre Lrw br thc following @n ($c.7031.5 <br />BBin6s and Prcfc$ion Codc): Any City or County which rcquim a po'mh to omtruct. altc. imprcve dcmolish or rcpair my <br />stucturc prior to hs issumcc. alrc rcquie thc eplicmt for such pcmit to 6lc I signcd Etdoot thd hG or shc b licfiscd pNerl <br />to thc prcvbioN of thc ContEctor's Licoscd kw (Chapt6 9, Comcrcing with Setiotr lOOOtf pirisloo 3 of thc Buins md <br />PmfcsioDs Codc) or that hc or shc is smpt thGcfrom md thc b0sis for thc allclcd qmption. Any violation ofSccrbn 7031.5 by any <br />applicutforapomhsubj€lsthc spplicartto8civilpcoaltyofnotmorcthsfivchuorlreddollrs(3500). <br />-1. <br />r omr of thc pmpcny, or my mploye with wagc c tlrh $lc smpcns8lioo. will do tlE sort sd thc $ndrc b mt <br />intsdcd or offcrcd for sle (Sa.70,14. Busin* ud Proftssions Cod€: Thc Contnclor's Lictrc lrw do6 not apply to e oMq of <br />thcFopcty rvhohril&orinprorstlson,ardwhodocruhwrthimclforhemlforlhoushhisorh6omcmployG. <br />providcd that such improrutmts rc not imadcd or offtrcd 6r slc. l[ horvryq. thc tuiHing or imFoffit is sld within onc yw <br />of onpkrion thc olvnr &rilCq will h8rc thc hd6 of Foviry thd hc or shc dit mr hriH q irprorc the popaty for thc prpo* of <br />slc). <br />-1. <br />as o\vner of the propcrly. am exclusively contracting rvith licensed contractors to construct the projcct (Sec. 7044, Business <br />and Pnoftssion Code: The Contractor's License Larv does not apply to an owner of property u'ho builds or improves thereon. <br />and rvho contracls for such projects with a Contracto(s)to the Conlractor's l-icense Larv). <br />_l am exempt under <br />Dete:_ <br />I hereby affinn under penalty of pojury one <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />I-abor Code. for the performance of the work for rvhich the perrnit b issued. <br />---l have and u'ill maintain rvorkers' compcnsation insurance. as required by Section -1700 of the l-abor Code. for the perfonnance of <br />the work for which this permit is issued. My rvorkers' compensation insurance carrier and policy number are: <br />Policy l:rprrcs: <br />_l cerri& that in the perfonnance of the rvork for rvhich this permit is issued. I shall not ernploy any percon in any manner <br />so as to become subject to the work6s' compensation larvs of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the l-abor Code. I shall. forthwith comply rvith thosc provisions.. <br />WARNING: Failure to sccure rvorkers' compensation coverage is and <br />civil fines up to one hundred thousand <br />Section -1076 of the Labor Code. interest <br />dollars ($ |the <br />and <br />I hereby allirm under penalty of perjury that I am licensed 9 (commcncing rvith Section 7000) of Division -3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />License Number: <br />('ONS'I'RUC'I'ION LI:NDING AGEN('Y <br />I haeby aflirm uodr penahy of 1rrjur)'that thq'c is a constnrdion lflding agocy for thc Jufomance o[ lhe s rrrk for s'hich this tnnit b <br />issued (Sec. 3U97. ('i\'. (-.). <br />Lender's Nanre: <br />[.ender's Adclress: <br />APPLICANI' DEC LARAI'TON <br />I hoeby alTinn under penalty of perjury one of the follorving declaratiorrs: <br />Derrrolition Pcrrnits-Asbestos Notification Federal Regulations ('I'itle 40. Parr6) <br />Requiretl l-etter of Notification <br />I regarding asbestos rernoval are not applicable to this project. <br />I <br />I rvith all City and County <br />and County to enter upon the <br />Dare: L al '=, I I <br />above <br />or Agent <br />the atnvc <br />-r \ <br />Date:_ <br />('onlraclor: <br />€tlffL it- t