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MECHANICAL.INSPECTOR RECORD <br />DATE !D/SIG.COMMENTSAPPROVALS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation \,/ <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />)Hood <br />Type I Hood a <br />Type ll Hood <br />Grease Duct <br />Fire Damp€r <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />.l elMeter Release rt <br />'7t)rD/F!NAL qry <br />Notes, Remarks, Etc.ll <br />'t'roN <br />followingherebyaffir'rrr under penalty of perjrty that arn exempt liolrr the ('ontractots'License l.as'ftrr the rcason (Sec.70-1t .5 <br />Busines and Prcfcsion Co&): Any City or County which rcquic a pcmit to coGlrucl. atc. imprcva &molish or rcpair my <br />structre, Fior to its isumcc, abo rcquire thc applicmt for such psmit to filc a ligncd ststmat thd hc or slE b licascd pNd , <br />to thc prcvisiorc of thc Contncttr's Licmscd kw (Cluptq 9. Comcncirg with Sction 7000 of Division 3 of thc BuitrB &d <br />PrcfcsioosCodc)ortharhcorlhcisamflthqcfrommdthebasisforth€allcgcdampaion. AoyviolationofsclbnT03l.5[my <br />applicantforapmitsubjetsthc applicanttoacivilpaaltyofnotmorcthmfivchudroddollus($500). <br />-1. <br />I oM6 of thc proFrly. or my mplo)6 with wag6 I thcir $lc compensdion. will do thc t'ott ad thc stnf,lr is ml <br />intadcd or otfac<l foi sic (!c.ZOiA. gBiK ud Prcfeioro Code Thc Conlrsc{or'3 Lic€e trw do6 mt tpply to m omr of <br />thcproFty whohrildsorinprcvcthonmdwhodocuhrcrkhiruclforhdfortlmughhischoommploye. <br />prcvidcd rhat such imFomB m mt iirtadcd or ofrqcd for sb. lf. hw. thc hdlditrg or imlf,ovsmt b oh within onc )a <br />of onpktioq thc Omr Buiktcr will havc thc hrdcr of poving the tr or she did rct build tr irprorc thc propoty 6r th. puposc of <br />slc). <br />_1. m omo of thc propcty. m cxcluivcly conaracting with licilcd contraclorc to corotrucl thc projd (36. 7044. BGinB <br />and Pmftsgirm Codc: Thc Contr&tor'! Licdsc Law do6 oot apply to o ownd of prcpqly who buitls or impmvs thmo. <br />rvho contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). <br />DECLARATION <br />I hereby affrrm under penalty of pojury one of the follos'ing declaralions: <br />__l have and rvill rnaintain a Certilicate of ('onserrt to Setf-tnsure for rvorkers' contpensation. as provided for by Section 3700 of the <br />l.abor Code. for the perfonnance of the rvork fior rvhich the pennit Ls issued. <br />_,-l har,e and rvill rnaintain workers' cornpensation insurance. as required by Section -3700 of the Labor Code. for the perfonnance of <br />the u'srk for rvhich this pornit is issued. My rvorkers' cornpensation insurattce can'ier and Snlicy nuntber are: <br />l <br />that in the performance of the work for rvhich this permit is issued. I shall not onploy any person in any mannef, <br />so as to become subject <br />workers' compensation <br />to the wor*ers'compensation larvs of California. and agree that if I should become subject to the <br />provisions of Section -1700 of the Labor Code. I shall. forthrvith comply rvith thosc provisions.. <br />WARNING: Failure ro secure rvorkers' compensation coverage is unlarvful. and shall subject an employer to oiminal pcnalties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the <br />Section 3076 of the Labor Code. interest and fees. A4-e-f'/? <br />LICENSED ('ONI'RACTOR <br />DECLARA ION <br />I hereby affinn under penalry of pcrjury that I anr licenscd untler provision of ('hapter 9 (corntnencing s'ith Section 7000) of Division J <br />of tlre Business and Professions Code. and rny license is in full ftrrce and effcct. <br />I iccttsc ('lass: I icctlse Ntttttlrt: <br />l)alc ('ottlt'aclrlr <br />CONSTRUCTION LENDINC AGENCY <br />I h@by sIfim undc Fnaty of pqjury that thm is s coirstrucrion lcnding agocy for thc psfomcc of thc mrk for which thb psmit b <br />isucd (Sc. 3(x)7. Civ. C.). <br />l.ctttlct's Nalttr': <br />Lcrrtlcr 's r\tlth t'ss: <br />APPLICANT DECLARATION <br />I hcr*y affirm under penalty of perjury one of the following declarations: <br />Demolition Pcrmits-Asbestos Notifrcation Federal Regulations (Title 40. Part6) <br />-Required <br />Lctter of Notificaion <br />-l <br />cori$, that the lderal regulations regarding asbestos removal are not applicable to this project. <br />certiI that have read this application and state that the above in[onnation is correct.agree cornply rvith all City and County <br />ordinances and State Larvs building construction.of this City and Countyto <br />7-{-rrabove mentioned propeay <br />Applicant or <br />Pennitee name <br />relating ttt <br />(A € <br />and hereby authorize representatives <br />x <br />enter upon the <br />ilhrnnz I <br />-l am exempt under Section.B. & P.('. for this reason. <br />7-4 l,(& <br />Policy Nurnber:_Expires: <br />JT <br />x