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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/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 />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />Installation <br />F. D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release rl [ ,y'l <br />FINAL 5l (n ui )foA{\ 4\w0 / <br />\\\Notes, Remarks, Etc.II <br />oWNER BUILDER DEI,(:ARAT]ON <br />I hereby amrm un<lcr pcnalty of psjury that I m excmpt from the ('onlractorc' l,icerc kv for thc folloiing rcmn (Sa.?011.5 <br />Businss md Profesion Code): Any City or County $hich requirs a lmit lo construcl. alto. improve donolish & rcpair any <br />struclurc. frior to its issuancc. also rcpirs the applicant for such pemit lo file a signed slatqnol lhat h€ or shc is licosed pu6pml <br />to thc ;rovisions of the Contractor's Licenrcd Larv (Chaple 9. Commencing uith Sstion 7000 o[ Difision -l of thc Rusinss and <br />Prcfesions Code) or that he or she is exempt thqefrom and the basis for the alleged eremption. Any violation ofSilion 70-r I 5 by any <br />applicsntforapennitsubjctsthc applicanttoacililpenaltyofnotmorelhanfivehundreddollars($500) <br />_ t. o o*ner oflhe Fopeny. or my emplolm rvilh rragts u their s)le compflsation, will do the riort and thc strudrc b nol <br />intodd or offsed for Mle (Sc.7044. Businns and Prof*sions Code: I'he Conlmcter's l-icmse l.au' do6 nol apply lo an owner of <br />the pmpedf, rrho builds or improvs thmn. and rvho dos such Ncrt himsclf or hmclf or through his or he orvn employs. <br />providcdthatsuch im1rer'onmtsreretintodedoroffarlfirrsle. lf.hosoq.thehrildingorimproronentismldrrithinonclw <br />ofcornplaion the O$ nq Builrts will havc the htrd6 ofproving thd hc or shc did mt hoild or improvc lhc plopqty for thc purpo* of <br />sle). <br />_ I. as osnr ofthe Jrop6ty. m crclusi\'.ly contractilg $,ith licmsd conlmctos to construcf the poj.c{ (Ss. 7014. BGinRs <br />and ProfesshnCodc:'IheContractor'sLicmsel-aNdo6notapplytoaooNncofpropertyNhobuildsorirnproleslhson. <br />and who conlncls for such lxojcts rvith a ConlEcto(s) licmsed puBuant to the ('ontractor's l,icos Las). <br />-l <br />on erempl under Sation----- <br />-. <br />t'. & P.C. for lhis rcmon. <br />I)alc: <br />DECLARA'T'ION <br />I hereby alTirm under penalty of perjury one of the follorving declarations: <br />__t haye and rvill maintain a Certificate of Consent to Self-lnsure for s'orkers' compensation. as provided for by Section 1700 of the <br />Labor Code. for the perflonnance of the work for rvhich the pennit is issued. <br />_l haye and s'ill rnaintain s'orkers' compensation insurance. as recluired by Section .1700 of the l-abor Code. for the peffolmance of <br />the u'ork for s'hich this permit is issued. My s'orkers' compensation insurance carrier and policy number are: <br />Policy fi v nirac. <br />_l certi& that in the performance of the rvork for rvhich this perrnit is issued. I shall not employ any person in any manner <br />so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the <br />workcrs' compensation provisions of Section -1700 of the Labor Code. I shall. forthrvith comply with thosc provisions.. <br />WARNING: Failure to secure rvorket's'coverage is unlarvful. and shall subject an anployer to criminal penalties and <br />addition to the cost of compensation. damages as provided for thecivil fines to one hundred thousand tn <br />Section inlerest fees. <br />6 2Z zo \'l <br />DECI-tRA'I'ION <br />I hereby affinn under pcnalty of perjury that I arn licensetl under provision of ('hapter 9 (commencing w'ith Soction 7000) of [)ivision -1 <br />of the tlusiness and Professions Code. and rny license is in full force and eflect. <br />License B l-icense Nurnber:b q <br />8 <br />I hereby affrrm undcr penalty of perjury that <br />issued (Sec. 3097. Civ. C.). <br />isa lencling agency performance of the rvork for rvhich this p,ermit is <br />l.crtrlt't 's Nalttc <br />Lender's Address: <br />APPLICAN'T DEC LARATION <br />I horb)'afiinn under penalty of perjury one of the follos'ing dcclarations: <br />Dernolition Pernrits-Asbestos Notiflcation Federal Regulations (Title 40. Pan6) <br />-_ <br />Required l,etter of Notilication <br />with all City and County <br />and County to enter upon the <br />s\ z*\ <br />Pennitee <br />I <br />1 <br />Dnte:ztHK( <br />the lHeral regulations regarding asbestos removalare not applicable to this project. <br />I have read this application <br />Larvs relating to <br />above for <br />Agent