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M ECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type Il Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release I A /\I ^/l F!NAL I L5 u)J/N Ir rury67 Notes, Remarks, Etc.I I I I I hereby affirm under penalty of perjury that I arn exempt from the Contractors' License Law for the following fcason a r (Soc.7031.5 . Buincs md Profeion Codc): Atry City or County which rcquiro a pornit to coBtruct, slt6, imprcvq doolisf or rcpaiS my struc{uc. prior to ils issumc also rcquirc the applicilt for such pcmir to file a sigrcd statmat that hc or shc b licmscd puuut to thc provisior of thc Contractor'! Lienrcd Lrw (Chapt6 9. Commcing with Sction 7000 of Divisioo 3 of thc Buirs ud Prcfeions Codc) or that hc or she is umpt thsGfiom md thc basis for thc allcgcd amdion. Any violation of Setbn 7031.5 by oy applicmt for a pcmit subjets thc applicmr to a civil pcmlty of not morc tha fivc hundrcd dollm ($500). -1. 8s owner of the p,roperty. or my employees with wages as their sole compensation. will do the work and the structurc is not intendod or offered for sale (Sec.7044, Business and Professions Code: The Contraclor's Liccnse Law does not ryply to an owner of the poperty who builds or improves tlrcron and who does such work himsclf or herself or through his or her own employees. provided that such improvanrnts are not intcndod oroffcrod for sale. If. howerrer, the building or impnovancnt is sold rvithin one )â‚¬ar of comple'tion, the Ourner Builder will have the hrden of proving tha he or she did not build or improve the p,ropcrty for the purpose of sale). -1. as owner of the property. am exclusively contracting with licensed contraclors to construct the projecr (Sec. 7044. Business and Pnofession Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves lhereon, and who contracts for such projects with a Contracto(s) licersed pursuant to the Contractor's License Law). -l am exempt under B. & P.C. for this reason. 0wner: woRK-RS' COMPENSATT DECI,ARATION I hereby affrrm under penalty of frerjrry one of thc follorving declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for rvorkers' conrpensation, as provided for by Section .3700 of the Labor Code. for the perfonnance of thc work for which the perrnit is issued. . -l have and will maintain workers' compensation insurance, as rcquired by Section -1700 of the Labor Code. for the pcrformance of the rvork for rs insurance carrier urd policy number are: Policy -l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compauation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvith comply with those provisions.. WARNTNG: Failure to secure workers' compensation coverage is unlarvful. and shall subject an onploycr to criminal poraltics and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of as provided for the Section 3076 interest and attomey's fecs. I LICENSED CON'I'RACTOR DECT ARATION I hereby affrm under penalty of pcrjury that I arn licensed under provision of Chapter 9 (cornmencing rvith Section 7000) of Division 3 of the Business and Professions Code. and rny license is in full force and effect. License Number:2r I hereby affrm under penalty of perjury that there is a construction issued (Sec. 3097. Civ. C.). agency for the performance of the work for which this pernrit b Lender's Narne. l'ender's Address: ,r, ,cANr "rc, RAT I lrâ‚¬râ‚¬byaffrrn under pcnalty of perjury one of the following declarations: Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Pan6) -Required Letter o f Notilication -l certi& that the federal regulatioru rqltrding asbestos rernovalare not applicable to this project. -I certify that have read this application and state tlrat lhc abovc rvith all City and County ordinances and State Laws relating Io building above mentioned property for insperction Applicant or Agent Pcrmitee narne K construction.and infonnation rs correct. and to entq upon the \ ContractorrK 2d^9