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M ECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS <br />Appliances <br />Nletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[Vlisc. Equipment <br />Duct Work <br />Pre- lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release tl .rl* <br />FINAL tbl t ho a\\k(b <br />Notes, Remarks, Etc.- <br />and hcrcby <br />I hcrcby aflirm under lrcnalty of lErjury thot I m exempt fDm thc Contracton' Liccns Lsw for the followirg rcssn (Scc.7031.5 <br />Business and Prcfcssion Code): Any City or County which rcquircs r [rcmit to construct, 8ltq. imprcvc. dcmlish or rcJuir rny <br />struclurc. Fbr Io ils issumc. rle requircs lhc Epplicanl for such pemil lo file 8 sigrcd ststcmnt thsl he or slE ir liensd pur$sfl <br />1o thc prcvisions of the Contmctor's Liccnsd kw (Chaptcr 9. Comrcrcing with S6lbn 7(m of Division 3 of thc Busincss md <br />PrrfessionsCode)orthatheorsheiscxemptlhcrcfrcmsndtheb8sisforthcsllcgcdexcmption. AnyviolationofsstbnT03l.5bysny <br />applicanr for a pcmit subjsts the applicsnt to 8 civil pculty of mt mrc than five hundrcd dollrs ($5fi)). <br />-1. <br />as owner of the property, or my employees with wagcs as thcir solc compensalion. will do thc work and the stnrture is not <br />intcnded or offered for sale (Sc.c.7044. Busincss and Profcssions Codc: Thc Contrnctor's Licensc Law does not apply to an owner of <br />the property who builds or improves thereon. and who docs such work himsclf or hcrself or through his or her own employecs. <br />provided that such improvenrcnls are not intended oroffcred for sale. If. however. the buiHing or improvenrcnt is sold within onc )€ar <br />of comphtion, the Owner BuiHcr will have the burden of proving ttrat he or she did rnt huild or inprove the propcrty for the purynse of <br />sah). <br />-1.and l <br />as owncr of the property. arn exclusivcly contracting with licenscd conlractors lo construct thc pr<rject (Scc. 7044. Business <br />antl <br />_l <br />Profcssion Codc: Thc Contractor's Liccnsc Law docs not apply to an owner of <br />who contracls for such projects with a Contracto(s) liccnsed pursuant to the <br />property who builds or improves thercon. <br />Contractor's License taw). <br />ll this <br />I hcrcby atTirrn uncler pcnalty of pcrjury orrc of thc following <br />-l <br />have and will maintain a Ccrtifrcatc of Consent to Self-lnsure for workcrs' compcnsation, as pmvided for by Section 37fi) of the <br />labor Code. for the perforrnarrce of thc work for which thc permit ls issued. <br />_l have and will maintain workcrs'compcnsation insurancc. as rcquircd byScction 3700of thc LahorCode. forthc performanccof <br />thc work for which this Jrcrnrit is issued. My workers' cornJrcnsation insurance carrier and plicy numtrer arc: <br />Policy <br />-l <br />certify that in thc performancc of the work for which this pcrmit is issucd. I shall not employ any person in any rumncr <br />so as to bccome subject to thc workers' comyrcnsation laws of California. and agrcc that if I should becomc subject to thc <br />workcrs' compensation provisions of Scclion 3700 of thc Labor Codc. I shall. forthwith comply with those provisions.. <br />WARNING: Failure to sccurc workers'comJrcnsation coverage is unlawful. and shall subject an grcnalties and <br />civil fincs up ttl onc thousand dollars ($100.(XX)). in addition lo thc of providcd for thc <br />Scction 3076 of thc Codc.li:e s. <br />I hercby alfirnr under penalty o[ perjury that I anr liccnscd 9 (commcncing with Section 7000) of Division 3 <br />of thc Business and Professions Code. and my liccnsc is in full forcc and effc.ct. <br />Licensc Class: Licensc Number: <br />Date:_ Contractor: <br />C(INSTRUC IION LUNDIN(: A(;f,NCY <br />I hcrehy affirnl undcr JEnrlly of pcrjury lhal lhcrc is a ()nslructhn hnding ugcocy for thc lErfonuncc ofthc work lo] which this lErnlit is <br />issucd (SG. .1097. Civ. C.). <br />Lrndcr's Namc: <br />Lcndcr's Addrcss: <br />APPLICANT DECLARATION <br />I hcreby affrm undcr penalty of perjury one of the following dcclarations: <br />Demolition Permits-Asbcstos Notification Federal Rcgulations (Tillc 40. Part6) <br />-Required <br />lrtter of Notification <br />-l <br />certify thut the fedcralregulations rcgarding asbcstos applicahlc to this projccl. <br />_l ccrtify that I have read this application and state is corrcct. I agree to all Cily and <br />ordinanccs and State [-aws rclating to thc <br />atxrvc mentioncd property for <br />0Applicant or Agcnt <br />l)crnrilcc nanrc (prinl <br />reprcscntalivcs of this and lo enlcr <br />l)ate: <br />Carricr:- <br />Exnircs: <br />€ <br />Dele: +---(-- <br />&