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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUILI'ER DELCARATTON <br />I hmby affm undr paalty of pcrjury that I m qmpt fiom the Contr.ctoB' Licens kw for thc hllowing @tr (Ss.7031.5 <br />Buine ud Prcftssion Codc): Any City or Couily which rcquiro a pa'mit to co$truct. altc. imprcve danolish or rcpair my <br />stmclut!. prior to its iswcc slso rcquiB thc eplicur for such Froil to filc a signcd stsimat thar hc or drc b licascd pwam <br />to thc FovisioN of thc Contnctor'! Lienrd Law (Chspt6 9, Comcncing with Sction 7000 of Division 3 of thc BwhB ed <br />Profcsioc Codc) u that hc or 3hc is aqnpt thqc&om ud thc basis for thc allcgcd uoptiotr. Aoy violstio[ of Sdbn 7031.5 by my <br />applicutforapqmitsubjeBthc rpplicettoacivilporltyofnotmorcthefivchundrcddollm($500). <br />ItlL t.* omaofthcpmpcrry.ormymplo)6withwag6sthcirslcompcrsstioo,sdldothcw*edtbcgndmbmt- htqdd or offcrcd for salc (Se.7044, Buine ud Profesioro Code Thc Contnc{or's Licmc Law do6 not apply to m oMa of <br />thcFoFty whohrildsorimpouthaa[{dwhodo6shwr*hirelforhffilforthmughhisorhrommploy6. <br />Fovidcdthatsuch impnowmrtsrcrcthtcdcdqofucdbrslc. l[,how.thchriHitrgorinprcmtispEwithinorc]6 <br />of omp!*ion, thc Ownq Buildq will harc thc burda of proving ilra hc or shc did mt build or imprcrc thc propsty &r thc purpos of <br />sh). <br />-1. <br />as owner of the propefly. am exclusively contracting with licensed contractors to construct the project (Sec. 7U4, Business <br />and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. <br />and who contracts for such projects with a Contracto(s) licensed pursuant to the Contractor's License Law). <br />-l <br />am exempt under Section-. B.for this reason. <br />I hereby afTinn under penalty of perjury one of the follorving <br />-l <br />have and will maintain a Cetificate of Consent to Self-lnsure for workers' conlpensation, as provided for by Section 3700 of the <br />Iabor Code, for the pcrformance of the work for which the permit b issued. <br />-l <br />have and will maintain workers' comperuration insurance. as requircd by Section 3700 of the Labor Code, for the performance of <br />the work for which this pcrmit is issued My workers' composation insurance catrier and policy numhr are: <br />Policy Number: Exllires: <br />Wrcediry that in the performance of the work for which this pcrmit is issued. I shatl not employ any person in any manner <br />so as to become subject to the workcrs' compcnsation laws of California" and agree that if I should become subject to the <br />workcrs' compquation provisions of Section 3700 of the tabor Code. I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure to secure workers'compensation covemge is unlawful. and shall subject an anployer to and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of the <br />Section 3076 interest and attorney's fecs. <br />,l \ <br />I ICF'NSF'N CONT]TACTOR <br />DECI ULITION <br />I hereby affrrm under penalty of perjury that I arn licensed under provision of Chapto <br />of the Business and Professions Code. and my liccnse is in full force and effect. <br />a. <br />9 (cornrnencing rvith Section 7000) of Diiision -1 <br />License Class: License Number: <br />W <br />I hercby aflirrn undcr pmalty of perjury that thse is a construction lending agcncy for th€ perfomilce of thc Nork for uhich this fmnit is <br />issued (Str. 3097, Civ. C.). <br />Lender's Natrle <br />Lender's Address: <br />,r,cANr ""cr <br />.RAt <br />I h€reby affirm under penalty of perjury one of the following declarations: <br />Demolition peimits-esbcstos Norilication Federal Regutations (Tirle 40. Part6) <br />-Required <br />Letter of Notification <br />_l cerli& that the federal regulations regarding asbestos rernoval are not applicable to this project. <br />%-t certiry thar I have read this application dd state that the above information is correct. I <br />ordinances and State Laws relating to building construction. and <br />above rnentioned property for inspcction <br />Applicant or Agent <br />Permitee name <br />the <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 <br />Toilet Room / Clothes Dryer I lt /. <br />Residential Range ,l -lldl &ftlttrt tgbK <br />Other <br />Hood <br />Type I Hood <br />Type ll 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 />I An ^A, <br />Rough Mech.u I rilt vp6l,lw)ud5 <br />Final Test I <br />Meter Release <br />FINAL 'ril-21 '116,,l#L4fr <br />Notes, Remarks, Etc. <br />nw A <br />Canier: <br />(lontrrclor: