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M ECHANICAL.! NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER AUILDER T'EI.CARATION <br />I hacby allim unda paulty of pcjury thd I m amd from thc ContrrclG' Liccne ls for thc following rqrotr (56.?031-5 <br />Bsins ard Prcfc*:ion Codc): Any City or County which rcquirc a pannit to onstruc-t. altq, imprcvc &mlbh or rcpak ariy <br />strudurq prhr to its isrc. allo rcquis thc applicflt for such p6nit to filc a signcd rtdffit thd hc or shc b licascd pwrl[ <br />to thc provisioB of tlrc Conrrcttr'r Licrucd Law (Chapta 9. Comcocing with Setiotr 7000 of Division 3 of thc Buins md <br />hof6sioBs Codc) or ttat hG or shc is dmpt thartom ed thc bcis for thc alQcd cxmgion. Any violstion of Serion 7031.5 by my <br />applicmt for a pannh subjcts thc applicut to a civil paalty of not morc thm fivc hundrcd dotlm ($500). <br />-1. <br />I om6 of thc Fopcrty. or my @ploy6 whh wag6 I thcir $le compquation, will do thc wo* ard thc stnrtre b rct <br />intadcd or oflkcd for salc (Se.7044, Buine md Profcssiore Codc: Thc Coilndor's Licre L6w do6 not qply to m omq of <br />thc prcpqty who buikt or inprcrc tluorr ad who &c sch wrt himclf or hmclf or thmugh his or hc om mploycc, <br />prcvidcd lhsr such improvlrEds N mt intqd.d or o&cd for slq lf. how. ttrc hriHing or inprovqst is mld within m !q <br />of onplabn. thc Ovrc Buildq wil haw tlE hrda of Fovitu tha hc or shc dlt mt hild or inErorc thc proFty 6r thc Frpos of <br />slc). <br />-1. <br />as owner ofthe prop€rty. am exclusively contracting with licerred cootractors to construct the pojecr (Sec. 7044, Buiness <br />and hoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improvcs thereon. <br />and who contracts for such plojects wilh a Contraclo(s) licensed pursuant to the Contraclor's Liccnse law). <br />-l <br />arn exempt under Section-. B. & P.C. for this reason. <br />l)ate: <br />I hereby alTirrn under penalty of pojury one of the follorving declarations: <br />-l <br />have and rvill maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as provided frrr by Section 3700 of the <br />Labor Code, for the p€rfonnance of the work for which the pennit is issued. <br />_l have and Code. for the pcrfonnance of <br />the work for are: <br />I <br />Policy t . ro /(Izt <br />-l <br />certi& that in the performancc of the work for which this per-mit is issued. I shall not ernploy any person in any manner <br />so as to bccome subject to the workers'compensation laws of California. and agree that if I should become subject to the <br />workers' compensation provisions of Section 3700 of the labor Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure to s€curc u'orkers' compensation coverage is unlarvful. and shall subject an onployer to criminal penalties and <br />civil fines up to one hundred thousand dollars ($100.000), in addition to the cost of compcnsation. damages as provided for the <br />attorney's fees. <br />I hereby affirrn under penalty of perjury that I arn licenscd 9 (cornrnencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and effect. <br />I J q4Szzo <br />License <br />a.U zg LI <br />W <br />I heeby allirm udr pcnalty of p€rjury that thtr is r coBtruclion lending agscy for the pqfomocc of the mrk for rvhich this pqrnit is <br />issued (Sc. 3097. Civ. C.). <br />Lender's Name <br />Lender's Address: <br />APrLrc Nr.""ct RA' <br />I hereb', affrnn under penalty of perjury one of the follou'ing declarations: <br />Demolition Perrnits-Asbestos Notification Federal Regulations (Title 40. Parr6) <br />-Required <br />lrtter of Notification <br />-l <br />cdiry thd thc fcd68l rqulatioro rcXrdiry rbetos moval e oot applicablc to this pmjet. <br />Wcaffy t a I hwc ud this ryplicEtion ad ststc thal thG abovc iofomdion b cor61. I agr to omply with sll City od County <br />odimcB md Starc tJB rchling to buildinS consructiotr and hdcby authorirc rcprsil8tivB of this City ad Couty to @tq upon thc <br />above mentioned property for inspection <br />Applicant or Agent <br />Pennitee narne <br />t <br />I )rrl r .'ulxl zt <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 />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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 />Rough Mech. <br />Final Test <br />Meter Release l ^:t A ll /.t l^ <br />FINAL UUI 2l'lrl D}Y{D -l <br />- ::D <br />by Section 3700 of the Labor <br />carrier and\ <br />? <br />Notes, Remarks, Etc.