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APPROVALS DATE ID/SIG COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler I /: <br />Furnace I <br />Compressor I <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 <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damp@r <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 .^ <br />FINAL I <br />Notes, Remarks, Etc.lt - <br />-+ <br />I hcby affm unda p6.lty of pqjury that I m qmpt ftoE the ConlrcloB' Lic@ L:w for thc followi4 re[ (Sc.7031.5 <br />Buins ard Proft*sion Co&): Any City or County which roquiro a pcmit to snstnrct, a[6. imprcvc dmolbh or rqair oy <br />struclurg prior to it! issucc, also rcquirB thc applkmt for such pamit to 8b s si$cd sd6at thd hc or $c b licos.d Fmtar <br />to thc prcvbioN of thc Cootrrctd'! Liccnscd hw (Chapto 9, Comming with Sction 7000 of Division 3 of thc Buine ud <br />PmfeiomCodc)orthalhcfishcbqmptthcc&omedthcbabforthcsllcgoda@ption. AnyviolaionofScrbnT03l.5bymy <br />applimtforapcrmitsubjatsthc rppli@ttoscivilposltyofaotmrcthefivchundrcd&llars(3500). <br />-1. <br />a ow of 0E Fopaty, or my mplole with wrgc u thcir slc ompmaioo uill do thc wqt Ed thc $udr b Dt <br />intqdcd or ofucd for ulc (Sc.7044, Buire md Profeiom Codc: Thc Contnctor'8 Licre Lrw do6 Nt apply to u omq of <br />thc prcpqty who hrikh or inprcs thmn, md who &c ruh wtt hirelf or haslf or thrcugh his m hc om mplole, <br />prcvidcd that rwh imprcwu*s rc mt Ltodcd or ofued for sh. l[ howffi, thc builCirg or irqrcvarut is rcld within orc ]a <br />of onplrbr, thc otrnr BuiEc will harc thc hrda of pmviry tha hc or drc dil rct tuild or iqrcw lhc propqty 6r thc Frpocof <br />sb). <br />-1, <br />a orc of thc propqly. m qcluiwly @Drrding with Ii6E€d coDtr cton to orstruct tlE pmj6{ (Sc. 7044, Brlitrd <br />ard Pofusbn Codc: Thc Conraclor's Licffi Law doc not lpply to e own6 of prcpaly who builds or imprcvq thmn, <br />md who mrtracls for suh FojEls with a Codracrd(s) lic6€d puEusfl to tlE Conrrsclor's LLrre Lry). <br />-l <br />m cxmpt udr Sction-. B. & P.C. for thb @r. <br />l):rtc <br />WORKERS' COMPENSATION <br />DECI,AITATION <br />I hereby affrrm under penalty of pcrjury one of the following declaratioru: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workem' compauation, as provided for by Section 3700 of the <br />I-abor Codc for the pcrformancc of the work for which the pcrmit b issuod. <br />-l <br />have and will maintain workers'insurance. as by Section 3700 of the Labor Code, for the performance of <br />the work for rvhich this pennit is issued.carrier and policy number are: <br />-l <br />certi& that in the performance of the work for which this pcrmit is issued, I shall not onploy any person any manner <br />so as to become subject to the workcrs'compensation laws of California, and agrec that if I should to the <br />workers' cornpcnsation provisions of Section 3700 of the Labor Code. I shall. forthwilh cornply with <br />WARNING: Failurc to sccure workers' compensation subject to criminal poulties and <br />civil lines to onc hundred thousand dollars as provided for the <br />a <br />Section Code and attorney's <br />DI.]CL,,\RA'I'ION <br />I hereby aflirm under penalty of perjury that I am licensod under with Section 7000) <br />of the Business and Professions Code. and my license is in full force <br />License <br />I hereby under penalty of perjury that agency pcrformance for which this perrnit b <br />issued (Sec. 3097, Civ. C.). <br />Lendcr's Name: <br />Lender's Address: <br />APPLICANT DECI {IIATION <br />I hcrr*D,aftmunder pcnalty of pcrjury one of the following declarations: <br />Demolition Pennits-Asbestos Notification Federal Regulations (Title 40, Part6) <br />-Required <br />Lctter of Notification <br />-l <br />certifythat the fbderal rqgulations asbestos rernoval applicable to this <br />that I have read this the abovc cornply with all City and <br />and State Laws City and <br />above mentioned property for <br />Applicant or Agant <br />Number: <br />Pennitee nzune <br />and <br />correct. I <br />,0 <br />upon <br />M ECHANICAL.I NSPECTOR RECORD <br />rw(z), <br />'on rL <br />0wner: <br />Carrier:-qlqPolicy Number:-_Expires: <br />Date: