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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWIIER BUILDER DEI,CARATTON <br />t hacby affm un&r FlElty of pqjury thd I e qmpt from thc Cont6cl6' Licorc Lrw for thc following ror (Se.7031.5 <br />Buincs and ProfBion C.odc): Any City or Coutrty which rcquirc a pcmit to onstruct. alt6. improvc. &rrclish or rpeir my <br />strucluc prior to its isuma alm rcquiro thc eplicut for such pcmit to file a signcd statmat thrl hc or shc is limscd pwsg <br />to thc FovisioB of th€ Contrettr's Limscd Lrw (Chspt6 9. Comming with Setion 7000 of Divisiol 3 of thc BBin* ed <br />Prcf*ios Codc) or that hc or shc b q@pt thftfrom ed th€ bGb for thc allcgcd amption. Any violstion of Sciion 7031.5 by uy <br />applicmt for a pcmit subjcts thc 8pplicet to I civil pcmlty of not morc thm five hudrcd dollan ($500). <br />UK ow of thc popcry, or my mploye with wag6 s thcir slc ompqBarior. will & thc wq* ed th€ nndr b mt <br />intadcd or olfcrcd for $lc (Ss.7044, Buins md Prcfcssiou Codc: Thc Contnctor's Lic@ kw do6 oot apply to u omq of <br />thc Fopqty who hil& or inprcu throtq ed who doc sh mr* himclf or hffilf or thrcugh his or ho om mploy6. <br />providcd thst such iEpromts m mt irtradad q ofu for slc. I[, how. thc hrilding or iteioffit b sld within orc ]s <br />of corplctirq thc Oma Bui$q will havc thc hrda of Foving thd h. or shc did mt hild tr inpmrc thc prcpqty fo! thc purpo* of <br />slc). <br />-1, <br />r om of thc propqty, m scluivcly sotrrcling with licas€d @otrsctoB to coBaud thc projcr (Sc. 7044. Busias <br />and PtoEsion Codc: Thc Conlnctor's Lic@c Law do6 not apply to u own6 of prcpaty who builds or improvG thqan, <br />ud who mntnc{s for sch prcjets whh s Coftr&ro(s) licdB€d pBWt to thc Contructor'3 Lic@ [iw). <br />I). &for this reason. <br />I hereby affrrm under penalty of perjury one ofthc following <br />-l <br />have and rvill rnaintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Scttion 3700 of the <br />Labor Code. for the p€rfonnance of the work for rvhich the permit is issued. <br />-l <br />have and rvill maintain workers' compensation insurance. as required by Section -3700 of the L.abor Code, for the performance of <br />the work for rvhich this pennit is issued. My workers' compensation insurance carrier and policy number are: <br />any person in any manner <br />so its to become subject to the work€rs'compensation laws of California. and agree that if I should bccome subject to the <br />workers' compensation provisions of Sedion 3700 of the tabor Code. I shall. forrhwith comply with thosc provisions.. <br />WARNING: Failure to sccure workers' compensation coverage is unlawful. and shall subject an onployer to criminal poulties and <br />civil fines up to one hundred thousand dollars ($100.000). in addition the cost of damages as providd for the <br />Section -3076 llrc Code, interest and attorney's fees. <br />t <br />LICENSED CON'TRAC'TOR <br />IIECI ^ R.ATION <br />I hereby affinn undcr penalty of perjury that I am licenscd under provision of Chapter 9 (cornmencing *'ith Section 7000) of Division 3 <br />of the Business and Profcssions Code. and rny license is in full force and effect. <br />License Class: License Number: <br />llo to. <br />CONSIRU('TION LT'NDING AGEN('Y <br />I hmby affim undo penalty of perjury thd thqc is a congruction loding agocy for thc psfonnmce of thc wrt for shich this pqmit b <br />issued (SE. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPI ICANT nr.CL{IL{flON <br />I hcr*yaftmund6 pcnalty of perjury one of the following dcclarations: <br />Demolition Permits-Asbestos Notifrcation Federal Regulations (Title 40, Part6) <br />-Requird <br />l-etter of Notificdion <br />rvith all City and County <br />and to enter upon the <br />above mentioned property for inspection <br />Appticant or Agent Signaturc: <br />Perrnitee name <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 Installed <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type Il 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 1,.\ <br />FINAL Io-'-A )h/U-n{) <br />Notes, Remarks, Etc.v V <br />LhvyOvY l\Er-lvfAco\rllMV * <br />_l am <br />Dete: o b Owner: <br />Carrier:_ <br />_ Contractor:. <br />0A\ fr -^..>lelz}