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M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS OWNER BUII.DER DELCARATION <br />I hoeby affm undd Jmalty of psjury that I m cxmF film the Contractors' Liccnse llw for the follorving remn (Se.70-11.5 <br />Buinas ud Profsion Code): Any City or County rvhich rcquirs a pmit ro conslrud. alt(. improvc donolish or repair oy <br />struc1uq prbr to its isumcc, also rcluirc thc applicant for such pemit to file a signcd stalm@t lhal he or she is licmsed pwant <br />to the provisiorc of the Contrrctor's Licenscd law (Chapler 9. Commencing with Setion 7000 of Division 3 of the Busincs ud <br />Prcfsions Code) or that he or she is cxmpt thsefrom and thc bcis for the alleged exqnption. Any violation of Setion 7031.5 by any <br />applicantforapennilsubjstslhe applicanttoacivilpcnalyofnotmorclhmfivehundreddollas($500). <br />-1. <br />c osno of the propcny. or my employm rvith rvags c their rclc compmulion. u'ill do the uorl. and thc $ructrc b rcl <br />intaxlcd oroffscdforrlc(Sc.T0,l4.BusinsandhofsionsCod€:Thc('ontractor'sl-icmselrrvdo6notapplytoilownsof <br />thc prclEiy who builds or irnprove th6oo. ad uho do6 such rrcrt himself or hcMlf or lhrcugh his or ha own mployc. <br />provided that such irnprovqmts il€ not iilqdcd or offqql for sle. If. hos'6,6. the building or impovomt is sld rvithin one yw <br />ofcompletion. thc Own6 lruildq will hale thc burdm ofproving that he or she did not build or improvc thc propqly for thc purpos of <br />ele). <br />-1. <br />as orvne of the prop!fly. an exclusively contracling rvith licmsd conlractoGlo coNlruct thc prcjet (Se. 7044. Bsins <br />ard LloftssionCodc: l'heConlractor'sLicenscLawdo6nolapplyloanorvnerofpropcnywhobuildsorimproveslhersn. <br />and who onlEcls for such prcjects wilh a Contmcto(s) licmsed puBuant to the Conlraclor's Licms Larv). <br />-l <br />m excmpt unds Sction-. B. & P.C. for this rwn. <br />Dsle: _ Owner: <br />rlQ8tsE&LgQllPilsAltlt! <br />USCIAEAITQN <br />I hoeby affirm under pcnalty of perjury one of the follorving drcluatiom: <br />_l have dd will maintain a Ceaificate of Corent to Self-lnsure for rvorkers' conrpensation, u prcvided for by Setion 37U) of the <br />Labor Codc, for lhe lnfonwcc of lhe rvork for which lhc pmnit is issued. <br />_l have and rvill maintain workers' compcnsalion insurance. 6 required by Sation .1700 of thc Labor Codc. for the lEfomncc of <br />the work for rvhich rhis pcmit is isucd. My workrs' compenstion insurancc cffiis ild policy numbq {e: <br />Policv Number: Exnires: <br />fucqt;ty tt rtin the psformocc of the work for rvhich this pqmit is issued. I shall not qnploy any pson in any mannq-io re to beome subjet lo thc wortc' compcnstion laws of Califomia. and agre that if I should become subj(l lo thc <br />uo*m' compwtion prcvisiom of Soction 3700 of the Labor Code I shall. fonh$'ith comply Nith thos prcvisions.. <br />-l <br />IVARNING: Failue to Eurc $ork6'compsBatiotr coveage is unlarvful. and shall subjst m onplolu to riminal tEnltie md .. <br />civil fina up to one hundrcd thoMd dollffi ($100.000). in addition lo thc cost of comperoation. damagc o provided for the <br />Setion 3076 of the Labor Codc htq6t ild attorney's fs. <br />",,", l/26fTetl <br />I ICENSEN CONTR/ACTOR <br />D.FCI.A]TATION <br />I hereby affirm under pcrialty of perjury that I am licenscd under provision of Chapter 9 (commcncing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my license is in full force and effect. <br />0LicenseNurnber: <br />CONSTRUC'TION I-ENDINC AGENC}' <br />I hrcby afffm undq fmalty of psjury that thsc is a consnrction lmding agmcy for the perfommce of the work for which this pqmit is <br />issucd (Ss. 3097. Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />,r, ,c N.T TECLAM. <br />I M>y aflirm under penalty of perjury one of the follorving declarations: <br />Dernolition Permits-Asbcstos Notification Federal Regulations ('title 40. Part6) <br />-Required <br />Letter of Notification <br />f?.*ify that the fe<leral regulations regarding asbestos retnoval are not applicable to rhis project. <br />-l <br />cdiry that I have read this application md statc that thc abovc infomation is conct. I agre to smply with all City and County <br />ordinancB ild Statc Laws rclating to building construclion. and hseby authorirc rcprGolalivG ofthis City md County to mtq upoo thc <br />above mentioned property for inspection prrmQses. <br />^ <br />Applicant or Agent siq ^t',rr", J ll 9Q0 ? <br />IPerrnitee narne <br />bqL9 """,fllef\oLl <br />Appliances <br />Meta! Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation -,lrrV l--n^ <br />lnsulation -H ilr UY <br />Smoke Detectors Installed <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type ! Hood <br />Type II Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar aq4,l (/-'2 / <br />Rough Mech. <br />Final Test <br />Meter Release <br />FINAL cr48^24 9,&3r^4rA nJrl <br />Notes, Remarks, Etc <br />Carrier: <br />i/r4 LgLI conrrrcto,, NQtz VWr Vtrl k{