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MECHANICAL.I NSPECTOR RECORD <br />t <br />APPROVALS DATE ID/SIG.COMMENTS Ownar-Buildtr Dcclmtion <br />t hscby aflim undcr Fnslty of pcrjuy ihat I m crmp fm thc Conretffi' L|€NG Law fc thc iollowing mo (rc.7031 .5 Builrc <br />ild Prcfgsim Codc): Any City a County which rcquire r pcmit to @ffitruct, alta, improvc. dcmlirh c Epsir sy structurq Fitr to ia <br />issuacc, also rcquiG thc applimt ftr such p.mit to filc s sigtrcd st.tcrmt th.t hc s shc is licascd puswt to thc povisiou of thc <br />Cmtretor's Limscd Law (Chrptcr 9, Commencing with Serim 7000 of Divirio 3 of thc Buins ud Prcfcim Codc) c thu hc or <br />shc is cxcmpt thftfm ed thc bais fff thc rllcged cxcmption .Any violrtim of S*tion 7031.5 by sy appliot f6 s F fliit subj@o Oc <br />applicmt !o a civil pcnslty ofnot morc the fivc hundrcd dollm (3500). <br />_1, o owna of thc popcrty, or my cmploycB with wag6 I thcir solc mpcnsatim, will do lhc wqk ud thc structuc is not int6&d <br />or offcrcd fq salc ( Scc.7044, Bsin6 ud Prcfsions Codc: Thc Conretq's Licqsc Lrv dc not .pply lo a wtrq of thc prcpcny <br />who builds or improvc th6m, ild who dG such wqk hiroclf or h6.lf r 6rough his c hc own mployc, Fovidcd thlr such <br />improvcmoB uc not intcndcd or offqcd for salc. lf. howcvcr. thc building u imprcvmcnt is sold within onc ys of @mplction, thc <br />Owncr-Builds will havc the burdar of proving that hc or she not build or improvc for thc purpcc ofsalc). <br />_1. as owner of thc property. am exclusively contracting with liccnscd contractonr to construct the projcct ( Sec. 7044, Business and <br />Profession Codc: The Contractor's License Law does not apply to an o\pncr of propcrty who buil& or improves thereon . and who <br />contracts for such projcc6 with a Contractor(s) licensed puruant to thc Contractor's License ky )' <br />_l am exempt under Section for <br />Date' Ownsr: <br />I hercby affirm under pcnalty of perjury one <br />_l havc ud will mintaia a Ccnificatc of Conscnt to SclfJnsurc for wortm' compcm8tion, u povidcd fo by Scction 3700 of thc <br />Labq Codc, for thc pcrfmc of thc wtrk ftr which thc pqmit is isucd. <br />_l havc ud will mintaio wcko' mpafatim imwe, a Equirrd by Scction 370O of thc Labc Codc, ftr thc p6fm* of th. <br />work for which this pqmir ir isucd. My wtrkm' cmpansatiil in3uocc tria ud policy numbcr re: <br />Policy Numbcc Expircs:(Thissectionn atc.s)- <br />_l certify that in thc pcrformance of the work for which this pcrmit <br />became subject to thc workers'compcnsation laws of California, and <br />is issued, I shall not in any manner so as to <br />the workcrs'that if I <br />compcnsation provisions of Scction 3700 of the Labor <br />Date: <br />WARNING: Failurc to securc workerc' compcnsation <br />fines up to one hundred thousand dollan ($100,000),in <br />the Labor Code, intcrcst and attorney's fecs. <br />coveraSc is unlawful, and an employer to criminal pcnaltics and civil <br />addition to the cost of compcnsation, damagcs as providcd for the Section 3076 of <br />LICENSEI' CONTRACTORS DECLARATION <br />I hscby affim und6 psfldty of pajury thst I m liccnscd uda povie io of Chrpr 9 (ommocing with Setio 700O) of Diyirion 3 of <br />thc Buinu ud Prcfsiom Codc, ud my limrc is in full fwc md cfrct <br />Liccnse Clacc'License Number <br />Datc: Cmtracttr: <br />CONSTRUCTION LENDTNG AGENCY <br />I hmby rlfim undcr padty of pdury rhst thc ir r mstructim lmding rgmcy fc thc p6fm8e of thc wdt fq which thir Fmit ir <br />i$scd (Se. 3(D7, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICAIIT'S DECLARATION <br />Demolition Permis-Asbcstos Notification Federal Rcgulations (Titlc 40, Parr 6) <br />_ Required Lener of Notification <br />-l <br />certify that the federal regulations regarding asbcstos rcmoval are not applicable to this project. <br />all City and County <br />County to enter upon the <br />Applicant or agart <br />Permittce nane (print): <br />and state with <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-!nsulation <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 Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />I I <br />Rough Mech iltol d9 r A)?2r <br />Final Test I Y-Z <br />Meter Release <br />FINAL <br />a <br />t <br />\ <br />/2 <br />bccome <br />srrSject <br />abovc mentioned property <br />?