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M EC HANICAL.I NSPECTOR REGORD t a APPROVALS DATE ID/SIG.COMMENTS Appliances Metal Fire Place Evap Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar 7 Rough Mech.M%t /"/. Final Test t \/T- Meter Release Ir FINAL q ?-lA Pfi,'ff2'I/t, I hmby afrim uda pcoalty of pâ‚¬rjury th.t I m cxmpt fm thc Corrctom' Licmc Lgw for thc following ruil (scc.7o3l.5, Buiros md Prcfcssion Codc): Atry City or CNty which rcquim a pcmit !o ffitsuc! 8lts, imprcvc, &molish or rcprir my sBucturr, prior !o its isuue, also rcquirc thc appliml fc such pcmit to filo a signcd slataMt that hc s shc is limscd pwwt to thc prcvision! of tho Cotrrctor's Licoscd Law (Chapta 9, Cmacing with Scctim 7000 of Division 3 of thc Buinqs ud Prcf*ims Co&) or thu hc c shc is cxmpt thm&om md thc bsir fathc allcgcd cxmption .Any violatim of Scctim ?031.5 by uy applimt fr a pcmit subjiu thc applimt to a civil paslty of not lIW the fivc hunrbcd dollm (S500). 1y', u owa of trcFopcrty, or my mployG with wags 6 thcir solc comps8ation, will do lhc wsL md tJlc stsuctw is not itrtm&d 6r ofrcrcd fc salc ( Se.70,14, Buins od Prcfssim C;&: Thc Cmtelor'! Licasc Lsw dG not apply !o u Mq of thc prcpcrty who buil& o inprcvs tham, ud who docr ruch wqk hiruclf or hcclf c through his c hc own mployca, prcvi&d thst such itrtpt'ovmaB m trot itrtcndcd ff offgrd ftr salc. If, hwoa, thc buildiog or imprcvmot is sold vithin mc ycd of complctim, thc Orwa-Buildcr will hevc thc bur&n ofprcving dlu hc c shc not build orimprcvc for thc purposc ofsalc). _I, I owner of the Profcssion Code: The propcrty, am cxclusivcly contracting with liccnsed construct the projcct ( Scc. 7044, Busincss and Contractor's Liccnse Law docs not apply to an owner builds or thereon , and who contracts for such projects with a Contracto(s) licensed pursuant to the Law.). _I arn Due: Scction & P.C. I hereby aflirm undcr penalty of perjury onc of the following I havc md will minain a Ccrtificarc of Consmt to SclfJroe fq wckcn' cmposatim, s prcvidcd fo by Scction 37OO of ftc Labo Code, fo drc pqfmme of thc wct fo which thc pqmit is ircucd. _I have and will maintain workcrs' compsnsation insurance, as work for which this pcnnit is issued. My workers' compensation rcquired by Section 3700 of the Labor Code, for the pcrformancc of the insurancc carrio and policy number are: Policy (This section need not bc completed if the permit is Onc or less) -/"*rrfthat in thc pcrformancc of thc work for which this pcrnrit Sccarne subject to the workcrs ' compcruation laws of California, and ls I shall not in any manncr so ils to to the workers' compcnsation of Scction 3700 of the Labor Code, I WARNING: Failure to secure workers' compensation fines up to one hundrcd thousand dollars ($100,000),in thc Labor Codc, intercst and atlorncy's fccs. LICENSED CONTRACTORS DECLA&{TION I hocby aftim udq pqralty of pdury thd I m limcd udr prcvisim of Chaptc 9 (cm6cing with S@tim 7000) of Divisiu 3 of thc Buincsr ed Prcfsim Codc, md my licaue is in full fqtc md cfrct. License Datc: Number CONSTRUCTION LENDING AGENCY I hcby affim udcr padty of pGjury rhat thc is a costruction lcnding agmcy fc thc pcrfomme of thc work for which this pmit is issucd (S@. 3097, Civ. C.). Lad6's Nmc: Lcnder's Address: APPLICANT'S DECLARATION Dcrnolition Pcrmic-Asbestos Notification Federal Rcgulations (Title 40, Part 6) _ Requircd Letter of Notification -I that the fedcral regulations asbcstos rernoval are not applicable to this project. I certify that I have read this that the information is correct. I agree to comply with all City and County ordinanccs and State Laws above mcntioned propcrty Applicant or agcnt ts to thc Pcrmittee name (print): constnrction,authorize rcprescntativcs of this City and County to enter upon thc 6 shall