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MECHANICAL.I NSPECTOR RECORD APPROVALS DATE !D/SIG COMMENTS Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation Insulation Smoke Detectors I nstalled Rouqh Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type II Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release l\ FINAL lc\l1 7)t\z(q40 Notes, Remarks, Etc.lt \\\ I hereby aflirm under penalty of pcrjury that I am exempt from the Contractors' License law for the following reason (Sec.703l a .5 Buines and Profsion Codc): Any City or County which rcquirs a pcmit to coctruct. dt(. imprcvc, danolish or rcpair my structue, Fbr to its issumcc, also rcqutB rhc eplicot for such pcmh to filc a signcd staldmt rhd hc or shc b licoscd pu6ust to thc povisioro of thc Contractor's Liensed trw (Ch8fl6 9, Comocing with Setior 7()0() of Division 3 of thc Buine md PrcfcsionsCodc)orthathcorsheiscxcmptthqrftommdthcbssisforthcdlcacdaoption. AnyviolationofSetionT03l.5bymy applicma hr I p6mit subjcts the applicart to a civil pcmlty of not more lhu livc hundred dollm ($500). -I, as owner of the property, or my anplopcs with wages as their sole compensation. will do the work ard the *nrtune b not intetrdod or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License l-aw does not ap,ply to an owner of the propcrty who hrilds or impnoves thcron, and who docs such work himself or hersclf or through his or her own cmployees. provided that such impnovcnreots rc not intcndod oroffirod for sale. I[, howerrcr, ttrc hlilding or inpnovernent is sold within one ]cr of complaion the Orvner Buildcr will have the hrden of proving ttra he or she did not build or improve the property for tlrc purposc of sale). -1, as owncr of the propcrty, am exclusively contracting with licemed contraclors to construct the project (Sec. 7044, Buiness and Profession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such pnojects with a Contraclo(s) licensed pursuanl to the Contrac{or's License l-aw). -l am exempt under Section-. B. & P.C. for this reason. l):rlc: I hereby affrm under pcndty of perjury one of the WORKERS' CONT PENSATTON DECLARATION fo I low ing declarat ions : <LJ have ad will maintain 8 Cqlificatc ofcoNat to Sclf-lNurc for workas' conrpensation, r providcd for by Sction 3700 ofthc /abor Code, forthc psfomuce of thc work for which the pmit b issucd. work and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for thc po'formance of for which this pcnnit is issued. My workers' compe'nsation insurance carrier and policy number are: s f at n&S Policy l lzt) zr _l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so a:i to bccome subject to the workcrs' compensation laws of Californiq and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code I shall. forthwith comply with those provisions.. WARNING: Failure to secure workers' compensation coveragc is unlawfut. and shall subject an ernployer to criminal pmahics and civit fincs up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 of the Labor Code. interest and attorney's fecs. ( _ oarc. lt lTol %)o I ICENST'N CON'I'TUACTOR DECI ARATION I hereby affrm under penalty of perjury that I am licenscd under provision of Chapter 9 (commencing with Section 7000) of Division -1 of the Business and Professions Codc, and my license is in full force and effect. License cr*, 6 License Number: d 0 G 7g I oete: lt lTol z-Lo ('()NS't'Rtl("t'loN t,llN Dl N(; A(; ItN('l' t hrcby aflim unda penalty of pqjury that thqc is a @nstruction lending agocy for the pdfomcc of thc work fur ttich this pqmit b issued (Sec. 3097. Civ. C.). Lender's Name. Lender's Address: APPLIC ANT NF'CLARATION I herâ‚¬by affinn under pcnalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40, Part6) -Required l-ctter of Notificaion -l certiff that the federal regulations regarding asbestos removal are not applicable to this project. that have read this application and state that the above inlbrmation is correcl.agree to comply s'ith all City and County and State Larvs relating to building constnrction.hereby authorize representat ives of this City and County to enter upon the oate, t ll\olbLe mentioned property for inspecrion purposes. Applicant or Agent Perrnitee name and +, Signature:_ (print):_c*v+I