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M EGHAN ICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS Appliances Metal Fire Place Evaporative 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 Rouqh Mech. Final Test Meter Release FINAL Notes, Remarks, Etc OWNER BUTLDER DELCARATION I haeby affim unda pcnalty of perjury tha I m qmpt from the ConuadoN' Licffi liw for thc followingi'rctr (Se.7031.5 Busins ud Prcfesion Codc): Any City or Couty which rcquiB a ponit to onstruct. altc, improvg danolish or rcpar ay strucluq irior to its iswcq also rcquim thâ‚¬ applimt for such permit to filc a sigrcd stat@6t tha hc or shc b licmcd piruant to thc prcvisioN of the Cotrtrctor's Liccnsd kw (Chapts 9. Comcncing with Setiotr 7000 of Division 3 of rhe Buiacs md r Prcfesiom Code) or that hc or shc is q@pt th@ftom md thc bssis for thc dlcgcd amption. Any violation of Sction 703 1.5 by oy a applimt for a permit subjets the spplicut to a civil pmlty of not more thm fivâ‚¬ hundred douils ($500). _1, as owner of the property. or my ernployees with wages as their sole compensation. will do the work and the structure is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improves thereon, and who does such work hirnself or herself or through his or her own employees. provided that such irnprovonents are not intended or offerecl for sale. I[, howevâ‚¬r. the building or improvement is sold within one year of cornplaion, the Owner Buildcr will have the burden of proving that he or she did not build or improve the propo'ty for the purpose of sale). _1. as owner of the propefly, arn exclusively contracting rvith licensed contractors to construct the project (Sec. 7044, Business and hofcssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and rvho contracts for such projects with a Contractor(s) licensed pursuant to the Contractor's License Law). -l arn exempt under Section , B. & P.C. for this reason. flolo. WORKERS' COMPENSATION DECLARATION I hereby affrrm under penalty of perjury one ofthe following declarations: _I have and will maintain a Certificate of Consent to Self-lnsure for workâ‚¬rs'compensation, as provided for by Section 3700 ofthe Labor Code, for the performance ofthe work for which the perrnit is issued. YH, have and will maintain workers' compensation insurance. as required by Section the work for which this permit is issued. My workers' compensation insurance carrier 3700 of the Labor Code. for the performance of policy number are: .,, I License Nurnber: \_ Policy .o-7 ll)/zL _t certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, 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 coverage is unlawful, and shall subject an ernployer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for the Section 3076 of the Labor Code, interest and attorney's fees. """, 8l cl lll \r^r,{ t^ lh -tA t\luV LICENSED CONTRACTOR DECLARATION I hereby aflirm under penalty of perjury that I am licensed under provision of Chapter 9 (cornrnencing with Section 7000) of Division 3 of the Business and Professions Code, and rny license is in full force and effect. Vz(()7 I =-T_v f '\., CONSTRUCTION LENDING AGENCY I hwby affinn undo penalty of perjury Ihat thqe is a construction lmding agocy for the pqfonnace of lhe work for which this pqmit is issucd (Se. 3097, Civ. C.). Lender's Name: Lrnds's Addre: - ATTI.IfANINESJABAII9N I hadry alfim undo poalty ofpajury one ofthc following delaations: Demolition Pqmits-Asb6tos Notilication Fcdqal RcgulatioN (Titlc 40, Pan6) -RcquLcd lf,tter of Notificatioo -l cqtify that the fedaal regulatioro rcguding ubctos rmoval ue not applicable to this prcj$t. {tlt cqtiff that I have rad this application ,nd state that thc above infomation is coErcl. I age to omply with all City and County ordimcG ed State taws relating to building consruction ud hmby authorir repffitativG of this City md Couty to at6 upon thc above mentioned property for purposes. D"t", oq 1" l/ a\contracror: Soi V-t- Gn- Lh , tti , r^ Yn Lt o^,", o Q( c\ ( tlApplicant or Agent Permitee n{une