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M ECHANICAL-I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work t I t a <br />Pre-lnsulation c llt 7)bv,YA <br />lnsulation 'l <br />Smoke Detectors Installed <br />Rough Ductwork <br />Vents I n <br />Toilet Room / Clothes Dryer ?T <br />Residential Range ,l <br />Other <br />Hood <br />Type I Hood <br />Type Il Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid lt -l ,.1 <br />tlrdAbove T-Bar o / <br />I r/rl <br />Rough Mech. <br />Fina! Test <br />Meter Release ll A tl o, <br />FINAL \ I r,t\U / <br />yNgtes, Remarks, Etc.l <br />'Pl I Y aCQWotuO S€c 1 -r-, <br />-)-D+ <br />-? lt;l?r '- bla-'u/ruro 'r vrvqnh iaU I !L bM_&l <br />I ,J J\ <br />OWNER BUILDER I'ELCARATION <br />I hcby affm undc pcoalty of pajury thd I m ampt from thc Contrscto6' Liccns [rw for thc following ren [Sc.7031.5 <br />BBin6s sd Pmf*ion Codc): Any City or County which rcquirc a pannit to @ngruct. alt6. imprcvc. danolish or rcpair my <br />stracturq pdor to its issumcc. also rcquirc thc applicmt for such parnit to filc a signc{ stamot tha hc or slc b licoscd prcuiat <br />to thc provisioB of thr ContrEclo('s Liccnsd Lrw (Chapt6 9. Comcncing wilh Setion 700O of Division 3 of lhc BBins ud <br />Prcfcsions Codc) or that hc or shc is cxmpt th@fiom md thc b6is for thc allcgcd cxoption. Any violation of Sction 7031.5 by ey <br />applicilt for a permit subjets thc applicmt to a civil pcoalty of not moE thu fivc hundrcd dollars ($500). <br />-1. <br />as ownef, of the property. or my employees with rvages as their sole compensation. rvill do the rvork and the structure is not <br />intended or offered for sale (Sec.7M4, Business and Professions Code: The Contraclor's License Law docs not apply to an orvner of <br />the propcrty who builds or improvcs thcron. and who does such work himself or herself or through his or her own employees. <br />provided that such irnprovonants are not intended or offered for sale. lf. howwer. the building or improvement is sold within one )ear <br />of complaion. the Orvner Builder will have the burden of p,roving that he or she did not build or improve the propcrty for the purposc of <br />sale). <br />-1. <br />as owner of the propcrty. am exclusively contracting with licensed contraclors to construct the project (Sec. 7M4. Brsiness <br />and Proftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon. <br />and who contracts for such projects with a Contraclo(s) licemcd pursuant to the Contrac{or's License l-aw). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />f)olo'( )n ner: <br />WORKERS' CONTPENSATION <br />DECLARATION <br />I hereby affrrm under penalty of pcrjury one ofthe follou'ing declarations: <br />-l <br />havc md will mintsh a Cali6cstc of CoMt to Sclf-lBurc for wrkerr' @mpcnEtion, s prcvidcd for by Sction 3700 of thc <br />t bor Codc. for thc pqfotrMcc of thc rcrt for which thc pqmit b isucd. <br />AI bavc ild will maintain workeru' compcnsstion irourucc, r rcquirrd by S€tion 3700 of the trbor Codc, for thc pqfomcc of <br />thc wrk for which this pqrnit is isrcd My worka' ompansation imuue ffi6 atd policy aumba m: <br />All ;-*l la;5ortr.3c $2,tvloe) - l*, <br />poricy Nu^*r. CA lOOOlO2S2ol Expires:a.bt - eo, I <br />-l <br />certi& that in the performance of the work for which this permil is issued. I shall not enrploy any person in any manner <br />so as to become subject to the wort€rs' compcnsaion laws of California. and agree that if I should bccome subject to the <br />rvork6s' compensation provisions of Section 3700 of the tabor Code. I shall. forthwilh cornply rvith thosc provisions.. <br />WARNING: Failurc to Guc wrkm' compqration ovaagc is unlawful. md shall subjct s mplo)€r to qiminal pouhks ud <br />cMl fina up to onc hundrcd ahormd dollm ($100.000). in addition to th€ cost of @mpcnstion, d.rug6 B prcvidcd for thc ' <br />Setion 3076 of thc Lrbor Codc, intaet md attomey'r fce. <br />'2q -}ot I TL'*'? D-*hou.- <br />LICF'NSED CONTRACTOR <br />DECI..AEAIION <br />I hereby affrm under pcnalty of perjury that I am licenscd under pnovision of Chapter 9 (commancing with Section 7000) of Division 3 <br />of the Business and Professions Code, and my licerse is in full force and effect. <br />a <br />t- <br />a <br />License <br />Date: <br />Chss' Dy't License Nurnber:75tt * <br />b-2.1- bz Conrracro r. -f -r.*.. ?.hlo--t ' Kt?[) ( r.tl. <br />CONSTRUCI'ION LT'NDIN(: AGENCY <br />I heeby affirnr undo penahy of p€rjury Ihat thqe is a coNtruction lending agency for the pcfomocc of the rvork for which Ihis lEtnil b <br />bsued (Ss. 3097. Civ. C.). <br />Lender's Nanre: <br />Lender's Address: <br />Aprt tcANT rr"cl *n <br />I hereby allirm under pcnalty of perjury one of the following declarations: <br />Demolition Pennits-Asbcstos Notification Federal Regulations (Title 40. Part6) <br />-Recluired <br />Letter of Notification <br />-l <br />certify that the federal regulations regarding asbestos rernoval are not applicable to this project. <br />@rcertis that I have read this application and stare that the above infltrnnation is correct. I agree to cornply rvith all Ciry ancl County <br />ordinances and Statc Laws relating to building represortatives of this City and County to cxter upon the <br />above mentioned property for <br />Applicant or Agent ,ur". 3'l'l' Tocl <br />pennitee name (prinr): Tn^a- D{ata va/ <br />JE.*r#IJ <br />DY+IT'I <br />t DWIT' <br />?t- <br />fuur(h,t