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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcreby affm uoder pmalty of pcrjury that I m cxempt fiom the Contractors' Licens taw for lhe following rc@n (56.7031.5 <br />Buinss md Profsion Code): Any City or Comty which require a pcmit to construct, altq. imp.ovq dmolish or tcpair oy <br />structuc, prior to its isuoce. also requirs the applicet for sucb p€nnit lo file a siSned ststmot thar hc or she is licfficd pwut <br />to the provisiom of rhe Cooraclor's Liccnscd law (Chapte 9, Comencing with S(tion 7000 of Division 3 of lhc Busincs ud <br />ProfesionsCode)orthatheorsheiscxmptthccfromodthe basisfortheallegcdermption. AnyviolaliooofSctionT03l.5bymy <br />applicant for a pmil subjets the applicst to a civil pmalty of oot more the fivc hundrcd dollss ($50O). <br />_1. a owns of the propeny. or my mployc with wag6 as their sle compcElion. will do the wo* md tlrc strudue b rct <br />intoded or offeed for sale (Sa.7044. Busins ed PrcfessioN Code: The ContGclot's Liccre law do6 not pply to m oma of <br />thc Fopcrty who tuilds or improve thqon rd who doc such wod< himself or hmelf or through his or hr om employe, <br />providcd that such improvm@a e not intodcd or offqcd for ele. lf, horvryq. thc tuilditrg or ihprcvmst is $ld within onc )qr <br />ofcomplction. the Owno Builds will hsvc thc budo ofprcving that he or she did not build or improvc the prcpqty for the purpos of <br />nle). <br />_1, o owno of the property. m exclusively contracting with licsed contractoE lo coNtrucl the project (Str. 7044. BBins <br />ed Prof6sionCode:TheConlrsctor'sLiccnscLawdo6nolapplytoanownsofprop€atywhobuildsorimprov6ths@n, <br />and who contncts for such projets with a ContEc'to(s) licmed puE@t lo thc Conlractor's Licrue tnw). <br />I m crmpt udq Sation-, B. & P.C. for this @tr. <br />I)Nlc:()\ ilcr <br />\\ ORKEIIS' ('ONIPI.]NS,\ I'ION <br />t)u( l,ARAt toN <br />I hrcby affim undr penalty of pejury onc of the follorving deloations: <br />_l havc ord will mainlain a Certillcatc of ('onsent to Self-lnsure for rvorkers' conrpensalion, as provided for by Sectfun .17(X) of lhe <br />l,abor ('ode. ftrr the pa fonnmce ol the rvork for which the pmit is issued. <br />_l havc and Nill maintain rvorkers coilipensalion insurance. a required by Scctirn 3700 ofthe l,abor Code, for lhe pciftrnnance of <br />lhe rvork for uhich this p6mit is iscd. ![workm' @mpqEdiotr insurscc wio ad policy numba ac: <br /><tl^Q 'k^f.,.> <br />Policy 1- <br />_l ceniry that ir the pslomce of the work for which this pemit is i$ued. I shall not mploy any pmon in uy muno <br />so otobccomcsubjetiothcwort6'compqEationlawsofCalifomia.mdsgrelhaliflshouldb€comcsubjcttothe <br />work6' compwtion prcvisiom of Sation 3700 of the Labor Code, I shall. forthwith comply with thos provisions.. <br />WARNINC: Failure to sure workqs compcnsation covemge is unlarvful. ild shall subjst m mployer to oiminal pfislliG md <br />civil fine up to one hundred thoued dollN ($100,000), in addition to thc cost of compcnsation. damage u providcd for lhe <br />Setion of the code, intq6l ed anomey's fc..l <br />IJCENIfD.EANBACIAS <br />DECI,ARATION <br />I hoeby aflinn undo pmaky of psjury lhat I m liccnsed unde provision of Chapto 9 (comocing wilh Srction 7000) of Division 3 <br />of the Busins ad PrcfGsios Code. md rny license is in full force ud effrt. <br />Liceue Numbo: <br />l)[l (: <br />CONSTRUCTION LENDINC ACENCY <br />I hereby aflirnr under penally of pcrjury lhat thse is a comtruction lending agocy for the pofomrance oflhe rvork for rvhich this ponit is <br />issucd (Sr. 3097. Civ. C.). <br />Lender's Name <br />Lender's Addrs: <br />AIXI.ICANLDECI.AMITON <br />I hotby affirm undq pcnalty ofpqjuy onc ofthc following dalaations: <br />Dcmolition Pmits-Asbetos Notification Fedqsl Rcgulatioos (Tirlc 40. Pan6) <br />-Rcquircd <br />Lelt6 of Notification <br />-l <br />cqti& thal the Iedqal regulatioN regsditrg rbotos rmoval re not applicablc to thie prcjGt. <br />_l cdiry thal I hsvc rad this application atrd statc that thc above infomalion is cor(t. I agrc to comply with Ell Cily ud County <br />ordinecG ed Statc laws Eldiry to builditrg coDmucriorl ad h6€by adhorizc rcprG$talivc of this City ud Couty to 6t6 upon thc <br />rbove mmtioncd property for iosp€liotr <br />Applicet or Agot <br />Pmite nme (priot): <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />,t I L <br />Rouqh Mech.tl l/',rep uzottyp U <br />Final Test I <br />Meter Release lt ,lzh <br />F!NAL ,v a-o )ftn/l '-f1.Yd I <br />Notes, Remarks, Etc.I ID <br />*," \,/lo\f lf