Laserfiche WebLink
-M ECHANICAL.I NSPECTOR RECORD a <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILI'ER I'ELCARATION <br />I hqchy allirm unda pcuhy of pcrjury thrr I m qmpt from thc Coflr8ctoc' Lic* Law for thc following ron (Ss-7031.5 <br />Buines and Prcfssion Codc): Ary City or County which rcquiro a pcrnit to coutruct, altq, imprcvc. danrolbh or npah oy <br />structuc. Fior to its isumca also rcquirc thc applicet for such pcnrit to filc a signcd stdmdt thrt hc or shc i liccnscd purgrilt <br />to thc provisioG of thc Contractor's Liccnscd txw (Chipt6 9, Comcncing with S*tion 7000 of Division 3 of the Busin* md <br />Prcfeions Codc) or that hc or she is cxmpt thacfrom fid thc bdh hr thc ,llegcd cxmption. Any violation of Sction 7031.! by my <br />applicmtforapcrmit3ubjeBth€ applicilttoacivilpcmltyofnotmorcthmfivchundrcddollus($500). <br />W.* omo of thc prcpcny. or my mplole wirh wag6 a thrt $le ompcrtsdion. will do thc wor* &d tha $nrtE b mt- intordcd oroffrcdforsalc(Sc.T(X4,BuiromdProfcsiouCodeThcCootmtor'sLicreLawdo6noteflytomowof <br />the prcpqty who hril& or inpros thsoG dd who do6 sch rc* himsclf or hmlf or thrcugh his or hr ow mployc. <br />providcd that such imFovqrcots e rct inladcd or oftrcd for $lc. lf, how. thc huiHilrg or impromt is sld within onc )ar <br />of compldiotr. the Omq Buik r wil havc lhc burdo of proviru thd hc or shc did rct build or improE thc propcty fur thc Frpos of <br />slc). <br />--1. <br />as owner of the property. am exclusively contracting with licensed contrac{os to construct the project (Sec. 70t14. Btsiness <br />and hofession Code: The Contractor's License Law does not apply lo an owner of properfy who builds or improve thcreon. <br />and who contracts for such projects with a Contracto(s) licensed puniuant to the Contractor's License [arv). <br />-l <br />am exempt under <br />orrc, J 6- 2-* O <br />DECLARATION <br />I hereby' alTirm under penalty of po'jury one of the follorving declarations: <br />-l <br />have and rvill nraintain a Cerrificate of Consent to Self-lnsure for \\'orkers' compensation. as provided for by Section -1700 of the <br />I-abor Code. for the perfonnance of the work for rvhich the pennit ls issued. <br />--l have and will maintain \r'orkers'cornpensation insurance. as required by Section.1700 of the l-ahor Code. for the perlormance of <br />the u'ork for rvhich this pennit is issued. My s'orkers' cornpensation insurance carrier and policy number are: <br />Policy l:r1lit t's <br />Wcertify that in the performance of the work for which this permit is issued. I shall not emptoy any person in any manner <br />so as to becorne subject to the workers' compensation laws of California. and agree that if I should become subject to the <br />workcrs' compensation provisions of Section 3700 of the Labor Code. I shall. forthrvilh comply with those provisions.. <br />WARNING: Failure to secure workers' compersation coverage is unlarvful. and shall subject an €mployer to criminal penahies and <br />civil fines up to one hundred thousand dollars ($100.000). in addition to of damages as providd for the <br />Section 3076 of the Labor Code. interest and attorney's fees. <br />or*, 6- 25- /?I <br />LICENSED CONTRACTOR <br />DECI"ARATION <br />I hoeby aflirm under peoaltyof perjury tha I am licensed under povision of Chapter 9 (commancing with Soction 7000) of r)ivision 3 <br />of the Business and Professions Code, and my liccnsc is in full force rrd effect. <br />l.iccttse ('lass: I .iccrrst' Ntrrrrhcr : <br />l)irlt' <br />CONSTRUC ION LENDING AGENCY <br />I heeby affifln undo Srnahy of pajury that th6e is a mnshrclion lqding agmcy for the pcrfonnmce of thc Nork for $hich this pmit is <br />issued (56. -!097. Civ. C.). <br />l,cnder's Namc: <br />Lender's Address: <br />AfII.ICANLDECI.AEAIION <br />I hwby aflim unde paalty of perjury onc of thc following dcluations: <br />Demolitiotr Pmils-Asb6tG Notification Fc{aal Rcgulations (Titlc 40. Pan6) <br />-Rcquircd <br />Lctts of Notification <br />-l <br />cqtify that thc lidcal rcgulatiom rcgarding ubetos rmoval ue not applicablc to this prcjccr. <br />fiLlJ catifytfatl havc rad thb application od state that the above infonmtion is cortrt. I .8rc to comply with all City and County <br />ordinancq and Statc lrrc rclating to building con$ruction, ud hmby authorizc reprMtativc of this Cityud Countylo at6 uportlE <br />above mentioned property for inspection <br />Applicant or Agent <br />Pennitee narne <br />*n", t (- 2-\- - /7 <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 />Rough Ductwork Mrrs? / ral <br />Vents <br />Toilet Room / Clothes Dryer a la,ft-e 16? ,oz <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type !l Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release lt <br />FINAL vl*lra i u,c"-u+e;@h/ <br />Notes, Remarks, Etc.(ur \--,2 <br />B. & P.C. for rhileason. />e <br />WORKERS' CONI PENSATION <br />()n lrer: <br />8lz, lr q <br />-+