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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/S!G COMMENTS OWNER BUILDER DELCARATTON <br />I hcrcby aflirm undcr pcnalty of Jrrjury thal I m exempl frcm thc Contrcro6' Lkrns hw for the following rcen (58.7031.5 <br />Busin$s ard hofession Codc): Any City or County which rcquircs s Frmit to cotrtruct. 81t6. imprcvc, dcmlish or rcpair my <br />strucrure. llk r to its issuance, ds rcquircs the applicmt for such Jrcrmit to file a signcd ststcrcnt that he or she is licens€d pusmt <br />to thc prcvisions of thc Conhctor's Lhensd t w (Chapter 9. Commncing with Scction 7000 of Division 3 of the Businesr md <br />ProfessionsCodc)orthstheosheisexcmpllhcrcfromedthebasisforthesllegedexcmption, AnyviolationofsElhnT03l.5byany <br />applic8nt for r pemit subjcts the spplicrnt to a civil pemlry of mt mrc thm livc hundrcd dollrs (95@). <br />-1. <br />as owner of lhe property. or my employccs with wages as their sole compensation. will do the work ard thc structure is not <br />inlendcd or offered for sale (Serc.704a. Busincss and Professions Code: Thc Contractor's License [.aw does not apply to an owner of <br />thc propcrty who builds or improves therenn. and who does zuch work himself or herself or through his or hcr own employees. <br />providcd that such improvcmcnls are not intended or offered for salc. If. however. the building or improverncnt is sold within one )car <br />of complcthn, thc Owncr Buildcr will have the burden of proving that hc or she did not build or improve the propcrty for the purpse of <br />salc). <br />-1. <br />aso\l'ncrof thc propcrly. arnexclusivclycontracting u,ith liccnscd c()ntractorsto constntcl ttrc pnrjcct (Scc. 704.1. Ilusincss <br />antl [htlbsskln Codc: 'I'hc Contraclor's Liccnse l-aw does not apply to an owncr of propcrty who huilds or irnproves thcrcon. <br />antl who contracls ltrr such projccts with a Contractor(s) liccnscd pursuant to thc (lontractor's l-iccnsc Law). <br />-l <br />anr cxcrnpt undcr Scction_. B. & P.Cl. lirr this rcason. <br />( )rr ncr. <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hcrcby affirm undcr pcnalty of perjury one of the following declarations: <br />I;thor Crxlc. ltrrtlrc pcrlonttlrtcc of thc work lirr which thc pcrrnit is issucrl. <br />-l <br />havc and will maintain workers' compensalion insurance. as rcquired by Section 37fi) of the l--abor Code. for the Srcrformance of <br />thc work for which this is issued. My workers'insurance carrier aml plicy number arc: <br />>fi4>ll\rlicy <br />a <br />-l <br />ccrtify that in thc performance of thc work for which this grcrnrit is issued. I shall not employ any frcrson in any manner <br />so as lo become subict to the workers'compcnsation laws of California. and agree that if t should become subjcct to thc <br />workcrs' compensation provisions of Section 3700 of thc latnr Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc to sccurc workers'contpensation coveragc is unlawful. and shall suhjcct an employcr to criminal penaltics ancl <br />civil fines up to onc hundred thousand dollars (S100,000). in addition to thc cost of compcnsation. damages os provided for thc <br />.Scclion 1076 of l-atnr Code. interest and attorncy's fees. <br />LICENSED C()NTRACTOR <br />DECI ARA'I'ION <br />I hcrchy al'flrnt undcr pcrtalty ol'pcrjury that I arn liccnscd undcr provisiorr ol'Chaptcr 9 (conrrncrrcing with .Scction 7(XX)) of Division 3 <br />of thc Busincss atrd Prol'cssions Codc. and rny liccnse is irr l'ull lirrcc arrd cllbct. <br />ILLiccnscNurnhcr: <br />c()NS'!'Rl.rc',t't()N LtiNt)tN(; AGl,lN(:l' <br />I hcrcby rflirm undcr Jrcnally of JEriury that ltm is a onstructk n hnding agercy for thc Frforrore of thc wrk for which this permh is <br />issued (Scc. 3097. Civ. C.). <br />lrndcr's Name: <br />Lendcr's Address: <br />,TLICANT DFCLAR t <br />I hcrcby aflirrn undcr pcnalty of pcrjury onc of thc following dcclarutions: <br />Demolition Permits-Asbcslos Notification Fcdcral Rcgulations (Titlc 40. Parr6) <br />_Requircd lrtter of Notification <br />-l <br />ccrlify thal lhc fc(lcral rcgulatiols rcgilrding osbcslos rctnovalarc not ilpplicdblc lo this projcct. <br />-l <br />ccrtily thnl I hnvc rcad this opplicalion und slotc that thc ahovc i[lo]ntati()n is corccl. I agrN lo comply wilh all City and Counly <br />ordinanccs and Statc ljws rclalilg to building conslruction. lnd hcrchy auth)rizc rcprcsntalivcs ofthis Cily ild County Io cntcr ulDn thc <br />alxrvc nrcntioned propcrly for inspection purlmses. <br />Applicant or Agent <br />Pcrnritcc nanrc <br />Datc:)rrla <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />It/isc. Equipment <br />Duct Work <br />Pre- Insulation <br />lnsulation <br />Smoke Detectors Installed <br />Rough Ductwork <br />Vents <br />Toilet Room I Clothes Drver <br />Residential Range <br />Other <br />Hood <br />fype I Hood <br />Type ll 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 <br />-FINAL ll"L5,ZP.tt"h*?F/9 <br />Notes, Remarks, Etc. <br />I)ale: