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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNENBULDERDELCANAflON 'I hercby affm under pcnally of lrrjury rhrr I m excmpr ftom thc ContEctoF' LLure llv for thc following m$n (56.7031.5 <br />Busincss and Profession Cndc): Any City or County which rcquircs a tsmil to @nslrucl, ah6, imprcrc. demlish or rcpair my <br />structurc. Jtrior to its issurre. 8lrc rcquircs thc applicant for such permit to lile a siSnct ststcrcnt thal he or she ir licensed pusmt <br />to the povisions of thc Contrelor's Licensc{ Law (Chapter 9. Comncing with S6tion 7000 of Division 3 of tlE Busircs md <br />Prcfessions Codc) or that h u shc is exempt thercfrom and the b$is for the rllegcd excrption. Any violstioo of Sction 703 I .5 by sny <br />spplicant for 8 lrcrmit subjccts the spplicanl to s civil pcnalty of not mrc thil fivc hundrcd dollus ($5fl)). <br />_1. as owncr of the proF,crty. or my cmplcryces with wages as their sole compensalion. will do thc work Brd the structurc is not <br />intenclcd or olfcrcd for salc (Sec.7M4. Business nnd Profcssions Code: Thc Contractor's License Law does not apply to an owner of <br />the proJrcrty who builds or inrpmves thereon. and who docs such work himsclf or herself or through his or her own employecs. <br />provided that such improvenrnts are nol intended orofM for sale. lf. howcvcr. the btrilding or in{trovcnrnt is sold wilhin onc }rcar <br />of complction, the Owner Builder will have the burden of proving that he or shc did not build or improvc the propcrty for thc purynseof <br />sah). <br />_t. as owncr ol'thc propcrly. amexclusivcly corrlracting with liccrrscd conlraclors lo conslrucl lhc projcct (Scc. 7(114. Busincss <br />and Pnrlbsskrn Codc: T'hc Conlraclor's l-iccrrsc l-aw rlocs not apply lo an o\r'ncr oIpropcrty u'ho huilds or ilnprovcs lhcrcon. <br />and u'ho contracls lirr such projccts with a Contraclor(s) liccnscd pursuanl lo lhc Cortlractor's I.iccnsc l,arv). <br />-l <br />artt cxcnlpl uttdcr Scclion-. l]. & P.C. lirr lhis rctson. <br />l)ale:Owner:_ <br />WORKERS' C(It}I PENSATI(IN <br />DECLARATION <br />I hcrcby alfirm undcr pcnalty of pcrjury onc ol'thc folkrs'irrg dcclaralions: <br />_l havc and will ntaintain a Ccrtilicatc of Conscnt to Scll'-lrrsurc lirr workcrs'cotttglcnsulion. as providcd lilr by Scclion 37(X) of thc <br />Labor Crxlc. ltrrthc pcrfornurnce of thc rvork frrr which thc pcrnrit is issucd. <br />_l havc and will rnaintailr workcrs'cotnpcnsation irtsuralrcc. as rcquircd hyScctiotr ITOOof lhc LahorCltldc. forlhc pcrftrrnuttceof <br />thc work tirr which this Jrcrrnit is issucd. My workcrs' conrlrcnsalion insuritncc carricr and Jxrlicy ttunrbcr uc: <br />Policy <br />_l ccrtifythat in thc pcrlirrmance of the work for which this perrnit is issued. I shall not employ any pcrson in any manner <br />so as to hccomc subjcct to thc workers' conrpcnsation laws of California. and agrce that if I should becomc subjcct lo the <br />workers' comlrcnsation provisions nf Scction .37fi) of thc l-abor Code. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failure to sccurc workers' compcnsation covcrage is unlawful. and shall subject an employcr to criminal pcnsltbs and <br />civil fines up to one hundred thousand dollars ($100.m0). in addition to the cost of compcnsation. damages as providcd for the <br />Scction 3076 of thc Labor Code. intcrest and attorncy's fccs. <br />l)irtt':Aoolicsnt: <br />LIC F'NSED CON'I'RA C'I'OR <br />DECLATTATION <br />I hcrchy allirrn undcr pcnalty of pcrjury that I arn licensctl undcr provision ol'Chaptcr 9 (cotttnrcncilrg with .Scctitltt 7(ru0) of l)ivision -l <br />of thc Busincss and Proll.ssions Codc. and nry liccrrsc is in full lirrcc and cfl'cct. <br />Licensc Class: License Numbcr: <br />('ortl raclrlr <br />W <br />I hcrchy f,ffirm undcr fEnnltyof frcrjury lhal thcrc is a crnstructku lcnding agctrcy for lhc [rcrforluncc oflhc wotk for which this Jrrmit is <br />issucd (Scc. 3097. Civ. C.). <br />lcndcr's Address: <br />'PPLT.ANT IT".LAR <br />I hercby alfirm undcr penalty of pcrjury onc of thc following dcclarations: <br />Dcnrolition Pcrrnits-Asbestos Nolification Fcdcral Rcgulations ('title 40. Part6) <br />-Rcquired <br />Lctlcr of Notilication <br />-l <br />ccrtify Ihilt lhc fcdcral rcguhlius rcEUding asJf,'rk)s rcmoval arc nol ilpDlicahlc b this proist. <br />_l ccnity that I htrvc rct(l this npplictrtiol ad statc lhtl thc rk)vc ilfi)rmilli(n is corccl. I agtc! k, comply with illl Cily trnd G)unly <br />ordinanccs and Strlc Laws rulating to huilding conslrucli(nl. ond hcrcby oulh)rizc rcprc{cnlativcs of lhis Cily and Counly lo cntcr uFrn lhc <br />atxrrc n*ntioncd prrJrcrty li)r inslEction purlm$cs. <br />Applicanl or Agcnl <br />| ,.*,*. nr,r," <br />I \.rra. <br />Appliances <br />lMetal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors Installed <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Drver <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type Il Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release I \I .n <br />F!NAL \a-\t -1-o DffiTO I <br />Notes, Remarks, Etc.I