Laserfiche WebLink
MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG,COMMENTS OWNER BUILDER DELCARATTON <br />I herctry sfftrm under Jrcnalty of Jrcrjury that I m exempt ftom the ControctoB' Liccnse lrw for the following rcasn (Se.7031.5 <br />Busiress rrd Prcfwsion Code): Any Cily ff Coutrty whbh rcquircs r tmit lo @nstruct. altq, in{rrcve, &mlish or qnir my <br />structurc. prior to its issurre. also rcIuires thc applicanl for Euch lf,mil to filc s sigred stalemnt thsl he or $hc is liensd puN8nt <br />lo thc povisions of tlE Conlrelor's Liccnsd [ry (Chspter 9. Commrcirg with Section 7000 of Diviskrn 3 of thc Busincss and <br />PrcfessionsCodc)orthalhcorshcisexemptthcrcfrcmsndthebosiifortheallegcdcxemption. AnyviolationofsstionT03l.5byany <br />spplicsnt for 8 tE mit subjets thc applicrnt lo s civil pcElty of not mE lhsn five hundrcd do[us ($500). <br />-1. <br />as owncr of the propcrty, or my employecs with wagcs as thcir sole compcnsation. will do the work and tlrc structure is not <br />intended or offcred for sale (Scr.7044. Business and Professions Codc: The Contractor's Lbcnse law does not apply to an owncr of <br />lhe propcrty who builds or improvcs thcreon. and who does such work himself or herself or through his or her own employccs. <br />providcd that such improvenrcnls are not intendcd or offcred for sak. lf. howevcr. the buiHing or inqrmrrcrrnt is sold within one y€ar <br />of completion, the Owncr Builder will harr thc burden of proving that he or she did not build nr inpmvc the propcrty for thc purynsc of <br />sale). <br />-1. <br />as owncr of thc propcrly. am cxclusivcly contracting with liccnscd conlractors to conslruct the projcct (Sec. 7044, Busincss <br />and l'rofessirnCodc: 'l'hcContraclrlr'sLiccnscLawdocsnotapplytoano\r'nerofpropertywhobuildsorimprovesthcrcon. <br />and who conlracts for such projccts with a Contraclo(s) liccnscd pursuanl to thc Contractor's Liccnsc Luw). <br />-l <br />am excnrpt undcr Scction-. B. & P.C. frtr lhis rcason. <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hercby affirm under pcnalty of Jrcrjury one of thc following dcclarations: <br />-l <br />have and will maintain a Certifrcate of Consent to Sclf-lnsure for workers' compcnsation. as provided for by Sc.ction 3700 of the <br />Labor Code. for the pcrformance of the work for which ttre permil is issued. <br />-l <br />have and will mainlain workers'compcnsation insurance. as rcquired by Section 370O of thc Labor Codc. for thc pcrformancc of <br />thc work tbr which this pcrnrit is issucd. My workcrs'insurancc carricr and policy number are: <br />Policy <br />-l <br />certify that in the performancc of thc work for this Jrcrmit is issucd. I shall not employ Bny pcrson in any manncr <br />so as lo beconrc subjcct to lhc workcrs'compensation laws of California. and agrce that if I should becomc subjcct to tlrc <br />workcrs' corrpcnsation provisions of Scction 37fi) of thc l-^abor Code. I shall, forthwith comply with thosc provisions.. <br />WARNING: Failure lo sccurc workcrs' com;rcnsation coverdgc <br />civil lines up to one hundrcd thousand dollars ($100.000). in <br />and shall subject an employcr to criminal pcnalties and <br />ion to thc cost of compcnsalion. damages as provided fo,r thc <br />Scctkrn 3076 of the labor Code. interest and altorney's <br />o*r, <br />=N0 { J. Zo ' <br />I hcrcby affirnr undcr pcnalty of pcrjury that I am liccnscd 9 (comrnencing with Scction 7000) of Division 3 <br />of thc Busincss and Prof'cssions Codc. aud my licensc is in <br />-- <br />forcc alfect. <br />68e37Liccnsc <br />oarc, Afou L-2;2' <br />I hercby affirm under penalty of perjury that there is a <br />issucd (Sec. 3097, Civ. C.). <br />aScncy perlilrmance of thc work for which this Jrcrrnit is <br />lrnder's Addrcss: <br />AppI ,cAN" <br />""c, aRA <br />I hcrcty atfrnn undcr Jrcnalty of perjury onc of thc following dcclarations: <br />Dcmolitiorr Permits-Asbcslos Notification Fedcral Regulations (Titlc 40. Part6) <br />_Rcquircd Lctter of Notification <br />-l <br />ccrtify that thc federal rcgulations rcgarding asbcstos rcmoval arc not applicablc lo this project. <br />_l certify lhal I havc rcad this information is corrccl. I agrcr to comply with all City and County <br />ordinanccs and Statc Laws rclating authorizc reprcscntativcs of this City and County to cnler upon thc <br />abovc mcntioncd proJrcrty for <br />Applicant or Agcnt <br />Pcrmilcc namc <br />ard state <br />L <br />o*", N t/j. 2.o' <br />Appliances <br />IMetal 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 Drver <br />Residentia! Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type II 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 />Rough Mech. <br />Final Test <br />Meter Release A\ <br />FINAL ll-17-?o V'W)01 <br />Notes, Remarks, Etc.ttJ <br />ll-16-?l'hi alL Frorrt <br />lheelldldL <br />_Expires: <br />t -- <br />l.endcr's Name: