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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE !D/SIG.COMMENTS ()}VN T.]R I} I. I I t,I)IIR I)I'I,CA RA'I'ION <br />I hcrcby afnrm undcr pcnslty of pcrjury that I u exempt frcm the ContrsctoF' Liccns kw for tlrc followitrg rcs$n (56.70.11.5 <br />Busincss and Profession Code): Any City or County which sluircs s Fmit to @nstruc|. rltfi. improve. dcmlish or rcpak 8ny <br />structurc. prhr to its issume. sls rcquircs the applicmt for sch Jrcrmil to lih 8 signcd stslcmnt thst hc or sttr is liensed iuruut <br />to the prcvisions of the Conlnctor's Lbcnsd trw (Chaptcr 9. Comrcrcing with Selion 7000 of Divisk,n 3 of the Busircss and <br />PmfessionsCodc)orthathcorshcisexcmptthcrcfromandtheb&risforthcrllcatedcxcmption. AnyviolrtionofSslhnT03l.5hysny <br />applicanl for s permil subjctts thc applicsnt to 8 civil pemlly of not mrc than fivc hundrcd dollars ($5fi)). <br />-1. <br />as ownerof the with wages as thcir solc compensation. willdo thc work and thc stnrlurc is nol <br />and Profcssions Code: Thc Contraclor's Liccnsc l-aw docs not opply lo an owncr of <br />thc pnrlru-rty who builds or irnprrvcs thcreon. and who drrcs such work hirttsclf or hcrsclf or lhrough his or hcr own employees. <br />proviclctlthalsuch inrprovcmcntsarcnotintcnclcdoroll'crctlfilrsalc. lf.howcvcr.thcbuildingoritttprovenrcntissoldwithinoncycar <br />of conrpktion. thc Owncr Buildcr witl havc thc burdcn of provirrg lhat hc or shc did not huild or intprovc thc propcrty for thc purprrc of <br />sah). <br />_1. as owncr of thc l)ropcrty. am cxclusivcly conlracling with liccnscd conlraclors lo conslrucl thc projcct (Scc. 7044.llusincss <br />an{ Pnrll.sskln Coclc: '[hc Contractrlr's l-iccnsc Law docs nol apply to an owncr of property who huilds or intprovcs thereon. <br />and who contracts fcrr such pnljccts with a Contraclor(s) liccnscd pursuant lo lhc Conlractor's Licensc [aw). <br />-l <br />am cxctnpl undcr Scclion-. B. & P.C. for lhis rcason. <br />Owner:_ <br />IVORKERS' CON| pENSA,t ION <br />ITECLARA',tt()N <br />I hcrcby af firrn undcr pcnalty ol'pcrjury ortc of lhc lirllowing dcclaralions: <br />_lhavcanclwill nuintainaCcrtificatco[ConscnttoSell'-lnsurclirru'orkcrs'conrpcnsation.as providcdforbySection3T(X)ofthc <br />I-ahor Ctxlc. for thc pcrforrnarrcc ol'the work frrr which the pcrnrit is issucd. <br />_lhavcanclwitl rnnintainworkcrs'cotnpcnsationinsurlrrcc.as rcquirctl by.Scclion37fi)ofthcl,aborCtldc. lorthcpcrlbrlttancertf <br />thc work for which this Jrcrrnit is issucd. My workers' cornpcnsation insuruncc carricr arrd Jxrlicy nutttbcr arc: <br />Policy <br />_l certify that in thc pcrformarrce of thc work for which this Jrermit is issucd. I shall not employ any person in any manner <br />so as to become subtct to thc workers'compensation lsws of California. and agrce thal if I shnuld trcomc subject to the <br />workcrs' compensation provisions of Scction 37CD of the Latnr Codc. I shall. forthwith cornply with thosc provisions.. <br />a <br />WARNING: Failurc lo sccure workcrs' cotnfrcnsation covcragc <br />civil lincs up lo onc hundrcd thousand dollars ($1ffi.0fit). in <br />is unlawful. nnd shall subjcct an crnploycr lo critninal pcnaltics arrd <br />rion. danragcs as providccl, tbr thcloof compcnsal <br />atk)rncy's <br />LICENSTD CONI'RAC'T'OR <br />DECLARATION <br />t hcreby aflirrn undcr pcnalty of pcrjury that I ant liccrrscd undcr provision of Chaplcr 9 (cotntnencirrg with Scction 7ilru) of Division 3 <br />of thc Busincss and Pnrlcssions Codc. and nty liccnsc is in full ftrrcc aml clfcct. <br />[-icensc <br />D,t", ?q 4?-.fr <br />W <br />I hcrchy affirnr undcr pnalty ofpcrjury that thcrc is ! conslrucliu lcnding agcmy fo, thc frcrforroncc oflhc work fi,r which this pnnil is <br />issucd (Scc..3097. Civ. C.). <br />l-cndcr's Nrmc: <br />[-cndcr's Address: <br />APPLTCANT DECLARATION <br />I trcreby aflirm undcr penalty of pcrjury onc of thc following declarations: <br />Dcmolition Pcrrnits-Asbcstos Notification Fcdcral Rcgulations (Tille 40. Part6) <br />-Rcqu <br />ircd l*tter of Notificat ion <br />_l ccrtify that thc fcderalrcgulations rcgarding asbcstos removalarc not applicablc to this projcct. <br />_t certify that t havc rcad this application and state that lhe atnvc information is conccl. I agrcre to comply with all City and County <br />ortlinanccs and Slrlc Laws rclalilrg to huilding authorizc rcprescntativcs of this City and County lo enter upon the <br />above nrcntioncd propcrty for insJreclion <br />Applicant or Agertt <br />Pcnnitcc rrnrttc <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Eouipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Tvpe I Hood <br />Type Il Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar A <br />Rouqh Mech.1-25-70 (WL('I <br />Final Test <br />Meter Release <br />FINAL la -16-70 I VTfiIA [, <br />Notes, Remarks, Etc. <br />Cankr: <br />tt \\- <br />,/egpziltu' <br />,^l <br />\,n <br />Y\