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M ECHANICAL-I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS Onns-BuildrDcclsntion . . . I hercby aflirm undcr pcmhy of pcrjury that I .m cxcmpt form thc Contnclon' Licemc lrw for thc following remn (sc.7031,5 Buincs ud Profqsion Codc): Any City or Couty uhich rcquiro a pcmit to satruct. rltff. improvc. dmlish or rcpsit my strucrm. prior to its isuamc, rlso rcquire thc lppliqnt for such pcmit to filc r ligncd strtcmnt thst hc or lhc is licered puBurDt to thc prcvbioE of thc Contrtclor'r Liamcd hw (Ch8ptcr 9. Commcncing with S@tior 7000 ofDivbbn 3 ofthc Busines and Profcssions Codc) or that hc or lhc h dmpr thqcfrom snd lhc basb for thc rllcScd rxcmprion .Any violrtion of Sction 7031.5 by my lpplicrnt for ! pcmh tubjcct3 thc spplicsnt to r civil pcmhy ofmt morc thso 6vc hundrcd dollan (t50O). _1. I owtrs of thc prcpmy. or my cmployG with we86 B thcir slc compcNtion, will do thc work md thc structuc is not iotmdcd or off.r?d for slc ( 5@.7044. B$in6! rnd Profcrsions Codc: Thc Contrrctoi's Liere Lrw dm not apply to u oms of thc prcpcrty who buildt or imprcv6 th@on. md who dG !rch wort him$lf or h6clf or thrcugh hir or h6 own cmployc. prcvidcd rhrt iuch improvcmcots rc not htcndcd or offcrcd for !sh. lf. howcvs, thc building or imprcvmat i! sold withir orc y6 of complction. thc Ouna-Buildcr will havc thc bwdcn ofproving thlt hc or rhc not build or imprcvc for thc purpolc ofslc). _1. as owner of the property. am exclusively contraoing with liccnscd contractors to construcl the project ( Sec. 7044, Busincss and Profession Code: The Contractor's Licensc Law docs not apply to an owner of propcrty who builds or improves thereon . and who contracts for such projects with a Contractor(s) licensed pursuant to the Conlractor's License Law.). _l am excmpt under Section & P.C. for this reason. Date: I hqcby allirtn unds r.*n, orO"r1rry onffi lhavcandwillmaintainaCcnificatcofComcnltoSclf-lnsurcforworkcrs'conrpenstion.as providedforbySstion3Tooofthc Lsbor Codc. for thc pâ‚¬rfomncc of thc work for which lhc pcnnit is issucd. (lhaveandwillmaintainworkers'compenstioninsurance..s requiredbysection3T00ofthetaborcode,forthcperformnccofthc work for which this permil is issucd. My workcrs' compcnstion insurance qrrier and policy numbcr arc: c,nx,,flCf Ata?ricrq,, 9n 5 poricy *"^*, Rtr)ccl^gll ti bo) Expires: a' I ' I 1 (This secrion need not be completd if the pcrmit is for One hundred dollars l$1001 or less) _l certi$ that in the performance of thc work for which this permit is issued, I shall not employ any person in any manner so as to became subject to the workers'compensstion hws of California, and agroe that if I should become subject to the workers' cotnpensation provisions of Section 3700 of the labor Code. I shall.rvith those provisions. WARNING: Failure to secure workers' compensation is and shall subject an enrployer to crinrinal penalties and civil fincs up lo one hundrcd thousand dollaE ($100.m0).in trddilion to lhc cost ofcornpcnsalion. damages as prol,idcd for thc Scction 1076 of the tibor ('ode. rnterest and atornay's fees. LICENSED CONTRAC ORS DECLARATION I hercby aflirm undcr penalty ofpcrjury that I an liccnscd unds prevision ofChapter I (coormcncing lvith Sedion 7000) of Division -l of lhe Business and Professions Code. and my license is in full force and cffcct.gq?oq '/Liccnse Clacc.Cu License orr",/0,21 'l(2 conrracror: I hcrcby aflinn undcr pcnalty of psjury thst lherc is a coNtruction lcnding agcncy for thc pâ‚¬rfomncc of thc work for uhich this pcrmit is issucd (Scc. 3097. Civ. C.). Lender's Nanre: [-ender's Address: APPLICANT'S DECLARATION Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part 6) _ Required Letter of Notifrcation __-l certify that the federal regulations regarding asbestos removal are not applicable to this project. _ I ceniry that I havc rod this rpplicrtion rnd statc that thc sbovc infomation is conect. I s$e to comply wilh rll City rnd County ordinances and State Laws relating to building and hereby authorize representatives of this City and County to enter upon the abovc mentioned property for inspection Applicant or agent Perrnittce narne (print):9L lo'2-l ' / b Appliances Metal Fire Place Evap Cooler Furnace Compressor Misc. Equipment Duct Work Pre-!nsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release AI J FINAL It'I ,Y lJfdwt V/t/ fl Record.doc 03.31.06 Applicant: io