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I hmby affim uda parlty of pcjury $11 rm ampt fm thc Conr8ctoB' Licmsc Law for thc following rcoon (scc.703l.5 Bain6s <br />od Prcfdsim Codr): Any City 6 Coutrty *hloh r€quiG 8 pqmil to cmtsucq dtcr, improvc, dmolish or rcpair my sEuctrc, prior ro ia <br />issMcc, dlo rcquis thc applimt fc ruch pa'mit to filc a sigrcd ltatmmi thct hc or lhc is licoscd pursumt to thc provirim of thc <br />Cmtreltr's Licmcd Lsw (Chapta 9, Concaciry widr Scstim 7000 of Dvision 3 of thc Buines md Profesioro Codc) or that hc or <br />shc k cxmpt $mfrm md thc bsic for thc rlc8cd cxmptim .Any violation of Scction 703 L 5 by my applicmt fo a pmit subjccts thc <br />applicmt to a civil pcrdty of nd mqr rhd fivc hu&cd clollm (3500). <br />_I,u omoofthcpropcrty,smyaryloyawithwagcurhcirsolccompcasuion,will dothcworkudthcsmctucirnotintodcd <br />o offocd fr salc ( Scc,7044, Buin* ud Profsiom Codc: Ihc Contaclor's Limc Lsw d€ not apply to a omcr of thc propcrty <br />who buildr orimpove thm, mdwho docr such wok hiruclf orhmclf o through his c hcr own cmployco, povidcd that such <br />improvmar e not intadcd o offacd fc ralc. If, hovcva, thc building or imprcvmmt is sold within onc ycu of completion, rhc <br />Ownu-Builda will havc thc buda ofproving $8t hc tr shc not build orimprovc for thc purposc of selc). <br />_I, u oma of thc prcpcrty, m acluivcly mtrrcting with licrucd mtrrctm to consmct thc prcjcct ( Scc. 7044, B6in6s ud <br />Prcfssion Codc: Thc Confasttr'! Licdc Liw dc trot spply to & M6 of propqty who builds o improvs thcrcon , md who <br />contreB for such projccB with I C6rerd(!) li@cd pmumt to thc ConErctor's Licmc Law.). <br />_lmqmpudaS6tim & P.C. for thh rcEon. <br />WORKERS COMPENSATION DECLARATTON <br />I hacby affim uda pcnalty of pcrjury onc of thc followinS dcclmtions: <br />_l hsvc ud will maintain 8 Ccatifics& of Cmot to SclfJnsuc for workm' compcosation, 6 providcd for by Scction 3700 of the <br />Labor Codc, for thc pcrfmme of thc work for which thc pmit is issucd <br />Z:[havc md will maintain wqkm' rcmpcasatior idsufficc, c rcquircd by Scctiof, 37Oo of the Labor Codc, for thc pcrfommcc of thc <br />work for which this pamit is issucd. My wortm' compcnsation insuocc cmic md policy numbcr ac: <br />Policy <br />(This sccti@ nccd not bc complacd if thc pcmit fu for Onc hudrcd dollm ($ 100) or las) <br />_l ccniry $at in thc pqfmcc of thc wd* for vhich this pcmit <br />bcmc subjcct to thc wortm ' compcnsatim lcws of Califmiq ud <br />is isud I chall not cmploy in my mmna so u to <br />agrcc that ifl should the worken <br />comPquation of Setion 3700 ofthc Labq Codc, I futhwith comply witlr <br />WARITIING: Failuc to sccuc workm' <br />finc up to onc hundrcd thowd dollm <br />mpcnsation <br />($loo,0oo),in <br />thc Lsbo Codc, iotqcat ud anmcy's fcs. <br />LICENSED CONTRACTORS DECLARATION <br />I hmby affim uda pcoslty of pqjury that I m limcd unda prcvision of Chrptq 9 (comcncing witl Scction 7000) of Division 3 of <br />thc Buines md Prcfesim Codc, ad my licanc is in firll fqcc md cffct. <br />Ddc: Omd: _ <br />Licosc Clus:_ Licmsc <br />I hocby affim uda pcnalty ofpqjury &at thft <br />issucd (Scc. 3097, Civ. C.). <br />Lodq's Nmc: <br />aSocy pafmocc of thc work for which thir pcmit is <br />Lmds's Addr6sl <br />APPLICANT'S DECLARATION <br />Dmolition Pmia-Asbcsts Notificstiq Fcdcral Rcgulations (Titlc 40, Pd 6) <br />_ Rcquircd Lcncr ofNotification <br />_l ccrtifr that thc fcdcral rcgularions rcguding ubetos rmoval ac not applicablc to this projcct. <br />-_ I cmiry that I havc rcad this applicatim md strE lhat thc abovc infom8tion is corcct. I agrcc to comply <br />ordinilcs od Stal. Laws rcluing to building construction, md ha€by authorizc rcprcsotativs of this City <br />with all City ud Counry <br />sbovc matimcd propcrty for <br />md County to 6id upon tlc <br />purpGcs. <br />Applicet tr <br />Pmincc nmc <br />APPROVALS DATE !D/StG.COMMENTS <br />Appliances <br />Metal Fire Place <br />Evap Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type 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.h, [).t't- <br />FinalTest <br />Meter Release <br />htrFINALQ-/?a//rAr, <br />MEGHANICAL.I NSPECTOR RECORD <br />l*Y