Laserfiche WebLink
MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCANATION <br />I hercby affum undcr peoalty of perjury that I m cxempt fiom th€ ContrrctoE' Lice[E Lrw for the following rcaSn (Se.703lS <br />Business and Profcssion Cldc): Any Cily or County which rcquircs a lmit to construct. 8lts. improw, demlish or rcJ[ir rny <br />structurc. Irir to its issumcc. ds rcluircs thc 4plicmt for such pcmil lo filc I sigrcd slalemnl that he or she is licensd pursrnt <br />to thc provisions of thc Contractor's Lkrnsd kw (Chapter 9, Comrcing wilh Seltion 7000 of Division 3 of the Busircss ud <br />Prcfessions Codc) or that he or shc is exempt thcrefrom snd the hrsis for the sllcged exemption. Any violslion of S6tiotr 703 1.5 by sny <br />appticant for a pemit subjrcts tk spplicsnl to 8 civil pcmlty of nol mre thil fivc hundred dollrs (5500). <br />_1. as owrcr of thc pmpcrty. or my enrploye€s with wsges &s thcir $lc comlEnsslion. wil do tlE wtr* std ttE $tune k rcl <br />intcrdcd or ofrcrcd for sh (58.7044. Busircss snd hofcssions Cods Thc ConlEctor's Liccns kw docs not spply to m owrer of <br />tlE pmpcny yho huiEs or inprcw ttEmtr dd uho dG sh mr* himsclf or hwlf or thrcugh his m hcr own cmploSces, <br />pmvided thrt such imp(owrcnts rc mt intclded or offered for sh. lf. horcq. thc huilding or itrprorcmnt is sld wilhin om ,sr <br />of sq)|€liorl the O{rcr BuiHcr will haw thc burdor of prcving tlut hc or shc did rct buiH or irpmre 0rc pmpcrty for the purpo$ of <br />slc). <br />_1. as owrcr of the prcpqty, m crclusirely contmcting with liccnsed contrrctoF to @nnruct thc Plojctr (Ss. 7044. Busircs <br />Urd Proftssim Code: Thc Contrutor's Liccnrc L8w d@s ml spply to m owns of prclEny wlo builds or imptores thcreon. <br />and who contmcts for suh prcFcts with 8 ConrEcto(s) lkTn*d puEunt lo tlrc Conlrctor'r LiEns hw). <br />[hrcxcmpt undcr B. & P.C. for this reason. <br />Urrra. 2-f <br />}V()RKERS' C(Ii\I PENSA'I'ION <br />DECLARA'I'ION <br />I hcrchy afllrrn under penillty of pcrjury onc of lhc followirrg dcclaralions: <br />_l havcan(lwill tnilintainaCcrtilicatcofConscnttoScll'-tnsurcl'orworkcrs'conrpcnsiltiotl.as providcdtbrby.Scction3T(XDot'thc <br />l;rtxrrCrilc. lirrthcpcrli)nnanccofthcworkli)rwhichthcpcrrnit isissucd. <br />_l havc alld will rnaintain workcrs'conlpcnsation insurilncc. as rcquircd hy Sccliott 37ffi of thc l-ahor Codc. for thc pcrlbrmattcc of' <br />tlrc work l'or which this pcrmit is issucd. My workcrs' conlpcnsation insurancc ctrricr lncl policy ltumbcr arc: \ <br />Policy <br />(%lccrtify rhat in thc Jrerformance of thc work for which rhis permit is issucd. I shall nor employ any person in any manner <br />so as to bccomc subject to the workers' compensation laws of California. and agrcc that if I should trecome subjc'ct to the <br />workcrs' compcnsation provisions of Section 3700 of the l-abor Codc. I shall. forthwith comply with thosc provisions.. <br />WARNING: Failurc lo sccure workcrs'compcnsation coverage is unlawful. and shall subjcct an employer to criminal frenaltics and <br />civil fincs up to one hundred thousand dollars ($l00.Un). in addition to the cosl of compensation. danragcs as provided for the <br />Scction 3076 of thc l-abor Codc. inlcrcsl und attorney's fecs. <br />Drt". 1(14(W <br />I ICENSED CONTRACI'OR <br />DECLARA'TION <br />I hercby all'irrn untlcr pcrralty of pcrjury lhat t arn liccnscct ulrdcr ;lrovision of Chaplcr 9 (contttrcncing with Scctittn 7(Xn) of Division 3 <br />ol' thc Busirrcss arrd l'rofcssions Codc. ancl rtty liccnsc is in tull fbrcc atd cll'cct. <br />l ):rlt <br />W <br />I tmby atfum unds pcnalty of pcrjury tlut tlse is a @nstretion lcnding agcmy for lhe perforc of thc mrk for which this pqmil is <br />issued (Se. 3097, Civ. C.). <br />APPLICANT DECLARATION <br />I hcEbyatlimundcr pcnalty of Frjury onc of thc following dcclarations: <br />Dcrmlition Permits-Asbcslos Notificulion Fcderal Rcgulalbns (Tillc 40, Pod6) <br />-Rcquired <br />krtcr of Notificalion <br />-l <br />ccnify lhd the fcderal rcgulations rcguding asbcslos rcmrval arc not applicrblc lo lhis preirl. <br />lofiirrity rttur t havc rcad this application and statc lhd the abovc infirnnation is comcl. I {8re to mmply wilh all City and County <br />ordimnccs and Statc [!ws rchting to huilding construction. ilxl hcrcby authorizc rqrcscntativcs ofthis Cily lnd Counly lo cnlcr ulnn thc <br />atxlvc nrcnlioned propcrty for inspcction purposcs. <br />Applicant or Agcnt <br />Pcrnritcc nanrc <br />I <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[\Iisc. Equipment <br />Duct Work <br />Pre- lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Tvpe 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 />Rouqh Mech. <br />Final Test <br />Meter Release tl ,ll t ^ -^ny' <br />FINAL llWPo UP3lroL vdo <br />Notes, Remarks, Etc.I <br />Date:._1t-$l l-l. <br />Contrnckrr: <br />_*,".? f l-izn) <br />\