Laserfiche WebLink
M ECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS ()\l',NIiR IttIIl.l)l:R I)l,ll.c'A RA'l'l( )N , <br />I hcrchy nffirm undcr pcmlty of pcrjury lhat I m cxcnrpt fiom thc G)nlrncb6' Liccn* ljw for lhc following rcasn (Sc!.t0.11.5 <br />Busirrcss and Prot'csskrn Code): Any City or County s'hich rcquircs a Jrrmit h conslrucl. allcr, improvc. dcmlish or rcpair lny <br />struclurc. prior k, its issuancc. ulso rcquircs lhc upplic^nl for such lrcrmil lo lilc a signcd statcment thal hc or shc is liccnscd pursuant <br />to lhc pmvisions of thc Contractor's Liccnscd Law (Choptcr 9. Commcming wilh Scclion 7fin of Division 3 of lhc Busincss and <br />ProfessionsCodc)orthalhcorshciscxcmptthcrcfronandthchrsisforthc0lhgcdcxcmption. AnyviolationofSEtionT0.ll.5byany <br />applicilnr for u pcrmil subjccls lhc applicant to a civil pcnnlly ()f nol mrc lhan livc hundrcd dollars ($5(D). ?I <br />]Ll. as owncr of thc pmJrctly. or my cmployecs with wogcs as thcir solc conrpcnsatkln. will do thc work und tlE slnrctrc is mt <br />intcndcal or offcrcd for slc (S8.7O44. Busircss aod hofcssions Codc: Thc Conlrrcbr's Licensc Law docs nol apply to an owncr of <br />thcpn)Frly whobuildsorimp(rrcsthcurn.urdwhodocssuchworkhhnselforhcrsclforthrortghhisorhcrowncnployccs' <br />p()vidcd rh{l such inrpmwnrcnls arc mt inlcndcd oroftLNt for $h. lf. k)welcr lhc huikling or ir{rmrclrcnl is sH within orc ]ta. <br />ofcomJrhtion, thc Osrcr Buildn vill harc thc hurdcn ofpmving that hc or $hc did nn build or tr{,mtc 0rc pmlEaly for thc PurJxts of <br />srh). <br />I <br />_fl. as owncr ofthc propcrly. antcxclusivcly contracling with liccnscd contmclos k) construcl thc pmj@t (Scc. 7044. Busincss <br />and Pnrfssirn Codc: 't'hc Contraclor's Liccnsc Law does not apply to an owncr of propcrly who huilds or improlts lhcrcon. <br />and who contracls for such proFds with a Conlruclor(s) liccnscd pursurnt to thc Conlractor's Liccns [rw).I <br />lIon,"*q,ntundcrSmtittn-.B'&P.c.l.orlhisreason'**,llZ-lu **- I1eA-U614YEN-I I WoRKERS'C0MPENSATI0N <br />IIECI.AMIION <br />I hcrchy allirm undcr lrcndly of perjury onc of thc following delaral ions: <br />Mharcurdwill rminlainaCcnificoteofConsnthsclf-lnsurcforworkcrs'comJrcns{lion.as pmvidcdli,rbySctionsT(X)oflhc <br />t{bor Codc. for thc pcrfortruncc ofthc work for which thc prmil is issucd. <br />r, nou"and will maintoin workcrs' compcnsation insurance. Bs rcquired by Scction <br />for which this permit is issucd. My workers' compensation insurancc calricr<W-fi'nd <br />3700 of the Labor Code. for the Performance of <br />and policy numhr arc:lhc wrlrk <br />641 24Policy <br />-{t ""nifythat in the performance of rhe work for which this pcrmit is issued. I shall <br />so as to becomc subject to the workers'compcnsation laws of California. and agree that <br />workcrs' compensation provisions of Scction 3700 of the L:tnr Code, I shall. forthwith <br />T <br />not employ any person in any manncr <br />if I should bccomc subje"ct to the <br />comply with those provisions.. <br />WARNING: Failure to sccure workers'compcnsation covcragc is unlawful. and shall subict an employer to ctiminal pnaltics and <br />civil fincs up to one hundred thousand dollars ($100.fiD). in addition to the cost of compensalion. damagcs as provided for thc <br />Scction 3076 Code. intcrcst and attorncy's fccs. <br />I ICENSED CONTRACI'OR <br />DECLARATION <br />I hcrcby atlirnr untler pcnalty ol'1rcrjury that I alrr liccnscd undcr provision of Chaptcr 9 (comnrcncing with Scction 7firu) of [)ivision 3 <br />ol' thc Busincss and Prol'cssiorrs Codc. and nty liccnsc is in full forcc antlcffccl. <br />Liccnsc Nurnlrcr: <br />r^Y <br />CONS'TRUCTI(IN LENITING ACENCY <br />I hcrcby affirrn unrlcr lEntlty of Jrcrjury thot thcrc is a construct ion hnding agcncy for lhc pcrform0ncc of lhc work for Nhich lhis Frmil is <br />issucd (Scc. .1097. Civ. C.). <br />lrndcr's Address: <br />I tnrchy aflinn undcr pcnalty of pcrjury onc of thc ftrllowing dcclarations: <br />Dcnrolition Pcrmits-Asheslos Notification Fcdcral Regulations (Titlc 40. Part(r) <br />' Rcquired [-e'tterof Notification <br />_t ccrlily that thc fcdcral rcgulations rcgarding asbcstos rcrrxrval arc nol apJrlicablc ttl lhis projccl. <br />I <br />V t ."rrity tSat t havc rcatl this application an<l statc that thc ahrvc inlbrnrariort is corrccl. I agrcc lo contply with all City and County <br />ordinanccs and State Laws rclating to building construction. and hcrcby authorizc rcpresenlatives of this City <br />abovc rncntioned propcrty for inspcction purg)ses. <br />Applicant or Agcnt <br />Pernritcc nanrc (print <br />and County lo enlcr up,on thc <br />Appliances <br />N/etal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors Installed <br />Rouqh Ductwork <br />Vents ,l <br />Toilet Room / Clothes Dryer q l7.l lto wq67 <br />Residential Ranqe ? ltt'nJ)Dll+frz <br />Other I I <br />Hood <br />Type I Hood <br />Type ll 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 I I I <br />FINAL tLl IrJlVo Dqr6 I <br />Notes, Remarks, Etc <br />{+o4 MGrY-nl <br />Erv <br />uv