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MECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I haehy affm undc panalty of pajury thd I m qmpt ftom the ContmctoE' Liccnsc Law for thc followitq twn (Sq.7031.5 Buins ud Prof6sion Codc): Any City or County which rcquiB a p6mit to @nstruct. dts, improvq rlanolish or rtpair my stluc{uq prior to its iswca also rcquic thc qplicmt for such pqrnit to filc 8 signcd stdmot thd hc or shc is licoscd pmet to thc prcvisioB of thc Conkactor's Liccnsed kw (Chaptq 9. Comacing with Sction 7000 of Division 3 of thc BBirN and Profcsions Codc) or that he or shc is cxcmpt thqcfrom md thc bosis for thc allcged ampioc Any violation of Setbn 703 I .5 by uy applicot for a pcrmit subjcts the applicut to a civil pcoalty of rot mor€ thfi fivc hundrcd dollm ($500). -1. as owner of the property, or my employees with wages as their sole compeosation. will do the work and tlrc stnEture b not intended or offerd for sale (Sec.7044, Business and hofessioru Code: The Contractor's License l-aw does not apply to an owner of the propcrty who builds or improvs tlrcreoru and who does such work himself or herself or through his or her own employees. provided that such improvanents arie not intended orofftred for sah. II. howevcr. thc hlilding or irnprovcmcnt is sold within one )€ar of complaion, the Ovner Builder will have the hrden of proving thd he or she did not build or impove the propcrty for the prposcof s8h). -1, as owncr of the prop6ty. am exclusively contracting with licensed contractors to construct the project (Sec. 7M4, Business and hof€ssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such projeds with a Contraclo(s) licansed pursuant to the Contractor's Licetse l-aw). -l am exempt under Section-, B. & P.C. for this reason. llolo. WORKERS' COMPENSATION DECLARATION I hereby affrm under penalty of pcrjury one of the following declarations: -l have and will maintain a Certificate of Consent to Self-lnsure for workers' conrpensation, as provided for by Section 3700 of the Code. for the performance of the work for which the perrnit is issued. have and by Section 3700 of the l-abor Code. for the performance of the carrier and policy number are: fA4t-2-- Policy _l certi& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to bccome subject to the workcrs' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section 3700 of thc Labor Code. I shall. forthrvith comply wilh thosc provisions.. WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an anploycr to criminal pcnalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 Code. interest and attorney's */n 1 ^eb?/) I ICT'NSED CONTRACTOR DECI,ARATION I hereby affrrm under penalty of perjury that I arrr licensed under provision of Chapter 9 (cotntnencing with Section 7000) of Division 3 of the Business and Professions Code. and my license is in full fcrrce and effect. Nulnber: i c-tq \a W I hcrcby alfim unda pqdty of psjury thd thc b a concructbn lcoding agacy for thc pcfot1me of thc mrl 6r which this Fmt b iscd (Se. 3097, Civ. C.). Lender's Name: Lender's Address: ,r, ,.ANT ""c,I herdry affnm under penalty of perjury one of the follorving declarations: Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6) -Required Later of Notification -l certiff that the federal regulations regarding asbestos removal are not applicable to this project. state that the above information is correct. I agree to comply with all City and County to enter upon the above mentioned properly for Applicant or Agent Permitee name ^e and hereby authorize rep,resentatives of this City and ?12,c> Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation !nsulation Smoke Detectors Installed Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type II Hood Grease Duct Fire Damper Openings lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release ,l FINAL '7-Dft,ft97(z Notes, Remarks, Etc. Owner: as 1-l-z I s&s 3l Ll 7-<)Contracto ,, kl