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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNEN BUILDER DELCARATION <br />I hereby 8ffrm uidcr penalty of lErjury thrt I m exempt frcm tlrc Coilnctos' Lktnrc tiw for the following rcE$n (Sc.7031.5 <br />Busincss 8nd Prcfession Code): Any City or County which rc1uircs a lvmit to @nnrucl, olls. imprcvc, &mlish 'or rtprir my <br />struclurc. prior to it$ issecc. also rcquircs the spplicsl for such pcmit to lih a sigred stalcmnt thst lE or she is liccn*d puroant <br />to thc pmvisions of the Contructor's Licnsd t:w (Chsplcr 9. Comrcing with Setion 7000 of Division 3 of thc Busimss md <br />Pmfcssbns Codc) or thsl lE or she is cxemlrt thercfrom and thc basis for lhc allcgcd cxemption. Any viohtion of Sethn 7031.5 by any <br />applicantforapmitsubjorlslhe rpplicatrttoacivilpenaltyofnotmrcthanfivehundreddollus($500). <br />-1. <br />as owncr of the propcrty. or my employees with wages as their sole compensation. will do thc work and the struciwc is not <br />intendcd or offercd for sale (Serc.7044. Business and Professions Code: The Contractor's License l-aw docs not apply to an owncr of <br />the propcrty who builds or inpmves therson, and who does such work himsclf or herself or lhrough his or her own employces. <br />provided that such improvenrcnts arc not intended oroffcred for sale. lf. howevcr. the building or improvemcnt is sold within onc )ear <br />of comphtion. the OwnCr Builder will have the burden of proving that lrc or shc diJ not build or inqrrove the fr-frerty for thc purp)se of <br />sah). <br />_1. as owner ol'thc property. am exclusively contracting with liccnsed conlraclors lo conslruct lhc projcct (Scc. 7044. Busincss <br />and PmfesskrnCode: Thc Contractor's l-iccnsc Law does not applylo anowncr of propcrty who builds ttr improvcs lhcreon. <br />and who contracts for such projccts with a C<lnlractor(s) licenscd pursuunl to the Cttnlraclor's l.iccnsc Law). <br />-latttcxcmptuttdcr.Scction-.B.&P'C.forlhisreason.( )n lrer <br />WORKERS' CONT PENSATION <br />DECI dRATION <br />I hcreby affirrn undcr pcnalty of Jrerjury onc of thc following dcclarations: <br />_lharerndwill mintainaCcnifrcsteofconsenttoSclf-lnsurcforrcrkers'@mpcnsation,re FovidcdforbySction3T@ofthc <br />hlgr Codc, for the Frformre of the mrk for which the pcmit is issucd. <br />Hfhrr" "na <br />*ilt *intsin workcc' com[Emstion insunrce. ss rcquircd by Setion 3700 of the kbor codc, for rhe perfomncc of- thc rcrk fq which this pcmit is is$rcd. My workc6' @rrlEnsalion insumre cuicr aod lDlhy numbs rc:( <br />t0I0t /-)oPolicy <br />_l ccrtify that in the perfornuncc of the work for which this pcrmit is issucd. I shall not employ any person in any m&nner <br />so as to bccomc subject to the workcrs'comfrcnsation laws of California. and agrcc that if I should bccomc subjcct to thc <br />workcrs' compcnsation pmvisions of Section 370O of thc [:bor Code. I shall. forthwith comply with thcrsc provisions.. <br />WARNING: Ftrilurc lo surc workcrs'compcnsation svc.agc is unhwful. afil shall suhjct an cmploltr lo diminrl lEnohhs and <br />civil Iincs up lo onc hundrd thousand dollars ($100.000). in addilion to thc cost of comlEnslion. damgcs rs provkled for the <br />Scclion and allorncy's <br />t <br />LICENSI.'D CON'I'RA CT( IR <br />DECLARATION <br />I hcrcby allirrn undcr pcnaltyol'pcrjury that I anr liccnscd undcr provision of Chaptcr 9 (comnrcttcing with Scclion 7(XX)) of l)ivisiorr.l <br />of the Busincss and Profcssions Codc. ard nty liccnsc is in full lirrcc and ell'cct. <br />q <br />l-iccnsc <br />3 <br />CoNSTRUCTION LINDTNG AGENCY <br />I hcn'hy nffirnr undcr pnalty of pcrjury thal thcrc is o conslruction lcnding {gctrcy lbr lhc pcrfotnarcc oflhc work for rvhich this lErmit is <br />issucrl (Scc. 3097. Civ. C.). <br />l.cn<lcr's Narttc: <br />ASPIJ'TNI.DE J.AEAIU <br />I Mry aflimundcr Jrcnalty of pcrjury orc of lhc following dNlarolions: <br />Dcmlition P6mits-Asbcstos Notificdion Fcdcral Rcgulations (Titlc l(). Pan6) <br />-Requircd <br />Lrlter of NotifKation <br />-l <br />cenify thal thc federal rcgulations rcgording asbcstos renmval src not applicohle lo this prcjcd. <br />ffi,t ""rrify <br />tn"r I have rcad this applicarion and strtc that thc alnre information is corrrrt. I sgre to mmply wilh all Cilysnd Counly <br />lirdinanccs and Statc tiws rchting to buiHing construction. and hcrcby authori4 rclrescnlalivcs oflhis Cily and Counly to cntcr ulnn lhc <br />lbovc mcntioncd propcrty for <br />Applicant or Agcnt <br />(Pcrrnitec narnc (prinl <br />,,,"d[\el )0 <br />Appliances <br />Itletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Nlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Drver <br />Residential Ranqe <br />Other <br />Hood <br />Type ! Hood <br />Type Il Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release 1t I <br />FINAL 1.15l'b?DKry*I <br />Notes, Remarks, Etc.I <br />n"t.'cfl 3o[]o