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MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/StG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affirm undcr pcnalty of pcrjury thlt I m exempt fmm the Contracton' Licenrc law for the following rearcn (Scc.703l.5 <br />Business and hofession Codc): Any City or County which rcquircs a pcrmit lo constroct. altcr. improvc. dcmolish or rcpair 8ny <br />struclurc. prior lo ils issumc. also rcquircs lhc spplicanl for such fErmil to file a signed stulcmnt lhst he or shc is licensed pursmt <br />Io thc pmvisions of the Conlraclor's Liccned law (Chaplcr 9. Commcncing with Scclion 7000 of Division 3 of the Busincss and <br />Profcssions Code) or thsl hc or shc is excmpt lhercfrom and the basis for lhe allcged excmption. Any violation of Section 703 I .5 by any <br />applicant for a pcrmil subjsts lhe applicsnt lo s civil penalty of not more thm fivc hundred dollus ($500). <br />-1. <br />&s owrcr of the propeny. or my cmployecs with wages s thcir mle compcnsation, will do the wtrk aid tlrc stnrtw is rct <br />intend€i or offcred for eh (5@.7044. Business and hofcssions Codc; The Contractor's Licens kw d@s not apply to an owrcr of <br />thcpmpcny whobuildsorir{rovsthemn.andwhodessuchworkhimselforherselforthrcughhisorherownemployes. <br />providcd that such impDvemnls re rct iilendcd oroffcrcd for slc. If. howcvs. the building or itr{,rcwmnt is mH wilhin orc }es <br />of completion, the Owner Builder will hore thc turdcn of ;mving that he o. shc dll mt build or imprcve the prcFny for thc purJrs of <br />uh). <br />-1. <br />as owncr of thc pmpcny. am exclusivcly contracting wilh licensd conlraclom h construct the pmj6t (Sec. 7044. Busincss <br />ard Proftssion Codcr Thc Contractor's Liccnsc Law docs not apply to an owncr ofpropcrty who builds or improvcs lhercon. <br />and who conlEcls for such Jmjects with a Contmclor(s) liccnscd pursuanl k) lhc Contractor's License [aw). <br />}Y(IRKERS' COI\IPFNSA'I'I()N <br />DECLAIIA'I'ION <br />I hercby affirm undcr pcnalty ofperjury orc oflhe followin8 deldationsl <br />l;rtxrr (irtlc. I<rr thc pcrlirrrrancc oflhc uork t'()r which thc pcrntit is irsucd. <br />-lhavcandwill <br />mainloiowo.kers'compens0tioninsurancc.as requircdbyScclion-lT0OofthetjborCode.fortheperfomrceof <br />thc work lbr which lhis pcnrit is issucd. My workcrs'insumnce cmier md lnlicy nunlhcr ecl <br />Policy <br />_l ccnify thal in lhe [Erformrcc of lhc work which lhis pcrmit is issued. I shall not crnploy any pcrson in any manncr <br />s as lo hccom suhjecl to lhe workcrs'l8ws ofCalilbrnia. and a8rcc that if I should bccorc subjcct lo lhc <br />workcrs' compcnsalion provisions of Scction ofthc Lstmr Codc. I sh8ll. fonhwilh comply with thos provisions.. <br />WARNING: Flilurc lo *cure workcN'comlrensalion coveragc is unlawful. und sholl subjcct an employcr to aiminal Jrcmltics and <br />addition lo thc cost of com[rcnsation. damgcs as providcd for thc <br />Setion 3076 of the tibor Code, intcrest ed eltomy's <br />DECI'\RATTON <br />I hcrcby affirm undcr frcnalty of Frcrjury lhal I am lien*d undcr prcvision ofChallcr 9 (comilrncing with Scctkrn 7000) of Division 3 <br />of thc Busincss and Prolcssfuns Codc. and rny liccnsc is in lull forcc ard clfcct. <br />?a DTLiccnscNumhcr: - <br />I hcrchy rllirm undcr NDrlly o, lrrjury thrt lhcrc i\ x con\lrclion lcidinS agcicy ti)r thc pcrlbtnxncc of lhc qork lbr which this pcrnrit is <br />issutrl (Scc. 3097. Civ. C.). <br />kndcr's Namc: <br />hnder's Addrcss: <br />- <br />ATELICANI.ATI!:IABATQN <br />I hcrcby aflim undcr pcnalty of pcrjury onc of thc tirllowing dcclaralions: <br />Dcmlilion Pcrnit$-Asbcslos Notillcation Fcdcral Rcgulations (Titlc 40. Parl6) <br />-Rcquircd <br />Lcltcr of Nolilicntion <br />_l ccnily lhxl thc ltdcral rcgulations rcgarding asnustrs rcrilovalilrc n(il tpplicablc lo lhi\ projcct. <br />-E{ c!'a i ly I hrt I havc rcatl I his appl icrl ion aild stillc I hul lhc ahovc i nlt,rnlilt hn is corccl. I ilgrcc lo coDtply w it h illl Cit v and County <br />above mnlioned pmFdy for <br />Applicanl or Agcnt <br />l'crnlilcc nililr <br />purpoFs. <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />NIisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranoe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinos <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />FinalTest <br />Meter Release <br />FINAL 74ll/?,e v tqrtHili /9) <br />Notes, Remarks, Etc.I lt <br />-l <br />merempt under Setion- B. & P.C, for this rcason. <br />Dats- 0rmcr- <br />civil fincs up lo ore <br />u"r",---t ll\j <br />I)nle:t-7 -aa