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MECHANICAL.INSPECTOR HECORD <br />APPROVALS DATE !D/S!G.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby aflirm under penalty of pcrjury thsl I m cxempt frcm lhc ContrBctoR' Liccns lnw for the following rcasn (Sec.7031.5 <br />Busincss ond Profcssion Code); Any Cily or Counly which rcquircs a lrrmit lo construcl. altcr. improvc. dcmolish or rcpair my <br />slruclurc. prior to its issuecc. also requires thc applicant for such pcmil to file a signcd slatement lhal he or she is licenscd pursuol <br />to the provisions of thc Conlractor's Liccnsed Law (Chapler 9, Commencing with Scction 7000 of Division 3 of thc Busincss and <br />PrefcssionsCodc)orthathcorshcisexcmptthcrcfromandthcbasisforthcallcgedcxcmption. AnyviolalionofsNtionT03l.5byany <br />spplicanl for a Frmil suh.iecls the applicant to a civil penalty of not mrc than live hundred dollss ($500). <br />_1. as owncr of thc prcImy. or my emplo)ccs wilh wsgcs as their $le compcnslion, will do tlrc work and the strutre is ml <br />interxled or offcred for slc (Ss.7O44. Business and Professions Codc: Thc Conlractor's Liccnse [lw d@s not apply lo an owner of <br />the prcFny who huilds o. inprores thcmn. md who dms ruch mrk himsclf or herself or though his or hcr own cmployees. <br />providcd th6t such impmvercnts re rct inlerdcd or offcrEd for sk. If, howcs, lhc building or inqrrcwmnl is sH within orc ,€a <br />ofcotr{,lctiotr the Owncr BuiHcr will harc thc burdcn ofprcving that he or she did mt buiH o. imprcrc thc prcJsry for the puqn$ of <br />sh). <br />_1. as owncr oflhc propcrly. am cxclusively conlracting with licetrscd contractom to construcl thc pmjecl (Scc. 7044. Busincss <br />and ProfesshnCodc:ThcContractor'sLicenseLawdocsnolapplyloanownerofpropertywhobuildsorimprovesthcreon. <br />and who contmcts for such prcFcts with a ContEcto(s) liccnscd pursuill lo lhe Contraclor's Liccnrc [aw). <br />-l <br />mercmpt under scction- B. & P.c. for this rc&son. <br />Datei- <br />- <br />Owner:- <br />-WORKERS' COITPFNSATION <br />DECLARATION <br />I hcrcby afllrilr undcr pcnalty ofpcrjury onc ofthc fbllowing dcclarations: <br />_l havc and will rointain a Ccrtificulc of Conscnt to Scl[-lnsurc for workcrs' compcnsalion. as providcd li)r by S&1ion -]7(X) of lhc <br />Latx)r Crxlc, for thc pcrforroncc oflhc work for which lhc pcrmil is issucd. <br />\avc and will maintain sorkcrs compcnsation insurancc. as rcquircd by Scction l?U) of lhc tibor Codc. for lhe pcrformancc of <br />thc work lirr which this pcrmil is issucd. My workcrs' conlpcnsalion insurilncc caricr drd lx)licy nunlbff uc: <br />Policy <br />_l ccnify lhat in thc performncc of thc work for which this permil is issued. I shall not ctrlploy any person in any manncr <br />so as to becom subject to thc workers' compcnsalion hws of Califomia. and agrcc lhat if I should bccorc subjecl to thc <br />workos'compensationpmvisionsofScdion3T00ofthcLaborCodc. lshall.fonhwilhcomplywithtlmspmvisions.. <br />WARNING: Failure lo scue workcrs'@mpcnsalion covcmgc is unlawful. ild shall subFct m employer to oiminal pemltics and <br />civil fincs up to orc hundrcd thousnd dollm ($100.000), in addition to th€ cost of compcnstion, damges as prcvidcd for rhe <br />Sstion 30?6 of thc kbor Code. intcrest md allorrcy's fes. <br />ucELsEDl:ANrlA.c.IgB <br />DECLARA'TION <br />ol thc Bu\inc\s iltrd I'roltssiols Code. nnd tny liccnsc is in lull lirrcc iln(l cllccl. <br /><,&)()Liccnsc Nunlhcr:n (iIlrilclor: <br />CONS'I'RUC'IION LTJNDIN(; AGT'NCY <br />i\sucll (Scc -1097. Civ. ( . ) <br />l.crrLl('r'\ Nilrrx : <br />Lrndcr's Addrcss: <br />AfIIJI;ANLIIEILABAIIQN <br />I lLnhy illl'irm undcr pcnalty ol prrjury orc of thc lollowing dcclaral bns: <br />Dctrn)lilion Pcrmils'Ashcslos Notification Fcdcral Rcgulalions (-l'illc 40. Prn6) <br />-Requircd <br />l,ettcr of Notilication <br />-l <br />certify rhat lhc fedcEl rcgulations rcga.ding asbcslos rcrmval trc not Epplicable to this pmjcct. <br />wirh all Ciry snd Counly <br />k) <br />atx)vc nrcntioned propcrty <br />Applicant or Agcnt <br />Pcrmilce namc <br />und stillc lhtrl thc <br />and <br />/Lo <br />thc <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <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 />FinalTest <br />Meter Release <br />F!NAL L-lo-2a HloS <br />Notes, Remarks, Etc. <br />I)illr: /\ppli(ilnl: <br />l)atel