40130631 - Permit - Laserfiche WebLink

Home Browse Search

MECHANICAL-INSPECTOR RECORD APPROVALS DATE ID/SIG. COMMENTS Owner-Bui lder Decla ra tion I hereby affirm under pe na lty of perjury that I am exempt form the Contractors· License Law for the following reaso n (f;c.70 3 1.5 Business- Appliances and Professio n Code}: Any City or County which requires a pcnn it to construct. alter. im prove. demolish o r repair any struct Ure. µ;ic -~o its issuance. also requires the a ppli cant for such permit to fi le a s ig n ed statement t hat he or she is licensed purs ua nt to the pro v isions o.o:-the Metal Fire Place Co ntractor's Licensed Law (Cha pter 9. Commencing with Section 7000 of Division 3 of the Bus iness and Professions Co d e) o r that he or she is exempt t he refrom and the basis for the a lleged exemption .Any vio la tion of Section 70 3 1.5 by a ny app licant fo r a pcn nit subjects lhc Evap Cooler ap plica111 10 a civil penalt y of not more than fi ve hundred dollars ($5 00). Furnace _I. as owne r of the propert y. o r my employees w ith wages as their sole comp ensat ion . will do the work and the s1ruc1 ure is not intend ed or offered for sale ( Sec.7044. Bus iness a nd Pro fess ions Code: The Co ntra ctor 's License Law does not ap p ly to an owner of the property Compressor who builds o r improves thereon. and who does suc h work himself o r h erself or through his o r her own e mplo yees. provided that such im provements arc no t intended or offered for sale. If. however. t he bu ilding o r im provement is so ld w ithin o n e y ear o f c ompletion. the Misc. Equipment Owner-Builder w ill ha ve the burden of proving that he or she no t b uild or improve fo r the purpose o f s a le). _I, as owner o f the property. am exclusiv e ly contract ing with lic ens ed c ontractors to construct the project ( Sec . 7044. Business nod Profess ion Code : T he Contractor's Lic en se Law d oes n ot apply to an owner of property who b uilds or improves t hereon . and who Duct Work contracts for such projects w ith 3 Contractor(s) licensed p urs ua nl to the Contracto r's Lice nse Law .). Pre-Insulation _I a m exe mpt under Section .B. & P.C. for this reason. Insulation Date: Owner: Smoke Detectors Installed WORKERS COMPENSATION DE!:;LARA TION I hereby affirm under penall y o f perjury one of the fo llow ing declaratio ns: Rough Ductwork _I have and will ma intain n Ce11ificate of Co ns e nt to Self-I nsure for workers ' compensatio n. as provided for by Sec t io n 3700 o f the Labor Code. for the perfo rmance o f the work fo r whi ch the pennit is issued. :::(11,we a nd wi ll maintain workers· compens atio n insu rance. as required by Se ction 3700 o f the La bor Cod e, fo r t he performa nce of the work for which th is permit is issued . My worke rs· co mpensat ion in surance ca rrier and po li cy num ber are: Vents Cl:ifficr: . ~k,,., r-vihJ Toilet Room I Clothes Dryer Po licy Number: • ~ /j =, {.p_ ::J. 2 Expires: • °l l • J-3_,rJ Re sidentia l Range (T his sect ion need not be completeJ ~ the permit is fo r One hundred d oll ars ~$1001 or less) Other _I certify th at in the perfonnance o f the work fo r whic h this p ermit is issu ed, I shall not employ any person in a ny manner so as to beca me s ubject to the wo rke rs' compen sat ion laws of Californ ia, and a gree tha t ifJ s ho uld become subject to the workers · compensation provis ions of Section 3700 o f t he Labor C ode. I sha ll, forthw it h co mpl y w i1h th ose provisio ns .. Hood Da te : . I 2 , ~ . I ~ A pplicant: 'I-~ b-'" Type I Hood WAR N I NG : Fa ilure 10 s ecure workers· compe nsa t ion c o,•erage is unlawful, a nd sha ll subject a n emplo ye r to crimina l pena lties nnd civ il fi nes up to one hun dred thousand d ollars ($ 10 0.000).in additio n to t he cost o f compensa tion. da mages as prnv ided for the Section 3076 of Type II Hood the Labo r Code. int erest and attorne y's fees Grease Duct LIC ENSED C O NTR AC TORS DECL ARA TION I hereby a rfinn under penall y o f perjur y that I am licensed under provis ion o f Chapter 9 (comme nc ing w i1h Sect ion 7000) o f Divis io n 3 of the Busin ess and Pro fes s io ns Code • .md my license is in fu ll force and effect. Fire Damper Licens e C lass: • f} Li cense N umber ~ g__t: 1/U- ; 2-. {;, L 0 -Openings Date : ' Co ntractor: ,C.. Installation CONSTRUCTION LENDING AGENCY I here by a ffirm u nder pena lty of perjury t ha t there is a construction lendin g a gency fo r the perfonna nce of t he work for which this pennit is F.D . Drop Test issued (Sec. 3097. C iv. C.). Lende r·s Name: Lender's Addre ss: Above Hard Lid APPL IC A NT'S D F.C LARATION Above T-Bar Demolitio n Pennits -Asbestos Notific ation Fed eral Regulatio ns (Title 40. Part 6 ) _ Requ ired Letter of Notificat ion I I I ' _I certify that the fed eral reg ulatio ns regarding asbesto s removal are not ap pli ca ble to th is project. Rough Mech. 1/ii/A mvr:Jt ~ ~rti fy that I have read this applicat io n a nd stat e t hat t he a bove infor mation is co1Tcct. I agree to comply w ith all City a nd County Fina l Test I r/ ordinances a nd State Laws relating to b uilding constru ction. and here by authorize representatives o f this City a nd Coun ty to e nter upo n t he I a bove m entioned property for inspec ti on purposes. Meter Release \0..\\-Q ,V\~1114 Applicant or ngcnt sii;.: I(. i -Date: . /2-. &.1 G FINAL I Pe rmittee name (print): 0(.. EL ltvQ1= G-L \i'. c}j_ £ /2.., M.\WP51\Perm1l-lnspect1on Fo rms\Mechanical-lnspector Record.doc 03.3 1 .0 6