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M ECHANICAL.INSPECTOR RECORD APPROVALS DATE !D/SIG.COMMENTS OWNER BUILDER DEI,CARATION I hscty affm undo pcnalty of pajury that I m qmpt from thc ContnctoB' Lico* Iaw for thc following mtr (Sc.7031.5 Buins sd hoftsion Co&): Ary City or County which rcquirc a pomit to construct. alt6, improvc, dcmolish or rcpair my structurq prior to its isuucc, also requiG thc applicilt for such pemit to file I signcd stdmat thd h€ or slrc b licctrscd pw6t to the FovisioG of thc Contretor'! Liensd Law (Chapts 9. Comocing with Sction 7000 of Division 3 of thc BuinB md Prcfesions Codc) or that hc or she is qmpt th@from ud thc basis for thc allcgcd amption. Any violation of Scction 7031.5 by ey applicant for a pmit subjcts thc applicmt to a civil pcnalty of not morc thm five hutrdrcd dolles ($500). -1, 0S owner ofthe prop€rty. or my employees with wages as their sole compcnsation. will do thework and the structurc is not intendod or offcred for sale (Sec.7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of the property who builds or improvc thcreon urd who does such work hhrself or herself or through his or her own employee. provided that such improvaneots are not intendcd or off€rod for sale. I[, howerrer. ttrc building or improvemcnt is sold within one ]Gd of complaion, the Orner Builder will havc the hrd€n of poving thd he or she dil not build or inprove the propaty for the pluposcof sale). -1, as owner of the prop€rty, am exclusively contracting with licerued contractom to construct the project (Sec. 7M4. Brsiness and Proftssion Code: The Contractor's License l-aw does not apply to an owner of propcrry who builds or improvc thereon. and who contracts for such projccts with a Conhaclo(s) licansed puniuant to the Contraclor's Liccrse l-aw). -l am exempt under Section-. B. & P.C. for this reason. l)ltc WORKERS' COMPENSATION DECLARATION I hereby affirm under pcnalty of perjury one of the following declarations: _l have and will maintain a Certificate of Consent to Self-tnsure for workers' conlpenmtion, ali povided for by Section 3700 of the I-abor Code for the p€rformance of the work for which the pennit is issued. -l have and will maintain workers' compensation insurance. as required by Section 3700 of the Labor Code. for the performance of the rvork for which this permil is issued. My workers' compensation insurance carrier and policy number are: Policy Number: Expires: -l certi& that in the performance of the work for which this permit is issued. I shall not employ any pcrson in any manner so as to become subject to the workcrs' compensation laws of California. and agree that if I should become subject to the workers' compersation provisions of Section 3700 of the Labor Code. I shall. forrhwith comply with those provisions.. J WARNING: Failure to secure workers' compensation coverage is unlawful. and shall subject an employer to criminal penalties and civil frnes up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the Section 3076 of the L-abor Code. interest and attorney's fees. D,r", q //g/lq LICENSED CONI'ITACTOR DECI..ARA'TION I hereby affrrm under penalty of perjury that I arn licensed under provision of Chapter 9 (comrnencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. License Class: License Dil", q//</lat W I hwby affm undo pqulty of pajury that th@ is I @ostruclbn hading agwy for thc pafortlmc of thc wort for which thb pqmit b isucd (Sc. 3097, Civ. C.). Lender's Name: Lender's Address: ,r, rc NT ""cr RArtoN I t!rcby aflirm under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notificaion -l cqtiry thd thc fedgal regulatioro rcgading abBtos rmoval ue not applicable to this prcjel. -l cstify that t havc red this application ad statc that thc above infomation is corot. I agrcto complywith all City and County ordinanca od Statc trws rclating to building coNtruction. md hseby .uthorizc rcprMtativ€ of this Cily md County to 6tq upon thc abovc mqtioncd prcpqty for iGp€,tion purDos. --z t t ,rppricuro.rgorsi*,^,*, 'f 1(n [EF- ^", 418/r? Pennitee name -t 1-rd Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors Installed Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings lnstallation F. D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release a FINAL / /-J'Zo (- eri tvotts -Zq Notes, Remarks, Etc. Orvner: fr