Laserfiche WebLink
M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS 0WNER IITII I,I)F:R I)F]I,('A RA'TION <br />I hcrchy aflirm undcr pcnatly of pcrjury thal I an cxcDpl fron lhc Conttacbr' Liccnsc Luw for thc lblktwin&rcas$ (Sf 70.11.5 <br />Busincss and Profcssi<u Codc): Any Cily or Couily shich rcquircs a lEnnil lo conslrucl. aller inprovc. dcnplish or rcillir al4 <br />struclurc. prior to its issuorcc. illso rcquircs thc appli('rnl for such [rcilnil l() lilc I siSncd stulcnrnl lhrt hc or shc is liccnrcd pursuant <br />b lhc provisions of thc C(rnlrilctor's Licen*{ kw (Chaptcr 9. Gmrnrcncing wilh Salion 7(x)O of t)ivision 3 of thc Busincss and <br />l,rolissbns Codc) or th{l hc or shc is cxelnpt thcrcfronr and lhc hasis firr thc allcgcd cxcrrptbn. Any violalion of Scction 70-l I .5 by any <br />applicnnt lb. il pcrmil subjccls thc applicflnl lo I civil pcnally of not fr)rc lhur livc hundrcd dollars (S5(X)). <br />_1. as owncr of lhc prrfrcny. or my cnDloyccs with wa8cs {s lhcir solc comJEns{lion. will do lhc work 4tl lhc slruclurc is nol <br />intculcd orollercdf<rr$h(Sa.TGl4.BusincssandPnrfcssionsCdc:ThcC'onlrack)r'sl-iccnsljwd@snolaPPlytonnosncrof <br />lhcpF[fny whot{liklsorhnprcvcslhcc)n.mdwhodocssuchworkhhrsclforhcrscl[orlhroughhiso]hcrowncmployccs. <br />providcd thdt such iflpmrrnEnts rc not inlcrdf,{ or olTcrcd for salc. lf. howcrcr, thc huikling or inprrvcnril is $kl wilhin onc ycu <br />ofcorr{rlctiotr. lhr Owncr Buildcr will hrrc rhc bunlcn ofprovirul that hc or shc dil not huiH ()r irpmrc lhc pruFaly for thc purIns of <br />slcl. <br />_1. {s owncr of thc p()|r ty. arn cxclusilEly conlraclilgl wilh liccnsd conlrilck)s lo conslruct lhc Projccl (S(r. 7044. Rushrcss <br />trd PnrllxsinGxlc:ThcContrilctor'sl,icenscLilwdocsnolapplylo!nowtrcrofproltrlyshohuildsorimPtovcslhcrcol. <br />lnd who conlrnctsforsuchprojcctswithaG)nlnct)(s)liccnscdpursuanlk)lhcCollraclor'sLiccnschs). <br />-l <br />am cxcnrpl undc. Scclion--. B. & l'.C. li)r lhis rc{v[ <br />( )rr nt'r. <br />WORKER*S' CONI PENSATION <br />DFCLARATION <br />I hcrcby afl'irrn under Jrcnalty of pcrjury onc of thc tirllowing dcclaraliotts: <br />_lhavcan<lwill maintainaCertificatcofConscntloSclf-lnsurcforworkers'compcnsilliotl.as providcdlbrhyScctionlTfi)ofthc <br />Latxrr C<xlc. l'or the pcrfornurnce of the work for u'hich thc pcrmit is issucd. <br />_l havc and will nlaintain workers' comfrcnsation insurancc. ils rcquircd hy Sect ion -37(X) of lhc l-ahor Codc. ltlr thc Jrcrf'ornuncc tlf <br />thc u,ork tbr which this pcrrnit is issucd. My workcrs' conrpcnsalion insurance calricr antl policy nunltrcr arc: <br />Policy Numher: ExPires: <br />_l certify thut in tirc perforrnance of thc work for which this permit is issued. I shall nol cmploy any pcrson in any manllcr <br />so ils to bccomc subjcct to the workcrs'comlrcnsalion laws of Culifornia. und agrcc that if I should bcconrc subjcct to thc <br />workers' compensation provisions of Seclion 3700 of thc Latnr Ctxle. I shall. forthwith comply with those pmvisions.. <br />WARNING: Failure to sccure workers'com[rcnsation covcrage is unlawful. und shall subjcct an cmployer to criminal penalties and <br />civil lincs up lo onc hundred thousand dollars ($100.m0). in addition to the cost of comfrcnsation. damages 8s providcd for thc <br />Section 3076 of thc l-abor Code. intcrcst and attorney's fccs. <br />I)ate:,\ pplicllrl: <br />LICI,-NSUD C( INI'RA CTOR <br />DFCLARATION <br />I hcrcby irffirrn undcr pcrraltyof pcrjury that t arn liccnsctl undcr provision of Chaplcr 9 (conurrcncing u'ith Scction 7Un) of Divisiolr 3 <br />ol' thc llusiness arrd Profcssions Codc. iurd nty licensc is in full lirrcc alil cll'cct. <br />('ontrirt'lrlr <br />CONSTRUCTION LFNDING A(;ENCY <br />I lrcrcby amrm undcr lxnillty of Jrcrjury thul lhcrc is a onslruction lcMing agcncy for lhe pcrforroncc of thc *ork tbr shich lhis Jrcnnil is <br />issucd (Sc. 3097. Civ. C.). <br />lxndcr's Natrrc: <br />- <br />APPLICAN'I' I)FCI,ARATI0N <br />I lrrchy itflinn undcr pcrrulty ol'pcrjury ottc ot'thc ltrllou'ing tlcclarations: <br />Dcrrxrlitiorr Pcrrnits-Asbcslos Notificutiorr Fcderal Rcgultlions (l'itle 40. Parl6) <br />-Rcquirctl <br />Lctlcr of Notilication <br />-l <br />ccrtify lhal lhc lcdcral rcgulutions rc8lrditllt ostEstos rclnovalilrc not applicilhlc k, lhis pmjccl. <br />_l cffify thill I have rcnd lhis 0pplicution ard stolc lhal lhc nh)ic intirrtrnlk)n is coreI. I n8rc! lo comply with all Cily and Counl) <br />odinarrccs !trd Statc Laws rchting to huildirg constructiur. ud hcrcby autlxrrizr rcprcscnlatilcs oflhis City {nd Counly lo cnlcr ulhn lhc <br />ahovc nEnlioncd propcny lbr inspcclion pur[nscs. <br />Applicanl or Agcnt I );rlt'. <br />Pt'rrrtilcc nlnt(' (1lr ittl ). <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[t/isc. 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 Il Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release <br />FINAL tl o t)/)bn#sl <br />Notes, Remarks, Etc.I <br />Carrier: <br />l)ntt':