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M ECHANICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG COMMENTS OWNER BUTLDER DELCARATION I hrcby amm unds poalty of pcrjury that t m qmfl fiom the Contmclon' Licffi lrw for thc following rmn (Sc.7011.5 . Buine ard hofcssioo Codc): Any City or County which rcquirc a pomit to conslrucl. aho, improvq dcrnolish or rpair uy structuc. prior to its isumca also rcquirs thc applicmt for such prmit to file a sigrcd slalmat that hc or shc b licmscd puBumt to thc prcvisioE of thc Contnctor's Lisscd Law (Chapto 9. Commcing with SEtion 7000 of Division 3 of the Bsins md Prcfeiom Codc) or that hc or shc is smpt thdefrom ed the bosis for thc alk8cd crmption. Any violation of S6rion 7031 .5 by 6ny applicmt for a pmnit subjcts lhc applicut to a civil pmlty of not mrc thm fivc hundrtd dollm ($500). _1. as owner of the property. or my employees with wages as their sole compensation. will do the work and the strucitre is not intended or offered for sale (Sec.7044. Business and Profcssions Code: The Contraclor's License law does not ryply to an owll€f, of the propcrty who builds or improve theron. and who does such rvork himself or herself or through his or her own employecs. provided that such improvanrents are not intadcd or off€rcd for sale. I(, howerrer. the hilding or improvernent is sold within one )car of compkrion the Orvner Buitder will have the burden of proving that he or she did not build or improve the propaty for the purposc of sale). -1, BS owner ofthe prop€rty, am exclusively contracting rvith licensed contractom to construc't the project (Sec. 7O14. Business and hoftssion Code: The Contractor's License Law docs not apply to an owncr of property who builds or improves thereon. and rvho contracts for such p,rojects rvith a Contracto(s) licensed pursrnnt to the Contractor's License Larv). _l am exempt B. & P.C. for thisr DECLARATTON I hereby affrm under penalty of perjury one of the follorving declarations: -l have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation. as provided for by Section 3700 of the Iabor Code. for the performance of thc work for which the pcrmit is issued. _l have and will maintain workers' compensation insurance. as roquired by Section 3700 of the l-abor Code. for the performance of the work for which this permit is issued. My workcrs' compensation insurance carrier and policy number are: Policy [lrpir es: _l certifu that in the performance of the rvork for rvhich this perrnit is issued. I shall not employ any person in any manner so as to become subject to the rvorkers'compensation laws of California. and agree that if I should become subject to the u'orkers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith cornply r+'ith those provisions.. I WARNING: Failure to secure rvorkers' compensation is unlarvful. and shall an onployer to criminal civil fines up lo one hundred thousand dollars in addition to the of damages as for the Section 3076 l,alxrr interest and a 8 f { v I hereby affirm under penalty of perjury that I am licenscd 9 (commencing rvith Scction 7000) of Division .3 of the Business and Professions Code. and my license is in full force and effect. [,icense Number: !)atr:: ('oltlritclor: W t hqrby affm unds pcnalty of pcrjury that th@ is a consruc{bn krding rgocy for thc pcrfomcc of thc work 6r *fiich this pamit b issued (Sec. 3097. Civ. C.). Lender's Name: Lender's Address: ,\l'Pl.l(',\\ I l)li('1.,\ll.\'l'loN I hereby affu:n under penalty of periury one of the follorving declarations: I)emolition Perrnits-Asbestos Notification l;ederal Regulations ('l'itle 40. Part6) _Required l.etter of Notification _l certify that the federalregulations regarding asbestos rernovalare not applicable to this project. -l cerri$, that I have read this ordinances and State [.as's above mcntioned property for Applicant or Agert Permitee name and state lhat tu",0,5. 11 Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Dryer Residential Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings !nstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech.q 2)a llH4t^^#'/4€D) Final Test u Meter Release ,\ F!NAL u l.t4T :lr-:rrr ^ (\lt ,vy Notes, Remarks, Etc.U\ 8 a