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M ECHANICAL.! NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hmby afiim unda pcrulty of pcrjury thal I m cxmpt ftom thc CootractoE' Licffi trw for thc following wn (Sc.?0315 Busince and Prcfeion Codc): Any City or County which rcquirc a pan'nit to snstrud, 8ltq, imprcve. dmolbh or (Dair oy structre, pdor to its isuucc. also rcquire thc applicut for such pcmit to 6lc a signcd sldmqt thd hc or shc b licoscd Plmmr to thc provisioru of rhc Conttrtor's Licascd t:w (Chaptq 9. Comocing with Sction 7000 of Division 3 of thc Busirc md Prefasiom Codc) or that lE or shc is qmpt th@from md thc bosis for the allc1cd qmpion. Any violstion of Sctbn 70i 1.5 by trI applicantforapcmitsubjEBthc applicanttoacivilpcmltyofnotmorcthmfivchun&cddollm($500). _- 1. as o\\,ner of the proFtrty. or my employees \r'ith \\'ages as lheir sole cornpensation. s'illdo the s'ork and the slructure is not intcnded or offered for sale (Sec'.7O{4. Business and Professions Code: 'I'he Contractor's License [as'does not apply to an os'ner of the properly u,ho builds or irn5noves thermn. and rvho does such $'ort himself or herself or thnrugh his or her os'n employees. provided that such improvanents are not intcrrded oroffered frrr sale. ll. hou'ever. the building or improvetnent is sold rvithin one year of cornptetion. the (hvner Buildcr rvill have the burden of proving that he or she did not build or irnprove the propory for the puqnsc of sale). - _t. .ts owncr of the property. arn exclusively contracting rvith licensed contraclots to construct the proiect (Sec. 7044. Business and hofession Code: The Contractor's License l.arv does not apply to an ou'ner of property u'ho builds or improves thereon. and rvho contracts for such pt'ojects rvith a Contractor(s) licensed pursuant to the Contractor's l.icense [-aw). I zun exempt under Section- B. & P.C. for thi.s reason. I )ir I t':Onner: WORKERS' CONI PENSATION DECLARATION of the follorving declarations:I hereby affrrm under penalty of perjury one -t harc ard will minrain ! Ccrtificatc of ColMt to SdflBurc for rcrtc' omparatiou'u povidcd for by Setion 3700 of thâ‚¬ Lrbor Codc fur thc psfoMc of thc mr& for which thc pmit b isucd. .Xhavc and will maintaitr work6' compffition insurmcc, r rcquircd by Serioo 3?00 of thc Lsbor Codc for thc pqfom of thi rcrk for which this pcrnit is iscd. My wottc' smposdioo imc mir ad policy numbc rc: l'olicy l:xpircs: I _l certi$, that in the performance of the work for s'hich this permit is issued. I shall not employ any person in any manner so as to become subject to the workâ‚¬rs'compensation laws of California. and agree that if I should bccome subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwilh comply rvith thosc provisions.. WARNING: Failure to secure rvorkers' compersation coverage is unlawful. and shall subject an â‚¬tnployâ‚¬r to crirninal penalties and civil fines up to one hundred thousand dollars ($100.000). in addition to the cost of compensation. damages as provided for the attorney's fees. DECLARATION t hereby alTirrn under penalty of perjury that I arn licensed under provision of ('hapter 9 (conrtnencing s'ith Section 7000) of Division -1 of the Busincss and Professi<lns Code. and rny license is in full florce ancl ef flcct. c fl?/7dLicenseNumber: ('ontrRctor: /e/ ('oNS'l'RU(' I ION LItNI)lN(;,\(;r.N('\', I hmby affim unds pcnalty of pcrjury that th@ is 8 @nstruction hnding agmcy for the pqfollmcc of thc wort for *'hich this pcmh is issued (Sec. -3097. Civ. C.). Lender's Name: Lender's Address: APPLTCANT DECLARATION I herâ‚¬by aflirm under penalty of perjury one of the follorving declarations: Demolition Permits-Asbestos Notification Federal Regulations (Title 40. Par16) -Required Letter of Notilication --l certify that the federal regulations regarding asbestos removal are not applicable to this proJect. ___l cotify that I have read this application and state that the atnve information is correct. I agree to comply with all City and County ordinances and State Larvs relating to building construction. and hereby authorize representatives of this City and above mentioned property for Applicant or Agent I'ennitee nauxe ? ru1xrn the 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 Openinqs lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release I FINAL /t4*,4[,t*'v1, Notes, Remarks, Etc..4V I'