Laserfiche WebLink
MECHANICAL-INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby afiirm undcr pcnalty of pcrjury thst I m cxempt ftom thc Contrscton' Lhens lrw for thc followitrg rc&sn (5€.7031.5 <br />Busincss ard Prcfession Codc): Any City or County which rcquircs a tmit to @nslruct. altr. improvc, demlish or rcpair my <br />structurc. prhr to ils issure. sls rcquiEs the applicet for such [f,mit to fih a sigrcd statcmnt that he or slE is licensd pur$ant <br />lo th€ pmvisions of the Contrrctor's Licenrd tru (Chaptcr 9. Commcming with S6tion 7000 of Divisic-of the ftircss and <br />PrcfcssionsCodc)orthstheorsheisexcmptthrefrcmandthe bosisforthesllcgcdcxemption. AnyviolstionofsE{krn703l.5byrny <br />applicant for a Jrcmit subjmts thc applicant lo a civil pcnslty of not mrc thu fivc hundrcd dollars ($500). <br />-1. <br />as owner of the propcrty, or my employees with wages as thcir solc compcnsation. willdo thc work ald the stnr{ure ls not <br />intcndcd or offcrcd for sale (Sec.7044. Business and hofcssions Code: The Contractor's License l-aw does not apply to an owner of <br />the property who builds or improrcs thcreon. and who does srrch worft himself or hcrself or through his or her own employecs, <br />providcd that such improvcrnents arc not intendcd or offercd for salc. If. however. thc building or improvement is sold within one )rcur <br />of conqrhtbn. ttre Owner Builder will have the hrrden of proving thol he or she dkl mt huild or inrprove thc propcrty for thc purpsc of <br />sah). <br />-1. <br />as owncr of thc propcrty. eun cxclusively contracting with liccnscd conlrilclors lo conslruct lhc projccl (Scc. 701.1. Busincss <br />arrd PnrtbssionCodc: ThcContractor'sLiccnscLawdocsnotapplytoanowncrofpropcrtywhobuildsorimprovcsthercon. <br />and who contracts for such projccls with a Conlractor(s) liccnscd pursuanl lo thc Conlraclor's Liccnsc t-aw). <br />-lamcxctllptunderScctiolt-.B.&P.C].f.orlhisrcuson.( )rr lrt r:%ilxiftfi* <br />I hcreby trInrm undcr pcnnlly ofpnjury one ofthe follosing dehrations: <br />/-lh*candwill mainlninaCcnifrcatcofConscntlosclf'lmurcforworkm'com[rcnsalion.as tmvidcdforbySslion.lT0Oofthc <br />ljbor Codc. for lhc JErfornuncc ofthc work for which thc pcrtrril is issucd, <br />1AAmvcanawitlnuinlrinworkers'compcnsalionin$urancc.as rcquircdhyScction3Tfi)oflhcLaborCodc.forlhcpcrformrccof' thc work for which this ;rcrrnit is issucd. My workers' comJrcnsalion insurancc caricr and grlicy numbcr uc: <br />.4",",, \,ltSS(N AhrGrr cQA <br />\,.'."r- , <br />-l <br />errify thrt in thc lxrformarce of the work for which this prrnit is issucd. I shrll not cmploy any pcrson in any manncr <br />$ as lo trcorrc suhjcct lo lhe workcrs' compcnsation lass of Californir. and agB lhat if I should hcrom suhjsl Io the a <br />sorkcrs'conrpcnsntionprevisionsofSetion3Tfi)olthctntnrCode-lshall.lbrthwithcontplywilhthrsprovisions.. <br />I{ARNIN(I: Failurc to swe workcrs'comFnslion covcmgc is unlowful. and shall suhjccl an emplo}€r to oiminal pmlrhs and <br />civil fincs up to orc hundrcd thousand dollars (Slm.ux)). in sdditk[ to thc cost of compcnsation, damagcs as pmvidcd for lhc <br />.Scction .3076 of thc l.atnr Codc. intercst and attorrcy's fccs. <br />I ICENSED C(IN'TRAC'IOR <br />DFCI ARATION <br />I hcrehy atfinn undcr pctrulty of pcrjury that I arn liccnsed undcr p()vision ol'(lhaptcr 9 (corttttrcncing with Section 70m) of Division 3 <br />of thc Busincss and Profcssions Codc. and nly liccnsc is in full lilrce rnd clll'ct. <br />C()NS'I'RUCTION LENDING AGFNCY <br />I hcrchy alllrm undcr lEmhyof Frjury that lhcre is a constructi(trr lcnding agcncy for thc Frformlncc ofthc work for which this prmit is <br />issucd (Scc. .1097. Civ. C.). <br />lrnder's Neme: <br />l.cndcr's Addrcss: <br />APIIJCANI.DECIdSAIIIIN <br />I hcr.tyaffimrundcr lEnalty ofJErjury onc ofthc folkrwing dslarutions: <br />Dcmolilion Pcrmits-Asbcshs Nolificolion Fcdcral Rcgulutions (Titlc 4(). Pan6) <br />_Requircd lrllcr of Notificolion <br />-l <br />ccnily lhat lhc fcdcral rcgulations rcgarding oshestos rcmovalarc nol applic.blc to lhis pmjet. <br />AA ccnify tnut I havc rcad this application ud ststc that lhc rhrve informlion is conet. I agre |o mmply with all Cily and County <br />filinanccs and State tiws rchting to building construction. ond hcrcby authorizc rcprcscnt{livcs of lhis Cily snd Counly to cnlcr ulmn lhc <br />abovc rncntioncd profrcrty for insJrcction <br />t L <br />Appliances <br />tVletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />[tIisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation <br />Smoke Detectors lnstalled <br />Rouqh Ductwork <br />Vents <br />Toilet Room I Clothes Drver /\ <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type Il Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test t <br />Meter Release tt /1\ <br />FINAL v,lblLt X]^\5 I ) <br />Notes, Remarks, Etc.nll \./ <br />I)tle: <br />&icen cctur*, S Liccnse Numbcr: \OKOZ g <br />\r",", 1(>r f <br />:o conrracro., S,ls\rrrc fiirAuul