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M ECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUIII'ER DELCARATION I hqcty affm undo pcnalty of pcrjury thst I m qmpt from thc CoilncroB' Licfilc law for thc following twn (Se.7031.5 Buincs and Profeion Codc): Any city or County which rcquiG I psnit to coNtruct. altq. improvc, dmolish or npair uy structurq prior to its isumcc, a.lso rcquira thc qplicmt for such pcrmit to filc a signed ststmot thd hâ‚¬ or dE b licoscd pmuet to thc prcvisioc of thc Contrrctor'3 Liccnscd kw (Chapt6 9. Comacing with Setion 7000 of Divisioo 3 of thc Buine qd Prcfeioro Codc) or thst hc u shc b cr@pt thqsfrom ed thc bosis for thc dlcgcd daption. Any violatioo of Scrbo 7031 .5 [ uy applicmt for a pamit subjcts rhc applicut to a civil pcnalty ofnot morc the Iivc hundrcd dollm ($500). -1. as owner of the property. or my employees with wages as their sole compcnsation. will do the work and the stnnure is not intended or offered for sale (Sec.7044, Business and Professions Code: The Contractor's License Law docs not apply to an owner of the property who builds or improves thcron. and who does such wort himself or herself or through his or her own employecs. provided that such improvanrents arc not intcndcd oroffered for sale. If, howevcr. the building or improvement is sold within one )â‚¬ar of complaiou the Orvner Buikdcr will have the hrdm of proving thd he or she did not build or improve the property for the purposc of sale). -1. os owner of the propâ‚¬rty, am exclusively contracling with licsnsed contracloni to construct the project (Sec. 7044, Bwiness and hoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves thcreon, and who contracts for such projects with a Contraclo(s) licensed pursuant to the Contractor's Liccnse l-aw). -l am exempt under Section-, B. & P.C. for this reason. ()s rter: WORKERS' COMPENSATION DT'CLARATION I hereby aflirm under panalty of perjury one of the follorving declarations: -l have md will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation, as provided for by Section 3700 of the Labor Code for the performance of the wor.k for which the pcrrnit is issued. -l have and will rnaintain 3700 of the Labor Code. for the performance of the work this and policy numbcr are: 'l oPolicy0o I -l certify that in the performance of the work for which this permit is issued. I shall not onploy any pcrson in any manner so as to become subject to the workers' compensation laws of California. and agree that if I should become subject to the workers' compensation provisions of Section .1700 of the l-abor Code. I shall. forthwith comply with thosc provisions.. WARNINC:lo secure workers' compensation and civil fines to one thousand dollars the Section interest and rl I hereby affrm under penalty of perjury that I am licensed 9 (commencing with Section 7000) of Division 3 of the Busincss and Professions Code. and my license is in full force and "ryt.w1 vLicense I hereby affrm under penalty of perjury that there is a construction landing issued (Sec. 3097. Civ. C.). for the performance of the work for which this perrnit is Lender's Name: Lender's Address: prr rc Nr "rcLAR.tI hoeby affirm under penalty of perjury one of the following declarations: Dernolition Permits-Asbcstos Notification Federal Regulations (Title 40. Part6) -Required Letter of Notification -l certi& that the federal regulations regarding asbestos removal are not applicable to this project. -l certi& that I have read this with all City and County ordinances and State l-aws relating and enter upon the above mentiond property for Applicant or Agent Pennitee name vl,Ctz It (g Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation L 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 lnstallation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Fina! Test Meter Release It ,t rl FINAL )17ta DWJ4i ,X7 Notes, Remarks, Etc. r( ort., I l-I $_