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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNERBIIILDERDELCARATION . T <br />I hcrcby affirm undcr Fnalty of pcrjury thst I m excmpt from the ConradoB' Licens [:w for the followin! rcQn (Sc.7031.5 <br />Business and Profcssion Codc): Any City or County whbh rcquircs a pemil to @nsiruct, 8lts. improw. demlish or rcpfir my <br />structre. Fior Io ils issme, also rcquircs the spplicanl for such permil lo file 8 sigrcd ststemnt thsl he or shc is liensd pursmt <br />lo thc pmvirions of lhc Conlrctor's Liensd lrw (Chsptcr 9, Comrercing with Seclion 7fl)O of Division 3 of thc Business and <br />PmfessionsCode)orthsthcorsheiscxemptthercfromandthcbssisfortheallcgcdcxemption. AnyviolstionofSstionT03l.5byqny <br />applicant for a Frmit subtrcts thc rprrlicsnt to s civil pcElty of mt mrc thm ,ive hundred dollus ($50O). <br />-1. <br />as owner of the property. or my cmployces with wages ss thcir sole compensation. will do the work ard the stnrture ls not <br />intcnded or offercd for sale (Sec.7044. Business and Profcssions Code: Thc Contractor's Liccnse l-aw does not apply to an owner of <br />the property who builds or inrproves thereon. and who docs such work himself or herself or through his or her own employees. <br />provided that such improvenrnts are nol intcrded or offcred for salc. If. howevcr. thc building or inprovcrrcnt is sold within onc )rar <br />of comphtion. thc Owner Buildcr will havc the burden of proving that he or she did not build or improve the property for tlre purpse of <br />sah). <br />-1. <br />as owncr of thc profrcrty. am exclusively contracting with licensed contractors lo construct lhc propct (Sc.c. 7044, Business <br />and Profcssion Codc: Thc Conlractor's Liccnse Law does not apply to an owncr of propcrty who builds or improves lhcreon. <br />and who contracts for such projects with a Contracto(s) liccnsed pursuant to the Contractor's Licensc l-aw). <br />-l <br />am cxcmpl undcr B. & P.C. for this <br />Orr", <br />DECI ARATION <br />I hercby affirm undcr pcnalty of pcrjury one of the f<rllowing dcclarations: <br />-l <br />havc and will maintain a Certificate of Consent to Self-lnsure for workers' compensation. as provided for by Section 3700 of the <br />L:bor Codc. for thc performrncc of tlrc work for which the permit is issued. <br />-l <br />huve and will maintain workers' compcnsation insurance. as rcquircd by Scction 3700 of thc labor Code, for thc pcrformance of <br />the work for which this permit is issucd. My workcrs' compcnsation insurance carrier and policy number are: <br />Policv Number: Exoircs: <br />-l <br />certify that in thc perfornrancc of thc work for which this pcrmit is issued. I shall not cmploy any person in any rnanncr <br />so as to bccome subjcct lo the workers' comlrcnsation laws of California. and agree thet if I should becomc subjcct to thc <br />workcrs' compensation provisions of Section 3700 of thc labor Codc. I shall. forthwith comply with thosc provisions. . <br />WARNING: Failure lo sccurc workcrs'compcnsation coveragc is unlawful. and shall subpct an cmploycr to criminal iienaltics and <br />compcnsiltion. damages ar pr6vidcd for thccivil tincs up lo onc hundred thousand dollars ($l00.0tlOl.to thc cost of <br />Section 3076 of the l-atnr Codc. intcrcst and q <br />LICTINSED CONTRAC'TOR <br />DECI ARA'TION <br />I hcrchy all-rrrn undcr pcnalty of pcrjury that I am liccnscd under provision of Chaptcr 9 (colnrrrcncing with Scction 7Uru) of Division 3 <br />of the Busincss and Prot'essions Cotlc. antl rny liccnsc is in full lorcc alxl cllcct. <br />Liccnse Class: License Number: <br />W <br />I hercby affrm under pcnslty of perjury that therc is 8 onstructbn hnding agcncy for th€ perfom of the wk for which thi! permit is <br />issued (Se. 3{D7. Civ. C.). <br />Lcndcr's Namc: <br />Lcndcr's Addrcss: prl rc.N" <br />"ECt <br />RAtr(,n <br />I hcrcby aflirm undcr pcnalty of pcrjury one of thc following declarations: <br />Demolition Permits-Asbcstos Notification Fcdcral Rcgulations (Titlc 40. Part6) <br />-Rcquired <br />Lcltcr of Notification <br />-l <br />ccrtily thal thc f'c$ral rcgulatiorts rcgarding ashcslos rcntovalarc rxrt applicahlc lo this projcct. <br />-l <br />ccrtily lhut I havc rcatl this allplication und statc lhat lhc atxrvc intirrrruliorr is corrcct. I agrcc to cornply with all City and County <br />ordinances and Statc [:ws rclating to reprcscnlalivcs of this City and County to cntcr ufnn tlrc.\abovc mentioncd propcrty for <br />Applicant or Agent <br />Pcrrnilcc nanrc <br />conslruction. and hcrcby authorizc <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />l/isc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors Installed <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />Installation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test n <br />Meter Release N\ <br />FINAL t.-ZT-A \,trt\t) <br />Notes, Remarks, Etc.\,\/ <br />o,r", - ll blrrn <br />Contraclor: <br />k-,*", til b/ te <br />fiAt+