Laserfiche WebLink
M ECHANICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEI,CARATION <br />I hoety affrm undo penalty of pajury thst I m cxmpt frcm thc Conraclon' Licre Lrw for thc following'ren (Se.?031.5 <br />Bwincs srd Profeion Codc): Any Chy or Couty which roquirc a pannit to @Ntrucl, altq, improvc darclbh or rraair uy <br />struclrc, prior to its isme. also rcquirc thc applicur for such p6mit to filc a signcd stdmat $d hc or strc b lic6€d pwut <br />to thc provisioG of thc Cotrtraclor's Licoscd Law (Chapt6 9, Comcncing with Sdtion 70fl) of Division 3 of thc Buirs ud <br />Prcfeions Codc) or that hc or shc is qmpt thqcfrcm and thc basis for the allcgcd croption. Any violation of Sdion 701I .5 by oy <br />appliffit for a pcmit subjets the spplicet to a civil pcmlty of not morc th4 live hun&cd dollas ($500). <br />-1, <br />dS owner of the property, or my employees with wages as their sole compersalion. will do the work and thc structue is not <br />intended or off€red for sale (Sec.7044. Brsiness and Professioru Code: The Contractor's Lic€nsc [-aw does not apply to an owncr of <br />thc p,roperty who builds or improvs thcron. and who does such work himself or hcrsclf or through his or hcr own employ€e, <br />provided that such improvanents are not intendcd orofftrcd for sale. I[, howwcr. the building or improvement is sold within one ]ryr <br />of compktion the Orrner Buildcr will have the burdcn of proving thd he or she did not hrild or irnp,rove the propcrty for the purposc of <br />sale). <br />_1. as owner of the propcrty. arn exclusivcly contracting with liccnsed contractors to consitruct the projcct (Sec. 7044, Business <br />and hofession Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, <br />and who contracts for such projccts with a Contracto(s) liccnsod punuant to the Contractor's Licensc Law). <br />-l <br />am cxempt under Section-, B. & P.C. for this reason. <br />f)q I r''O*ner' <br />WORKERS' COM'ENSAT <br />DECLARATION <br />one of the following declarations:I hoeby affinn under penalty of pojury <br />-l <br />have and will maintain a Certificate of Conscnt to Self-lnsure for workers' compensation, as provided for by Section 3700 of the <br />I-abor Codc for thc pcrformance of the wort for which thc pcrmit b issued. <br />_l have and will maintain work€rs' compensation insurance, as required by Section 3700 of the l-abor Code, for the performance of <br />the work for which this perndt is issued My workers' compensation insurance carrier and policy number are: <br />a <br />.t,//61 13>Policy <br />_l ccrri& that in the performance of the work for which this permit is issued. I shall not employ any person in any manner <br />so as to become subject to the workcrs'compensation laws of California, and agrec that if I should bccome subjcct to the <br />workcrs' compensation provisions of Section 3700 of thc l-abor Code I shall. forthwith comply wilh thosc provisions.. <br />WARNING: Failure to sccure workers' compcrsation coveragc is unlawful, and shall subject an onployer to oiminal poahies and <br />civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compcnsation, damages as provided for the <br />Section 3076 of the Labor Codc, interest and attorney's fe6. <br />o,r", d/ 13/2/rc d{L <br />LTCENSED CONTRACTOR <br />DECTI\RATION <br />I hereby affrm under pcoalty of perjury that I am licensod under pnovision of Chapter <br />of the Business and Professions Code, and my license is in full force and effect. <br />) <br />9 (commencing with Secrion 7000) of Division 3 <br />\.c7D l7c <br />License <br />tj <br />CONSTRUCTION LENDING AGENCY <br />there is a construction lording agency for the performance of the work for which this permil isI hereby affrrm under poulty of pcrjury that <br />issucd (Sec. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />AfII.ICANI.DECI,ASAIION <br />I hadyaf&rn undc porahy ofperjury onc ofthc fotlowing dclarations: <br />Dcmolition Pmits-Asb6tos Notification Fedml RegulatioB (Titlc 40. Pan6) <br />-Rcquircd <br />kltfi of Notifietion <br />-l <br />cqliry thsl thc Hqsl regulatioro regrding cbclos rmoval ac not applicable to this prcjet. <br />DLI cdify that I havc red this application and statc that thc abovc iafomdion is corel. I agrc to smply with all City and County <br />ordinancB 6d Statc hw rclating to building corotruciion, ed h@by authorire reprcotative of this City ad County to otq upon thc <br />above mentioncd property for <br />Applicant or Agent <br />Pennite-€ name <br />D^,", N/3/)l <br />Appliances <br />lvletal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release tt ,l <br />FINAL \o\ U,tt'Z "DU.\^ryX <br />Notes, Remarks, Etc.\\ <br />-D <br />(^