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MECHANICAL.INSPECTOR RECORD APPROVALS DATE ID/S!G.COMMENTS OWNER BUILDER DELCARATION I hccby affim uda p@alty of pdjury thrt I m cxcDpt tom thc Contrsclo6' Liccnsc lrw for thc following |ten (56.7031.5 Buine ad Prcfeion Codc): Any City or Couty which requirB a pqmit to snstruct, alts. imprcvc &nolislf or rcpair.my structe, fior to its ismcq alm rcquirc thc applicut for such pcrmit to filc a signcd statmot that hc or strc b licmcd pmuadt to thc provisioB of thc Conrrctq'! Lieorcd taw (Chapt6 9, CommcioS with Satioo 7000 of Division 3 of thc Buine ud Pmfeions Codc) or that hc or she is smpt thscfiom ad thc bosis for thc allcgcd qmptior. Ary violaliotr of Sction 7031.5 by my applicmtforapfinitsubjeBthc applicuttoacivilpmltyofnotmorcthuhvchundrcddollm($500). -1, as owner of the property. or my employeâ‚¬s with wages as their sole compensation. will do the work and the s0uctue is not intended or offercd for sale (Sec.70t4, Busincss and Professions Code: The Contractor's Liccnse law does not apply to an owner of the p,ropoty who builds or improvc thcron and who does such wort himself or herself or through his or her own employees. provided that such improvonants are not intended or offered for salc. If, howgrrer. the building or imp,roverncnt is sold within one ]â‚¬ar of complaioq the Orvncr Builder will have thc hrdcn of proving ttra he or she ditt not build or improve the propaty for thc purposcof sale). -1. as owner of the property. am exclusively contracting with licensed contractors to conslruct the project (Sec. 7M4. Business and Pnoftssion Code: The Contractor's License Law does not apply to an owner of property who builds or improves lhereon. and who contracts for such projects with a Contracto(s) licorsed pursuant to the Contractor's Liccnse Law). -l am exempt under Section-. B. & P.C. for this reason. Owner:_ WORKERS'CONTPEN DECLARAI'TON one of the following declarations:I hereby affrm under penalty of pojury -l have md will maintain a Certificate of Consent to Self-Insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which the pcrmit b issued. -l have and will maintain workers' comperuation insurance, as required by Section 3700 of the Labor Code, for the perfonnance of the work for which this permit is issuod My workers' compensdion iruurance carrier and policy numbcr are: a Policy -,zlr ?-L _l certi& that in the performance of the work for which this permit is issued. I shall not employ any pemon in any manner so as to become subject to the wo*ers' compasation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall. forthwith comply with those provisions.. WARNTNG: Failure to secure workers' compersation coverage is subject an anployer to criminal penalties and civil fines up to one hundred thousand dollars ($100.000). in of compensation. damages as provided for the attorney's fees. LICF'NSED CONTRACTOR DECT-ARATION I hereby aflirm under penalty of perjury that I am licensed under provision of Chapto 9 (commencing rvith Section 7000) of Division 3 of the Business and Professions Code. and my license is in full force and effect. I D License t {t W f horby atrrm unda parrty of pajury tha th@ b r srgruclion lcnding !g@y for thc pqfomce of thc rcil br wlfch thb Fmil i isucd (Se. 309?. Civ. C.). Lender's Name: Lender's Address: APILICANI.DECI.AEAIION I hfibyaffim unds poalty of pcrjury one of thc follorving deluations: Dcmolition Pmits-Asbcstos Notification Fcdqal Regulations (Title 40, Pan6) -Rcquircd trtter of Notilication -l cdiry that thc lusd rcgulatiom regarding rbcslos rmoval 4c not applicablc to thls prcjccl. hl,-*rrr, ,nnl havc rod this application ad state rhat the aborc infomation is cors{. t agrc to comply with all Ciry and County le[inance md State Laws rclating to building coBtructiotr ud hqcby authorirc rcprGcntativG of this City md County to st6 ulpn lhc above mentioned property for Applicant or Agart Signature: Pennitee name (nrint): \4. V,"MaYl Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors Installed 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. Final Test Meter Release I ,ll ,t t FINAL qltal>l DIt4s',6 Notes, Remarks, Etc. -+ -Licensecontractor'\A