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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BT'TLDER DELCARATION <br />I hercby allirm unds pcnally of perjury that I u excmpi fiom ihc ContracloE Liccns ku for thc following lt&n (56.7031.5 <br />Busincss ard Prcfcssion Codc): Any City or Couily which rcquircs a pcmfu to @nslruct, dtE, improrc, dcmlish or rcpair my <br />structurc. prior to ils issrc, aho rcquircs lhc applhmt for such pcmit to fih I sigrcd stalemnt thrt he or slE is licn$d pEtilt <br />to the prcvisions of the Conarrctor's Liccnsd Llw (Chrprer 9. Comrcing wilh SEtion 7fi)O of Division 3 of lhc Busircss md <br />PrcfcssionsCodc)orlhathcorshciscxcmptthscfromatrdthcbasirforthealbgederemption. AtryviolstionofsctbnT03l.5byany <br />applicant for I pcmit subjsts thc rpplicant to q civil penalty of nol mrc lhm fivc hundred doll8s (5500). <br />-1, <br />as owner of the propcrty, or my employees with wages as thcir sole compcnsation. will do the work and thc stnrture is not <br />intendcd or offered for sale (Sec.7044, Busincss and Professions Code: The Contractor's License [,aw does not apply lo an owner of <br />the propcrty who builds or improves thercon, and who does such work hinr.sclf or herself or through his or hcr own employces. <br />providcd that such improverrents arc not intcnded or offered for sah. lf. howcvcr, tlre building or improvcment is soH within onc )car <br />of complction, the O*,ner Builder will have thc burden of proving thal hc or shc did not buiH or improve the pmpcrty for thc purynse of <br />salc). <br />-1, <br />as owrrcr of the propcrty, am exclusivcly contracting with licenscd contractors lo construct the project (Sec. 7W, Busincss <br />and Profcssbn Code: The Contractor's Liccnse l-aw does not spply to 8n owner of propcrty who builds or improvcs thcrcon. <br />and who contracts for such Fojccts with a Contracto(s) licensed pursusnt to the Contractor's License [aw). <br />-lamexcmptunderSection-,B.&P.C.forthisrcason.Owner'-woRxn'wlttx <br />DECLARATION <br />I hcrehy affirm under penalty of pcrjury onc of the following declaratiorts: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workcrs' compensation, as provided for by Section 3700 of the <br />Labor Code, for thc pcrformance of thc work for which the permit is issucd. <br />_l havc and <br />thc work fior <br />will 3700 of thc tabor Code. for thc pcrformancc of <br />and policy numbcr arc: <br />O <br />Policy a $tsB or/rs ln <br />-l <br />ccrtify that in the pcrformancc of lhc work for which this pcrmit is issucd. I shall not cmploy any pcrson in any manncr <br />so as to bccome.subject to thc workcrs'compensation laws of California, und agrcc that if I should becomc subjcct to the <br />workcrs' compensation provisions of Section 3700 of thc Labor Code. I shall. forthwilh comply with tho:;e provisions.. <br />WARNING: Failure to sccure workcrs' conlpcnsation covcrdge is unlawful. and shall subjcct an employcr to criminal ;rcnalties and <br />civil fincs up to one hundrcd thousand dollars ($100.000). <br />Scction 3076 of thc l-abor Codc, intcrcst and attorncy's fccs. <br />in addition to lhc cosl damagcs as providcd for thc <br />a <br />LICENSED C()NI'RAC'I'OR <br />DECLARATION <br />I hcrcby allirnr undcr pcnalty of pcrjury that I arn licensed undcr provision of Chaptcr 9 (comrnencing with Scclion 7firu) of Division 1 <br />of thc Busincss and Prol'essiorrs C<ldc. aml my liccnse is in tull tbrcc antl cflL'ct. <br />bLiccnsca <br />I <br />W <br />I heEby sfrmur&r Fmlty of pcrjury that tlre is a @rs&wtbn brding agemy for th Frforc of tic wrt for whbh lhi! Fmt i! <br />isEd(Ss. 3097, CisC.). <br />[rrd6's Nrrc <br />l-cndcr's Acldrcss: <br />^rpl <br />,c . N., ,r"c, <br />I trcrcby allinn undcr pcnalty of pcrjury onc of thc following dcclarations: <br />Dcnxrlition Pcrmits-Asbcstos Nolification Ftdcral Rcgulations (Titlc 40, I'}art6) <br />-Rc<lu <br />ircd lrttcr of Notilicat ion <br />_l certify that the fcdcral rcgulations regarding asbestos rcmoval are not applicabh to this prcjct. <br />Af,, ccrtify rhat I havc rcad rhis application and statc that thc with all City and County <br />and County lo cntcr upon thcordinances and Statc [-aws rclating to building construction. <br />abovc mentioncd property for inspection <br />Applicant or Agcnt <br />( <br />l)crrrrilcc nurrrc <br />.6) lu <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />N/isc. Equipment <br />Duct Work <br />Pre- lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room I 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 />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rouqh Mech. <br />Final Test <br />Meter Release <br />FINAL <br />Notes, Remarks, Etc. <br />4 <br />l)ltc: <br />- <br />Conlracror' )A