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M ECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION <br />I hcrcby affm undo poalty of pcrjuy that I m cxcmpt ftom thc Contractors' Licmle [aw for the followiag rcn (Sc.7031.5 <br />Buincs ud hofeion Codc): Any City or County which rcquire a pcmit to corctruct, alt6, improvc, danolish or rcpoir uy <br />structuc, pior to its isumce. also rcquirs the applicet for such pcrmit to fil€ 8 signed stalmat thar hc or shc b licoscd puset <br />to thc prcvisioB of thr Contractor's Liccnsd Law (Chapts 9. Comcncing with Setion 7000 ofDivision 3 oFthc BwiB ed <br />Prcfcsions Codc) or that hc or shc is cxcmpt thftfrom ed thc b6sis for thc allcgcd cxmption. Any violation of Sctbtr 7031.5 Uy ey <br />applicet for a pmrit subjets thc spplicmt to I civil pcnalty of not morc thu fivc hundrcd dollrs ($500). <br />-1. <br />as owner of the property, or my employees with wages as their sole compensation, <br />intended or offered for sale (Sec.7044. Bu'siness and Professions Code: The Contractor's License [aw does not apply to an orvner of <br />thc propoty who builds or improves ther@rL and who does such work himself or herself or through his or her own employees. <br />provided that such improvernents arc not intendod or offsed for sale. l[, howerrer. the building or improvemeot is sold within one yed <br />of complaion" the Ourner Builder will have the hrden of proving tha he or she did not build or improvc the property for the purposeof <br />sale). <br />.-1. as owner of the property. am exclusively contracting with licensed contractos lo construct the project (Sec. 7M4. Business <br />and Profession 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 projocts with a Contraclo(s) licerued puniuant to the Contractor's License taw). <br />-l <br />am exempt under Section-. B. & P.C. for this reason. <br />Date:( )rr rrtr' <br />WORKERS' COMPENSATION <br />DECLARATION <br />I hereby alTirm under penalty of perjury one of the following declarations: <br />-l <br />have and will maintain a Certificate of Consent to Self-lnsure for workers' conlpensation, as provided for by Section 3700 of the <br />Labor Code. for the pcrformance of the work for which the perrnit b issued. <br />J I ha'eand/E work for <br />Section 3700 of the Labor Code. for the performance of <br />carrier and policy number are: <br />poricyN,,,b., --t Ut )FCzqBJ?l ) Expires: <br />-l <br />certi& that in the performance of the work for which this pcrmit is issued. I shall not enrploy any person in any.*o' <br />so asto becomc suQiect to the workcrs'compemation laws of California. and agroe thd if I should become subject to the <br />worters' compcnsation provisions of Section 3700 of the Labor Codc I shall forthwith comply with those provisions.. <br />a <br />WARNING: Failure to sre *ork6' compenstion covogc is unlarvfirl. ad shall subjct e mployq to qininal poslties md <br />civil fina up to ooc hundr€d thoMd dollm (t100.000). h addition to thc sst of compcmtion. d8ro96 I providcd for rhc <br />Section 3076 Code. interest and attorney's <br />-t <br />LICFNSED CONTRACTOR <br />DF'l AILITION <br />I hereby affrm undcr pcnalty of pcrjury that I anr lic€ns€d under povision of Chaptcr 9 (commencing with Section 7000) of Division 3 <br />of the Business and Profcssions Code, and my license is in fuU force urd effect. <br />2-Number: <br />W <br />I hotby aflm uoda pctulty of Fjury thd ths€ is 8 condilctbn kadin8 agacy for thc pqfdmmcc of thc rcrt 6r wlich this pqnil b <br />isued (Se. 3097, Civ. C.). <br />Lender's Name: <br />Lender's Address: p-r tcANr <br />"".LARA,I hercby affinn under penalty of perjury one of the follou'ing declarations: <br />Dernolition Permits-Asbestos Notification Federal Regulations (I'itle 40, Part6) <br />-Required <br />Later of Notification <br />-l <br />cerri& that the federal regulations regarding asbestos removal are not applicable to this project. <br />-l <br />certi& that I have read this application and state that the above with all City and County <br />and County to enter upon theordinances and State laws relating construction. and <br />above mentioned property for <br />Applicant or Agcnt <br />Pcrruilcc narne <br />a- <br />!1 <br />Appliances <br />Metal 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 ! Hood <br />Type II 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 <br />Meter Release ll Al <br />FINAL (a(h,h /fi{o <br />Notes, Remarks, Etc.I V <br />a <br />-Dele: I A <br />Date: <br />is correct. I <br />Jtl-'