Laserfiche WebLink
M ECHAN ICAL.! NSPECTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCANATrcN <br />I htrby aflim ud6 pf,alty of pcrjury that I m q@pt &om thc ContractoF' Licce t w for thc follo'wing trc&n (te.7031.5 <br />Bwines aad Profsion Codc): Any City or Courxy which rcquirc a po'rnit to @nslruct, sltq. improvc, dmolishrrr rtpair uy <br />struchrq prbr to its issuucc, also rcquire thc eplicmt for such p6mit to filc a signcd statoot that hc or slrc b licoscd pumam <br />to thc provisioE of thc Coot &tor's Licoscd taw (Chapt6 9. Comacing whh Setion 7000 of Division 3 of thc Bsin* ed ' <br />ProfsioNCodc)orthsthcorshcbqmpthcfrommdthcbqsisforthcalbgcdqmption. AnyviolaionofseliotrT03l.5byuy <br />applicstforapdnitlubjctsthc applicetto8civilp@ltyofnotmorcthofivchutrdrcddoll6($500). <br />-1. <br />as owner of the properly, or my employees with wages as their sole compensation. will do the work and the structure is not <br />intendod or offered for sale (Sc.7O44. Busincss and hofessioru Code: The Contraclor's Licorse l-aw does not apply to an owner of <br />the p,roperty who builds or improv€s ttrcroru and who docs such uaort himsclf or hcrself or through his or her own cmployees, <br />provided that such improvancnts re not intcnded oroflbrcd for sale. I(, howcvcr, ttrc hilding or improvement is sold wilhin one yetr <br />of complaion, the Orrner Builder will havc the burden of proving thd he or she did not hrild or improve the property for the purposc of <br />sale). <br />-1, <br />as owner of the propertyi am exclusivcly contracting with licenscd contraclon to construct thc p,roject (Sec. 7044, Btsiness <br />and Proftssbn Code: The Contractor's Liccnse Law does not apply to an owncr of property who builds or improves thereon, <br />and who cofficts for such projcds with a Contracto(s) licenscd pursuart to the Contractor's Liccnsc law). <br />-l <br />am excmpt under Section-, B. & P.C. for this reason. <br />I)o I r.' <br />WORKERS' COMPENSATTON <br />DECI.ARATION <br />I hereby affrm under pcnalty of perjury one of the following declarations: <br />){mrc ua *itl msintain a Cenificate of Comt to SclfJrourc for workc'compffation, 6 provided for bysetion 37OO of thc <br />Yabbr Codc for thc pqfommce ofthc wort for which thc pqrnit b hsued. <br />-p!i[ou. <br />una *itt raintain workc' compcrcation ircuilcq 6 rcquircd by setion 3?00 of thc Labor Codc. for the pqformcc of <br />the rvork for which this pcrmit is issuod. My workers' compcnsation insurance carier and policy number are: <br />n <br />not anploy any p€rson in any manner <br />if I should bccome subject to the <br />comply with those provisions.. <br />/ <br />WARNING: Failurc to sccure workers' compensation coverage is unlawful. and shall subject an onployer to crimind penahies and <br />cMl fines up to onc hundrcd thousand dollars ($100.000). in addition to the cost of compersation, damagc ali provided for the <br />Section 3076 of the l-abor Codg interest and attorncy's fe6. <br />u 1- <br />LICFNSED CONTRACTOR <br />DECII\RATION <br />I hereby aflirm under pcnaltyof pcrjury that I am lic€nsod undcr provision of Chaptcr 9 (commancing with Sation 7000) of Division 3 <br />of the Busincss and Profesions Code, and my license is in fu[ force and cffect. <br />Licersc Nunrbcr: <br />I <br />cl !'\, LLC-W <br />t hcnby arfm ud6 paulty of pcjury that thG is a @ostruclbr lcndhg agtry for thc pcfome of thc wort 6r which lhb psmh is <br />isucd (Sc. 3097. Civ. C.). <br />Lender's Name: <br />Lender's Address: <br />APPLICANT DECL <br />I herdry aftirm under penalty of perjury one of the following declarations: <br />Dcmolition Permits-Asbcstos Notification Fcderal Regulations (Title 40. Part6) <br />-Requ <br />ired Letter o f Not ilication <br />-I <br />qtiry thst thc fcdqal regulatioro rcgrding sbctos moval e not eplicablc to this pmjEl. <br />-.$\1-i-'l cdiry thd I lEvc rBd thi! appliotion dd statc thd Oc sbovc informdion b cotrEl. I tSrc to ornply with all City and Couty <br />ordimcB ed Statc Lm Elding to buildiDg coNt uclioG ad h6cby authorirc rcprsnais of thb City ed Couty to 6tc upotr thc <br />above mentioned property for inspeaion purposes. <br />Applicant or Agant <br />IPennitec name <br />C..\-/ <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 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 />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release ,4 <br />FINAL ,ollglel -n tr^rffi <br />Notes, Remarks, Etc.I U\ <br />I <br />2