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M ECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUII,DER I'EI,CARATION I h*by afnm und6 pflalay of pajury thar I m exmpt from thâ‚¬ Coofactots' LicN L.w for the following Iren (Se.7031.5 Buine ard Profmion Codc): Any City or Couty which rcquirG a pqmit to @Etruct. a.ltc, improvc, damlish or rpair uy strucluc. prbr to its iswcc. also rcquic thc applicet for such Frmh to 6lc I signcd stalmat thd hc or slE b liccnscd pwant to the prcvisioB of tlrc Cortrrctor's Liccnscd Law (chsptq 9. Comcncing with Sction 7000 of Division 3 of thc Buine ud Prcfcsions Code) or that hc or she b dmpt thscfrom md thc bsis for thc allcgcd amptiotr. Aoy violEtion of Sctioo ?03 1.5 by my applicet for 8 pctruit subjats rhc applicet to a civil pcnalty of mt more tho livc hundrcd dollus (5500). -1, as owner of the propcrty, or my cmployecs with wages as thcir rcle compensation, will do the work and the stnrture b not intended or offered for sale (Sec.7044, Business and Professions Code: Thc Contraclor's License Law does not apply to an owner of the property who builds or improvcs thcnon, and who docs nlch wort himself or herself or through his or her own employee. provided that such improvanrents arc not intcrdcd oroffcrcd for sah. If. howevcr, ttre hilding or improvcrncnt is sold within onc )rar of cornpl*iorl the Orvner Buildcr will havc tlrc hrdcn of proving thd tle or strc did not build or improve the property for the purposc of salc). -1, as owner of the propcrtyt am exclusively contracting with licenscd contractors to construct the projecr (Sec. 7044, Brsincss ard Pnofession Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereou and who contracts for such projects with a Contacto(s) licenscd pursuant to the Contractor's Licensc law). -l am exempt under Section-, B. & P.C. for this reason. flqlp' WORKERS' COI|TPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: -l have ard will maintain a Certilicate of Consent to Self-Insurc for workers' compensalion, as provided for by Section 3700 of the L^abor Code. for the performance of thc work for which the permit is issued. -l have and will maintain 3700 of the tabor Code. for the pcrfonnance of the work for which this and policy number are: tJr tl f4X ILL _l certi& that in the performance of the work for which this permit is issued. I shall not employ any pcrson in any manner so as to beconre subject to the workerr'compernation 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 thosc provisions.. .l WARNING: Failure to scrure workers'is unlawful. and shall an anployer to criminal pcnalties and addition to the darnages as provided for the \ I < I hereby affrm under penalty of pcrjury that I am licensod under provision (commencing with Section 7000) of Division 3 of the Business and hofessions Code, and my license is in full force and effect. td '? o u/q/ql.icense Number: \ W I halby sffm und6 pauhy of pajury tha thc b 8 onnructbn lodirg agqEy for thc pafom of thc mrt br which thb pqmit b issucd (Sc. 3097. Civ. C.). Lender's Nanre: l-ender's Address: APPLICANT DECLARATION I ho&y aflinn under penalty of perjury one of the following declarations: Demolition Permits-Asbestos Notifrcation Federal Regulations (Title 40. Part6) -Required t-ater of Notification -l certi& that N federal regulations rcgarding asbestos removal are not applicable to this project. -l certi0 that I have read this application ordinances and State Laws relating to above mentioned property for Applicant or Agent ( Pcrrnitee name al 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 r[t FINAL rolzola,r Jnttno Notes, Remarks, Etc.\l , I 4 Ai-'a