Laserfiche WebLink
MECHANICAL.INSPECTOR RECORD a <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BU]LDER DELCARATION <br />I hocby affm undq poaltyof perjury that I m exmpt from thc Contrscto6' Licce Lrw for lhc following r@n (Se.7031.5 <br />Businas md Profcsion Codc): Any City or County which rcquim a pcmit to @Gtruct. altq, improvq danolishfr rcpair uy <br />structue, prior to its issuacc, also requirg thc applicilt for such pcf,nit to filc a sigoed statmot that hc or slrc b licqscd plNet <br />to thc provisioE of thc Contrctor's Licqscd lrw (Chaplr 9. Commcncing with Sction 70O0 of Division 3 of thc BNinN ard <br />PmfeionsCodc)orthsthcorshcisGrmptthqcfromedthcbasisforthcallcgcdq@ption, AnyviolationofsetionT03l.5bymy <br />applicilt for a pcrmir subjats thc applicut to a civil pcnahy of mt morc thil fivc hundrcd dotlas ($500). <br />_1, 6 omq of thc prcperty, or my cmploys with wagc c thcir mlc compcmation, will do lhc rcrk ad thc stnrtw is rct <br />intqded or oIM for sale (Se.7044. Buin6s ed Prcfsioc Codc: Thc Contraclor's Liccre lrw do6 not apply to e oms of <br />thc propsry who builds or improE thqp!, ed who dc srch wrk himclf or hcNlf or thrcugh his or hr om mployc, <br />provided that such imprcvmats @ not intqded or ollsod for slc. If, how. thc hriHing or irnpovmt b mld within onc )qr <br />ofcompl:tiot the Ownq Builda will havc thc hudor ofprcving tha lrc or shc dkl not build or inpIovc lhc Fopqty 6r thc prpo$ of <br />sle). <br />-1, <br />c omq of thc prepqly, m qclu5ivcly contracling with licef,scd contractots to construct thc prcjwl (56. 7044. Bsins <br />and Proftssbn Code: ThG Cootr&tor's Liccnse Law do6 not apply to il owos ofpropcrty who builds or improvG thssn, <br />and who ontBcls for such projsls with a Contracro(s) liccnscd pm@t to thc Contraclor's Licw law). <br />-l <br />an erempt unds Secrion-. B. & P.C. forthis reen. <br />Drte_ O*ner, <br />ya86E8[.CO![EENSAUAN <br />DECIdSAIION <br />I hqeby allim unds poalty of pcjury onc of the following delratiom: <br />_lhavcadwillmintainaCgtificatcofcotMtroSGlfJNUeforworkm'compcnsalion,r povidcdforbysetion3T00ofthc <br />labor Codq for thc pcfomcc of thc wrt for which thc pamit b isucd. <br />ff*" <br />the work <br />and will maintain workers' compensation insurance, as by Section 3700 of the Labor Code, for the pcrformance of <br />and policy number are:Ve*for which this permit is issuod. My workers' compensation carrier <br />- <br />(J - r/4 <br />in thc performancc of the work for w'hich this pcrmit is issued. I shall not employ any person in any manner <br />so asto <br />workefs' <br />become subject <br />comp€Tsation <br />to the workcrs'compensation laws of California and <br />provisions of Sec-tion 3700 of the l-abor Code, I shall,with those provisioru..I <br />WARNING: Failure to sE workm' compqration covmge is unlawful, ud shall subjct u mployr to qiminal pmltics ud <br />civil lines up to one hundrcd thousdd dollm ($100.000), in addition to thc cost of comperoation, dmagc c providcd for the <br />Srction 3076 of thc Labor Code. intsct md attomey's f6. <br />o.,", ?l6h\ aopro*, lcL Lcw*qi C*uta&alr'Tz.r- <br />ffi* <br />I hercby affrm undo pcnalty ofpojury that I m licoscd undo prcvision ofChapts 9 (commmcing with Sstion 7000) of Division 3 <br />of the Buins md Profsiom Code, md my licw is in full force and cfTct. <br />TVlo,t8 <br />Licensc Number: <br />( <br />CONSTRUCTION LENDING AGENCY <br />there is a construction krrding agency for the performance of the work for which this pennit bI hereby affrm under peralty of pcrjury that <br />issucd (Sec. 3097, Civ. C.). <br />Lcnder's Name: <br />Lender's Address: <br />APPLICANT DECLARATION <br />I hereby affirm under penalty of perjury one of the following declarations: <br />Demolition Permits-Asbestos Notification Foderal Regulations (Tille 40. Part6) <br />-Required <br />Letter of Notification <br />.1'l-]-l cctiry that the Iederal regulations regarding asbcstos removal are not applicable to this project. <br />(, ccrtiry that I have read this application and state that the above information is correct. I agrec to compty with all City and County <br />ordinances and State Laws rclating to building authorize rcprcsertativcs of this City and County to erter upon the <br />T|LT/2 | <br />above mentioned propoty for <br />Applicant or Agcnt <br />Perrnitee <br />Ilate' <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 />Rouqh Ductwork <br />bn^yz Br ffi d <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <br />Other <br />A. <br />Hood <br />Type I Hood 4-kuzJ D-il,\t <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 lo4<,t t**ttt <br />Rough Mech. <br />Final Test <br />Meter Release <br />F!NAL /o-Lo-?-l >^P.lz <br />Notes, Remarks, Etc <br />J <br />I Alqfian <br />lr <br />l-/\