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M ECHANICAL.I NSPEGTOR RECORD <br />APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DEICARATION <br />I hacby affm unda poalty of psjury thd I m qmpt frcm thc Cotrr8c{o6' Lic@ kw licr thc following tteo (5€.7031.5 <br />Buinas and Profesion Codc): Any City or Couily which rcquiB a pqmil to @struct. alt6, improvg &molish or rpair uy <br />structuc. prior to its ismcc. also rcquira thc applicilt for such pentrit to filc a signcd stalmf,t that he or slE is lics€d pNmt <br />to thc provisiore of thc Contretor's Licascd Law (Chaptq 9, Commcing with Setion 7000 of Division 3 of thc BEin6 ed <br />Prcfesiou Codc) u thst hc or shc is cxmpt thqcfrom ud thc basis for thc allsgcd q@ption. Any violarion of Sctbn 7031.5 by uy <br />applicut for a pqrnit subjcts thc spplicot to s civil paalty of not morc thu livc hun<ircd dollm ($500). <br />-1, <br />as owner of the properly, or my employe€s with wages as their sole compcnsation, will do the work and the stnrcture is not <br />intended or ofFered for sale (Sec.7044, Business and ho ssions Code: Thc Contractor's License Law does not apply to an owner of <br />the property who builds or improvs theron, and who does such work himself or herself or through his or her own employees. <br />provided that such impnovonents are not intendod or offcrod for sale. If, howwcr, the hrilding or improvcment is sold within one )car <br />of complaion. th€ Orrner Build€r will have the hr&r of proving thd he or she diJ mt build or improve the property for the trrposcof <br />sale). <br />_1. as owner of the property. am cxclusively contracting with licensed contractors to construct thc project (Sec. 7044, Btsiness <br />and Prrofession 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 projects with a Contractor(s) ticerued pursuant to thc Contraclor's License l-aw). <br />-I <br />am exempt undcr Section-, B. & P.C. for this reason. <br />f)qlo'Owner: <br />WORKERS' COMPENSAT <br />DECLARATION <br />one ofthe following detlarations:I hereby affirnr under penalty of pojury <br />_I have and will maintain a Certificate of Consent to Self-lnsure for workers' comp€nsdion, as provided for by Section 3700 of thc <br />Labor Code, for the performance of thc work for which the pcrmit b issucd. <br />-l <br />have and will maintain workers' compensation insurance, as required by Section 3700 of the l-abor C-ode, for the performance of <br />the work for which this permit is issucd. My workers' compensation iruurancc carrier and policy numbcr are: <br />Policy <br />t <br />_t certi& that in the performancc of the work for which this permit is issuod. I shall not anploy any p€rson in any manncr <br />so as to become subject to the workers' compensation laws of Californi4 and agrce that if I should bccome subject to the <br />workers' comperuation provisions of Scction 3700 of the Labor Code, I shall, forthwith comply with those provisions..- <br />WARNING: Failure to secure workers' <br />civil fines up to one hundred thousand <br />is unlawful, and shall subject an onployer to criminal penalties and <br />to the cost of compensation. damagcs as provided for the <br />Section 3076 of the kbor Code. interesl and <br />LICENSED CONTRACTOR <br />DECI.ARATTON <br />I hoeby affrrm under penalty of perjury that I am licensed undcr provision of Chapter 9 (commencing with Section 7000) of Division 3 <br />of the Business and Professions Code. and my license is in full force and ef[ect. <br />\ <br />License Nurnbcr:\\r <br />W <br />I hocby affrm undr p@alty of p€rjury that thft is 8 construclioo lending agocy for thc pafonrucc ofthc wrt for which this pqmh is <br />isued (Se. 3097, Civ. C.). <br />kndq's Narnc: <br />I-ender's Address: <br />APPLICANT DECII\RATION <br />I hcr*yaftrn under penalty of pcrjury onc of the following declarations: <br />Demolition Pcrmits-Asbestos Notifrcation Federal Regulations (Title 40, Part6) <br />-Required <br />Lctter o f Notifi cation <br />_l certi& that the federal regulations regarding asbcstos ronoval are not applicable to this projed. <br />\_l certify that I have read this application and state that the abovc information is correct. I agree to comply with all City and County <br />ordinances and State [.aws <br />above mentioned propoly <br />and hereby authorize representatives of this City and County to enler upon the <br />Applicant or Agent <br />Permitee name <br />to building <br />*,., S\q,s\ <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Misc. Equipment <br />Duct Work <br />Pre-lnsulation <br />Insulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Drver <br />Residential Ranqe <br />Other <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openinqs <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Final Test <br />Meter Release I I I --, <br />FINAL o tyD DftT.ry <br />Notes, Remarks, Etc.