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M ECHANICAL.INSPECTOR R ECORD <br />APPROVALS DATE !D/SIG COMMENTS ( )wNER rlul l.l)FlR l)Fll.cARA'il( )N ! <br />I hcrcby aflirm undcr Fna[y of pedury that I m cxcmpt frcm thc Contr ctoB' Licens [rw for thc folloeirg rc&sn (58.7031.-' <br />Business ard ftofession Code): Any City or County which rcquircs a Jmit to @nstruct. 1116, irtPmrc, dcmlisi or rcJnir rny <br />structre. lrbr to its issure, abo rcquircs thc rpplhmt for such pcmit to fih a signcd stalclmt lhrt he or sll is lieosd Pwsil <br />to the pmvisions of thc Contrrctor's Licenrcd llw (Chaptcr 9. Comncing with Sstion 7fi)0 of Division 3 of the Busircss and <br />PmfcssknsCodc)orthslhcorshciscrcmptthcrcfmmstrdlheboslsforthcalhgcdcxcmptkn. Anyviolalbnofsct{ion703l.5byrny <br />spplicant for a pemit subjets the spplicant lo I Givil penslty of nol mrc than five hundrcd dollss ($500). <br />_1. as owner of thc propcrty. or my cmployees with wagcs &s their sole comlrnsation. willdo the work and thc structure Ls not <br />intcnded or offered for sale (Scrc.7044, Business and Profcssions Codc: The Contractor's Lhense [.aw docs not sPply to an owner of <br />the property who builds or inprovcs thermn. and who does such work himsclf or hcrself or through his or her own cmployccs. <br />providcd that such improvenrnts arc not intended or offerc<l for sah. lf. however. the building or inqrrovenEnt is sold within one year <br />of completion. the Owncr Builder will have thc burdcn of proving that hc or she did not build or in{rrove the propcrty for thc purlnsc of <br />sah). <br />-1. <br />as owner of the propcrty. am exclusively contracting with licensed contraclors to construct the pmict (Sec. 7W. Business <br />and Pmfcssion Code: The Contractor's Licensc Law docs nol apply to an owner of pro;rrty who builds or improvcs thercon. <br />and who contracts for such pmjects with a Contracto(s) liccnsed pursuant to lhe Contractor's Licensc [:w). <br />I am exemnl B.&ftrr this slvp,-o ?r <br />I hercby allirrn undcr Jrcnalty of pcrjury one of lhc lbllowing <br />_lhavcatrdwill rnainlairraCerlilicatcofC<lnserrtloSclf-lrrsurclirrworkcrs'compcttsitlion.as providedlirrbyScctiott3Tfi)ttl'thc <br />I;rtxrr Cotlc. Iirr thc pcrltrrnrancc of thc work lirr which thc pcrrnit is issucd. <br />_t hlvcarrtlwilt rnaintains,orkcrs'cotnpcnsationinsurance.ils rcquirctl hySc'ction.l7il)rtfthcLrhorCodc.forthcpcrl'ornllnccof <br />thc work lirr which this pcrrnit is issued. My workcrs' corrrpcnsalion ittsurilncr'calricr arrd ;xrlicy lttttttbcr iuc: <br />Policv Nunlbcr: Expircs: <br />- <br />, <br />_l ccnify that in rhc Jrrformncc of thc work for which this Frmil is issucd. I shull nol cmploy any pcrsn in any manncr <br />s) as to bccom subjcct lo thc workc$'compcnsalion laws ofcnlifornia. ald agrcc lhat ifl should bcconr subj€l lo lhc <br />workcrs' comJrcnsati(r1 ppvisions of Scction 3700 of thc lltnr Codc. I shall. forlhwith comply with thos provisions.. <br />I <br />WARNING: Failurc to s.urc uorkcrs'conqrcnsatirrn coirrugc is unla*ful. nnd shilll subj(t an cmplolrcr lo riminal lrmlics und <br />civil fincs up to one hundrcd thousand dollars ($1fi).ffiO). in to thc cost of danuges as provided for thc <br />.Scction 1076 intercsl and attorncy's l'ccs. <br />("l0 Zo 7 l- <br />DECI ARA'I'ION <br />I hcrehy af'tirrn unclcr lrcnaltyof pcrjury that I am liccnscd undcr provision ol'Chaplcr 9 (coltuttcttcirrg s'ith Seclion 7Un) ot'Division J <br />of thc Busincss and l'rol'cssions Coclc. and rny liccnsc is in full litrcc antl ctl'cct. <br />Liccnsc <br />Dale: <br />Class: License Number: <br />W <br />I hcrcby allirm undcr Enrlly ofpcrjury rhol lhsc is a construction hnding .gory for lhc lrcrfonmncc oflhc work for which lhis Jf,nnil is <br />issuc(l (S$. .1097. Civ. C.). <br />l-cndcr's Addrcss: <br />I trcreby alfinn under pcnalty of pcrjury onc of the following dcclarations: <br />Denxrlitiorr Permits-Asbestos Notification Fedcral Regulations (Titlc 40. Pan6) <br />-Rcquircd <br />lrtter of Nolificalion <br />_l certify that thc federal rcgulations regarding asbeslos rcnxrval are nol applicablc to this projcct. <br />-l <br />ccrtify lhal I have read this applicution and statc that thc atxrvc is corrccl. I agrcrc lo comply with all City and County <br />ordinunces arrrl Statc Laws rclating lo autlrorizc rcprcsentat ivcs <br />abovc mcntioned propcrty for <br />Applicarrt or Agcnl <br />Pcrrtrilcc rrlnrc <br />and <br />f <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 />Rouqh Ductwork <br />n <br />Vents n I <br />foilet Room / Clothes Dryer 1-K -vt A.'{llL\l, <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 n <br />Meter Release <br />FINAL 3-7s-A trAril,l <br />Notes, Remarks, Etc. <br />l)ate. <br />Carrier: <br />v /4 ^;fr <br />(/$--l <br />/4.'