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M ECHANICAL.I NSPECTOR RECORD APPROVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCARATION I hmby affm undc pmslty of pojury that I m qmp from thc Contractors' Licfls Lew for thc following r@r (Se.703lJ Bwincs and Profeion Codc): Atry City or County which rcquirc a pamit to sEtrud, alts. improvc danolish or rtpair my stsuctuc Fior to its isuace, also rcquirc thc applicet for such psmit to filc a sigtrGd darcmt thd hc or slE b licosâ‚¬d BEUat to thc provisios of thc Contractor's Liccnrcd Law (Chapt6 9, Commcing with Sctioo 7000 of Division 3 of thc Buiae ud Prcfeioro Co&) or that hc or shc b qmpt thscfrom sd thc b8is for thc allegcd cxmption. Any violation of Sdbtr 7031.5 by aoy applicmt for a pcmit subjcts thc applicut to a civil pmlty of not morc the fivc hundrcd dollm ($500). -1, isi owner of the property. or my employee with wages as their sole compensation. will do the work and the structure is not intended or offâ‚¬red for sale (Sec.7044. Business and Profcssioru Code: The Contractor's License Law does not ryply to an owner of the property who builds or improvcs thcreon, and who does such wort himself or herself or through his or her own employees, provided that such improvcnrents are not intcndod orofu for sale. If, howwer. thâ‚¬ buiHirry or improvcment is sold within one )ear of complaion, the Orvncr Buildâ‚¬r will have thc hrdcn of proving thd hc or she did not hrild or inprove the property for the purposeof sale). -1, as owner of the property. am exclusively contracting with licensed contraclors to construct the project (Sec. 7044. Brsiness ard Professbn Code: The Contractor's License Law does not apply to an owner of propcrty who builds or improves thereon. and who contracts for such projects with a Contraclor(s) liccnsed pursuant to the Contractor's Liccnse l.aw). -l am exempt under Section-, B. & P.C. for this reason. Owner: WORKERS' COMPENSATIM DECLARATION I hreby affm undo pcmlty of pcjury one of thc following dclratiom: _l havc Ed will maint8in a Cstificatc of Comt to SclfJmurc for rcrkds composation, c providcd for by S6tion 3700 of thc labor Codq for thc pGfomcc of thc wo* for which thc psmit b issucd, ,llflmuc ma *itt maintain wor*cru' com[mation iruuarcc. 6 requircd by Setion 3700 of thc lrbor code. for thc pofomcc of Ihc worl for wNch this pcmit is issuod. My works!' comFrution irewcc mis ad policy numbcr uc: a (e Policy _l certi& that in the performance of the work for which this permit is issued, I shall not anploy any person in any manner so as to become subject to the workers'compensation laws of California. and agree that if I should become subject to the worters' compensation provisions of Section 3700 of the l-abor Code, I shall. forthwith comply with thosc provisions.. WARNTNG: Failure to secure workers' compansation coveragc is unlawful, and shall subject an crnployer to criminal penahics and civil fines up to one hundred thousand dollars ($100,000). in addition to the cost of compensation, damages as provided for the Section l-abor ''r"*and attorney's {L( I ICENST'N CON'IRACTOR DECI ARATION I hereby aflirm under penalty of perjury that I arn licensed under provision of Chapter 9 (commencing rvith Section 7000) of Division 3 of thc Business and Professions Code, and my liccnse is in full force and cffect. License Numbcr: W I hcby alfm unda Fnlty of pqjury thd th@ is s constructbn koding agmcy for thc pqfomcc of thc work for which this Fnit b Civ. C.). Lender's Address: APP! ICAN'I' DECI ARATION I herdry affrnn under penalty of perjury one of the following declarations: Demolition Permits-Asbcstos Notifrcation Fedcral Regulations (Title 40. Parr6) -Required Letter of Notification . -l catiry tbd thc fcdoal rcgulatioc rcgodiag Eb6tos @oval rc trot applic8ble to this prcjcl. Mdi$ ttu llwcsd thb applicstion ed statc thd thc abovc informariotr is cotrcl. I agrE to comply with all City ed Couty 'ordioins ud Stuc hw rclding to builditrg cordructioo, md h6rby uthorirc rc?rMtdiE of this City ud Couty to 6ta upon thc above mentioned property for Applicant or Agent I Permitee niune a *,,S/t6l)l, Appliances Metal Fire Place Evaporative Cooler Furnace Compressor Misc. Equipment Duct Work Pre-lnsulation lnsulation Smoke Detectors lnstalled Rough Ductwork Vents Toilet Room / Clothes Drver Residentia! Range Other Hood Type I Hood Type ll Hood Grease Duct Fire Damper Openings Installation F.D. Drop Test Above Hard Lid Above T-Bar Rough Mech. Final Test Meter Release l- ,/l-. \raJ ?) FINAL \H\ l/> l0 l yWv o7 Notes, Remarks, Etc.\ Date:. I \, tct tt+r !4/VL'[,hf*,,,., 0b[ LS /]- contr rrrrr, &l^li C),il\