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MECHANICAL.INSPECTOR RECORD <br />APPROVALS DATE ID/SIG.O1INER BUILDER DEITARATION <br />t hmby !mn, undd pallry of p.tury lnal I dn cBno ion rh. CotudoB Lic . Lrw lorrh.lollowing r.en (Se70315 <br />Busin6s tud Proasion Codc): Any Cily or Cornly lvhich rcquir6 s Psnrn lo coonod. ah6. im!rcva <lnolish or Epon mv <br />srtuclu.. |rbr lo irs Lrsudc.. al& ..!{irB lhc arPli. l aor luch p.di $ filc t lrgn.d 3l.ldclll $d h. or ih. b licaEd pulfufl <br />ro lhc FovilioB of $c Conlr*toas Licss.d l,.w (Chapld 9. Com.ncin8 wnh Sdion 7000 of Divisio. I of lh. EurinRq sd <br />Pof*ion! Cod.) or rh.t lE or shc is crenpl fioc&om and lh. bosis for lh. all.s.d qmPtio.. Anv violalion of S..tiofl 701 I 5 bv an, <br />.pplicet for a pnrit subj*r3 th. applicml lo a civil pdahy o liot 6or. $& iir. hundr.d dollds ($500). <br />- <br />I. s own6 of lh. Ftrp.fly. or mt .6plor6 witt wtg6 c lh.t sL ooP..elio.. sill & lh. *ot dd th. dflde i$o! <br />i ad.d or ofi6.d lor elc (S6.?el4. BBind od Pmfsiotu Cod.: fi. CoolEclor's Licd. ltw doa not apPly lo M osn of <br />rhc rroFty vho bil<& o. ir4,ove th@r od sho do6 loch s!ll( hinslf or hddfo.lhtoogh his or hE om dplovd. <br />providdl rh.t surh inprcvoers @ rct inlqi.d or ofl.Ed for sL lf. ho\leq, Oc hildsg or inFtr\Eful b $ld winino.. y€t <br />olcompk io( rh. O, ftr Buildn win hlE tk tuda oapmviis fid h. o. sfic did 6l hild or inF.v. fi. pbpdy for tli. plrpo$ of <br />-1, <br />s oMd ofln Fopcly. d q.l@itcly co.lt&1i.8 w n Icffi.d coarodoc to @Dnod th. proj.d (56 7044 BcinB <br />ed PmEsion Co&: Th. Conmoor'r Lic.nr LN do6 nol ,Dply lo s oenq of prup.rly rvh. b!il& or inpro!6lhddi. <br />a.d *ho codracrr ror.uch Foj.ds with a coitBtu(r lic4.d puEunr ro (h. contador-3 Lic@ L3s). <br />I M.xc'nF und6 Scrlion <br />la8aE8!:CqUtDSEAIlO!olcldtalla! <br />I h@by .IIim und6 pd.ty olFjuy on. of lh. followinS d.cldlioB: <br />th.v.adlrilln.inlnifldCcnificalcofc.NdtoS.ll-lnsurclor$orkss'corn!.Nalion.spmvidcdlotbysdlionl?()uotlhc <br />t,sbor Codq lor rh. Ffomanc€ otllE rvork ior Nh,cn lnc ponir is isu.d. <br />I navc snd rill nrinlain vorl6 coop.Bario. iNurance ss r.quned by sdiof, l?00 ot tlr€ Labo. Cod. lor lhc psfomd.. of <br />rhc work iorshichliis pnil is Mywo*6 comFNlio.iGu c..eicr Md policy nunbo ecl <br />lzft n'g lhar r !h. D.rrom.ncc or rh. vo* ror r hrch rhi! panil ie isud. I sh.ll nor .nploy ey Pssn in anv mond <br />tr'sro b6om. subrd ro lh. *ork6 ornpcnsl'on laF ofCtlifomia. ud a8R lhar if, sholld b.codc sbj<t lo thc <br />srk6 comFrElion Forisioc of Scction lT00 oaln. l$or Codc, l shall. aontwith cohplr Niln lho* pmltioE.. <br />IVARNINC: F.illrc ro Furc rvortC contdiariod o.vo,8c is unlarvful. tud shtll 3ohl< an mployt lo dininal Fmhi6 .nd <br />(o onc hnndr.d lhoudd dolla6 (3100.000), h .ddni.n b lhc co$ oa.omFisalio!. dmag€ a Providcd lor ln. <br />C.de inr.ren and atdmcl s f.rs <br />DECLAAAIIO! <br />IncEh) amrn !.dd pmalrv ofperiury rhal t n'n l.en$l un.ld pnn'ision ofChaprs 9{.omnrncins \ilh Sel n70LI)).al)nision 1 <br />ol the Busircss and l!'ol$sionscod.. md nry liccNc is in ft'llft8tat.ftd. <br />Li(l-i..ns.Nuo <br />I hqcby amm undd p..ahy of prjury lh.l lhdc i. . oBttucl ion ldding tscncy lor lhc pqloflmncc of lhc *ork aor {hich this !<rnn is <br />Ladei! Addrs: <br />- <br />AIITICANLDEIIAAAIOT <br />I @aftm uftlc Fnalr! of psjury on.of lnc follo\inr dccltrtlionsl <br />l)..d n,n Pcnrns- sb.srosNolificalt'n F.dral R.*rla'ions(liile10, l'in6) <br />R.qtrn d l-errroaNorificarir <br />I cdifo lhat lt Ld6d r.eulaliom Esddins 6b€sls rmovd e. nor atplictblc lo lhis poj..l. <br />(fLir, rmr t u'c roa rrs rppnc,,inn axl {!r. rhd rh. rb.\. inrom, <br />hdinucB Md srat. bs5 Elalinx lo buildrns <ocrrudian. tnd h.r.hy iulhn <br />abor toolioned pop.ny for inspclio. <br />Appli.anl or Ascnl S is.drur.: <br />(1 <br />r, comtl\ \ir[.ll('ir! a (_N,nr) <br />f'h\( \ ,l1{ t\r?c 6,'rinrhe <br />"'"tl+tl*'to <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />Ivlisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Range <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 />) <br />FINAL ?/B/))t 4tztoV <br />{ <br />COMMENTS <br />Meter Release <br />Notes, Remarks, Etc. <br />issmd(s(.109'7. ( iv c.) <br />I-cndo s Nimc