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MECHANICAL.INSPECTOR RECORD <br />APPROVALS IDiSIG.COMMENTS OWNER AU&DER DELCARATION <br />I hcrchy rllirh udd Fnahy of lcrj!ry thar I cm cicmpr tum the ConrBtoF Licen* Liq for rhc lollosing een (Scc,70ll,5 <br />Businc$ arld Profcssion Codc)r Any Ciry.r Counry *hi.h ,cquncs 3 F1ni ro oNtru.L 1116. intl,ove rhmlish or EIat cny <br />stddB. pri,r lo iri issue.. ats rcquircs rhc.tpli.er ro! such p.mh ro ,jlc a siercd (dem rtal lE or slE is li.cnsd Irls.r <br />ro rh4 Imvhions of rlt Conr6croas Lieisn ljw (Ch,pl6 9. Commming wilh Sccriotr 7000 of Divisio. I ol rlr Busin.$ nnd <br />Pofcsrioni Codc) or lh.r h. or ihc iscxemfl rhcEiiom $d rh. basis for r hc slleged exe mfl ion. Anyviddrii,notScdionr03l.5byooy <br />lmli.anl for a pernir iubjNl! rhc amlic.nl ro { civil ncMhy of nor mc lh.n firc hundrct dolld (1500). <br />-1. <br />N owmr of lhc ropny. or my cmployNs {ilh w!8cs as thcir slc .ompcnslion. *ill do llE wk rid 0E nnrlm ir ml <br />intcdlcd d.ftcEd for sle (Se.7Ol4, Busircss lnd h.fcsions Codc, Tlc C.mr&r6Cs Lien* tlw docs nor 0Fply ro .n owmr ol <br />lhc pmFny who blilds or imtmws rlten. ltd who dc $ch sll( ninlsclf or hcrslf or ltDu8h th o llcr oq cnphycc., <br />pmvidcd that such imlrDwmnls 4 ml i.l.nd.d or offlEd for src. Il rNcwi lhc hiildir8 or inp,ovcmnl is sld airhin onc Fe <br />oa.o'qilcfion. tlr O*tur Au d.r *ill h8r dr htdcn oaFDvinB tlEr lE or slrc dil mr hiild or inqNr tlE FltEly f6. tlE lupoc of <br />-1, <br />asosncrolrhe pnperry. rnexclusilcly.ontracrins wirh liccnsd.onrr!.r.nr. on$rud rh.Ia,]..r (s.c.7044, 3usrc$ <br />ard Pmi*sir. C.d.r Thc conir{ciols Liccnsc L,w dds Bn.rply ro !n o*nn ofrop.ny*ho builds or imlmlcs thcr.on- <br />a.d *to coirels for s!.h ,ftj.rls *irh o ContrEro(, ltcflsd !u6u ro rhc Conrncrols Li.cn* L!s) <br />-l <br />mcremt und6 Sfttio.- B, &P,C. for lh]s E.son <br />lr r O{Nr <br />!I}Bf,E8S:IOMI!!SAIIONp&cIdSaII(a <br />I lrrcb, lffirm u nder pcnalty ol pcrru.y od of rlE followinB daladrions <br />-l <br />h.r strd will minl.in ! Cmifrdc ol Corsnr r. Sclf-ln!!rc for 6rkss dmrcnsdion. e pbvid.d for by Sn on 3700 of $c <br />rlbor Cod., for t,E Frfolrrm of rh. mrt for $,ntn lh. p.mil is k.ud. <br />_lhuvcatrd*illmaintuinso cncom!..!!lioninsurancc.0srcquncdnyScclion:lT0OolrheLihorCodc,fttrrhcpc,tortuccnt <br />lur trh(hrhF Nirnr N r.uc{ Mvsnlln\'!ornNtr\dmn 'n.u.u\crJnicr J'xtrricynun /^ a/F, u <br />/-U A C-O--O o'z o4 <br />-l <br />eniry $at in rlE pc.rormE 6l rlE wort lor whkh rhk pc.mn is iliucd. I shall rcl .nDl6y any Fm. i. $y lMmr <br />s a3 b tEofl subj.rl lo lhc mrt6 omlens.lion laws ofcllfomia. d {ge th.l if I snoukt.omsubFl lollE <br />workm corr..salior pmvhions ol Sc.tion lT0O of lnc htjor @c, l sttrll. fonhwnh omrly Bilh llns tmvisions.. <br />WARNING: Fdilurc io sm work rs coryEnsrion covcngc L, unhwful Md stall subt{ cn l.y!r lo siminal Fmllts and <br />.ivil fincs ur lo oft hundEd thousnd doll,s (Sloo.0ur i! addhion lo rlE cosl of onocNrion. d.m*cs 3i DbvB.d ror rhc <br />z_ <br />IICEISEDJONIIACIAB <br />DEqIdIAION <br />I hcrc$y !fftrm lndcr pendry of l*rjury thdt I an liccn$d undn previsior ofchsptq 9 (onfttuins airh S€cion Il00) of Divtion l <br />ol rhc Buiin.ss dnd Pmfcssio.s Cod., n ny licctr* k in full foN and cnicl <br />c €7/)Z <br />IONjII&JEIII}NItrNDINC.dIiENII <br />issrcd (Sc. .1097. (ir C.). <br />APzuIAN[DEEL$AIION <br />I lrnti! ]llldrdndrr Ittrrlrt olprrlury one of rhc lnlkNing dr(larti{,n\ <br />Do r)lirn{ Pcii ir\ \b({oi Nooh.drn'n rr&nl Rcgrhrii,n\ (l irlc 10. Prl6) <br />ItquirL.d I-c(cr ol Norh.nri([ <br />_l c.nify thol rhc fcd@l ..lularioB Ee(dirB sb.sloi rcmval e ml aptlh.bh ro rhi' pDirt <br />*l ccrlity ihal I h.vc rcod lhis lic0lion ond srurc rh rn 0bv. informlion iscorccr.I !8rc ro conpurntr-all Ciry cod Colnry <br />odinntucs and srd. bws rch(bu itd in8 .o nslruct ion. od ho.by aulrhrie rcpFsnhlivcs ollhis Cily and Coutrry ro cntcr upotr r,E <br />alnrc nrnr iomd <br />'mpcny <br />for lz / <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 />Rough Ductwork <br />Vents <br />Toilet Room / Clothes Dryer <br />Residential Ranqe <br />Other <br />Hood <br />T ype I Hood <br />Type ll Hood <br />Grease Ducl <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Rough Mech. <br />Final Test <br />Meter Release I I <br />FINAL (/L1 \g ,,{lJt4 r 0 <br />Notes, Remarks, Etc.I I <br />DATE <br />Above Hard Lid <br />Above T-Bar <br />-t--- <br />I <br />I <br />I <br />I <br />=