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MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE ID/SIG.OWNER BUTLDEX DELCAIATION
<br />I hcEby lmrn und$ penslry of Friury ln l mcEnpt frtrn lt. ConlracloE Li.ens La{ for lhe followin8 rc!re! (S6.70:ll.t
<br />Busiress lnd Pofcssion Code): A.y Ciry or County ehi.h r.qllEs a pcmh ro @trnrucl. !116, impmB. &rulih or Eprt Dr'
<br />srMnr, priM io ils iaM., d$ rquiB thc .rpltrnt for *h Fmit ro frt r siSE{ sraLrnr rhlr tE or rhc i! li@E d puN.,!l
<br />|o $e lrDvisio.i of rlE Coniretdk Lkcncd kw (Ctapr.r 9. ConmNiir wilt S.ction ?000 of Divisiof, 3 of lhe Busincs nd
<br />Pmlcasion. Codc) or rhat hc or rlE h cicmDl lhcrcfom and lhc bcrir fo! lhe alLgcd cictrrpliotr. Any viol,lion ofSrlbn 7031.5 by any
<br />affllicafl lo! a lEmi slbhcr! the sprli.air m acivilpcnaltyoflor lmE lhm,ive lundEd dollffs ($500).
<br />-1,
<br />as owft. of rh. FoFny. or my cnphyes wirh E.Ecs !s lh.n $t @n!rcn$rior will do rhc rcrt lrd {r dlfu is ml
<br />inrdd or o,fcEd ror nk 1Sd.7044. AGirca{ lld Pmlc*ions Codc Tnc C.nrmlols Lien* tjw do.s ml al,I)ly lo d o$n( of
<br />lhc popcny who builds or in{,mws lhemr ud *to dms smh mi( himslf or hcB.lf or rhoueh hi. 6t hd own.lployes,
<br />previd.d rh!! su.h Fpmrlrnh m mr inrcnd.d o.o,IcEd lo. sL. U. hosw, llE hoildi,3 or inpmwEnl ii sld wirhu o* )@
<br />of coq,lcrior rlE Ovrcr BuiE€r *ill haw dE tirfrkn of povin8 rh.r hc o. ilE dil mr boild or inpmw lh. r,DIETy for llE I,EID9 of
<br />-1.
<br />asoqtur olrhc pmn ny. !ncxclusivcly...ruding wirh lien*d.onra.bN ro consrucr lh. pmjcd (Se. 1044, B6in$s
<br />ond Pnircsbn Codc: ThcConkocrols Lic.nscLawdocs notapplylo onowncroaF opcnrwto builds.rinptuvcsrh.r.on.
<br />and who conrEcts lor su.h Imjccls warh r Co.u!.ro(s) liensd pu^u ro th. Coni@tocs Lienr tjw).
<br />-l
<br />am€xcmfl undf Sedon- B. & P,C. for rhLi !e&n.
<br />]T!]Af,ETS:IOAIEEMAIAN
<br />PECId8AIIQN
<br />I h€rcby amrh under pemlty of lcrjury orc of lhc follo*ins deladrioB:
<br />l]htr(ixlc. lnrrhcl{rnn rrn.colrhcrork lnrs[i.hrltr'lf,nnl n N{ul
<br />,l hav. und will nEinrain workcr' co'nEnsal ion iNurlmc. as rcquircd ty Sdion:1700 ofthe Libo, Codc, fo. $. pnfornuncc of
<br />lhc 'ork for phicn lhistcrnril is hsucd. MyworkeN ompcnsol ion insumncc .dicr ml rolicy numbcr m:
<br />_l.cnify lh!' in rhe Frlomncc oilh. work lor shkh rhir p.nnir k hsucd.l slEll nol employ any pcr$n i, an, turn(
<br />$ a\ ro b.com subj({r to rhc Edkcm'compcnsrion la*s of Califonr[ ud asEC rhar it I sh.uld t&om subiGt to llE
<br />wolkns.onu.nsrionpmvisionsofsErion1700ofrhcLaiDrCodc,Ishall,aonhwirhsm ywnh.ho*!m sions
<br />WARNIN(;: Frailurc ro scurc "o crs compcns.tion covcr08c h unlo*tul. and shlll suhjccr an cDtl.rtt b ri,niMl p.trihis md
<br />cMt linc. r! lo onc hundEd lhous.nd dollaB (ll in (idition ro $€.o\r of con Enrnrion. d@8.s !s pmvid.n aor lhc
<br />L
<br />DECIIIXAIION
<br />I h.Ehy ofli.m undc. pcMlly of pcrjury lhd I nfl lien$d uodcr lbvi\nnr of Chaprcr 9 (N6ftn ing wirh s..rkln 70(10) oi Divisn'n l
<br />of rhc BusiBsand Pr'a.ssions Cod., rnd nrt li.cnsc k in tullior.c dcfte!
<br />CllSI8lJqIlllIiU'lDIN AENqI
<br />I h.rcbt alfinn und.r Fn0hyofp.lury rhd thcrc h a conslE.tion Lnditrs lscnc, to, rhc t.rfolfuc. orrh. work lor whi.n thk Fi rir is
<br />i\sucd(s( :llr7. civ c )
<br />APPI ICANT DIICLARATION
<br />I treby Jninn und.r Fnnlly of pcrjury oflc olth.lbllowirS dc.lidbns
<br />Dcmhion P.irnils'Ashcsros Notilicarion ltdcrul Rcsul!rions l'lirlc.l0. Pan6)
<br />-Rcqut
<br />rl t lrer.f Noriar.rrion
<br />-l
<br />ccnilirhar rhc fc.lcful rosuldrio.i egrding ash.sr.s to rvalar. horamlicahlc k' lhh lnjsr.
<br />-{, .*,r, ,nu, , *," ,"oU ,nn arulicarn,n !d darc rtnr rhe atnvc inlonori,n is c.n cr I rCN t, comply * irh all c y and (-otnry
<br />odinrncN nnd Sra'. tiws
<br />$ovc mtrlioncd pmlcny
<br />hcrcby luhorne rcprc\c ariv6 drlhh Cily tr.d Counlyto cnls uFn th.
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<br />Furnace
<br />Compressor
<br />l\.4isc. 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 />Type I Hood
<br />Type ll Hood
<br />Grease Duct
<br />Fire Damper
<br />Openinos
<br />lnstallation
<br />F.D. Drop Test
<br />Above Hard Lid
<br />Above T-Bar
<br />Rough Mech.?/tt /iv tbfrn
<br />Final Test
<br />Meter Release
<br />FINAL 7n(n*nArc
<br />Notes, Remarks, Etc
<br />COMMENTS
<br />\l"0ro..r
<br />kndc.s Nsmc:
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