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MECHANICAL.INSPECTOR RECORD
<br />ID/SIG.COMMENTS OWNER DIJILDER DELCARATION
<br />I h.chy afiirm u.d.r F.dry of !.rjury rhrl I o cxcofl lDm the Conrad6' Lic.s tlw fo.lh. lollowi.g Ersn (Sa.7031.5
<br />Busiocsi ard Profcssion Cod.)r Any Ciry or Couly which r.quiRs r Fmil lo mnrttocl, dls, inprovc. d.mlish or rcIhn My
<br />srru.lurc. Fbr lo ns nsuaN. d$ rcqliB rhc lpplicsnr for s*t pcdjr ro flc ! sigftd sr,r@nr thd lE or $c h lien$i 0uN!,1
<br />ro rhc Eovkions or tlE Contrecroas Liaflsd Llw (Ch!pr.r 9. Comtuins *irh Scdio. 7000 of Divisio.I of$c Busi.css rnd
<br />Pmf.sions Codc) or thlr h. or sh. is crcnu thdlrcm lnd rhc bash for rlE alkgcd crcnplion. Any viohrion of Selnn ?031 .t hy 8ny
<br />lpptico tor a pcmir sutj.lts rlE applkan ro !.itil ncmlr, of mt me $s tivc hundrcn dob' (99m).
<br />-t.
<br />us owrc. ol rh. pNpcny. m my coplorss vilh w8.s $ thcn $k compcnsdion. sil do tlE esl srrd llt stune is @r
<br />inrcndn or oficrcd fm sh (Sa 7044. Susiffis lod Profcssions Cod.: Thc Conrmtoas Ltcnse Llw d6cs nor ll)ply
<br />'o
<br />an owrcr of
<br />rhc thl.ny sho hnilds o. inlmhs iliG,n. 8rld who des *kh slt hi,bs.lr or hcMlf or lnrough nis tr ncr own chtloyc6.
<br />provA.d rhar Mch inqmwmnls N mr hrcn&d orotu fm sl lt tpg(s. tlr hiidiia or inpmEft.r i* sn ailhin orc i{e
<br />of o,lph otr tlr ol,n$ Buitlcr wil iarc llE hrd.n of Imvi.s thal lE o sh. dit mr t its or i.!mk tlE FrFny ror rh. Furlt* of
<br />-1.osowEofrhern,I'.ny.adcx.h\ivclyonttutinswnh[ccn$dconlftcrmroconsr.rttEpmj.rl(Sd.?044.Sunms,nd Ebt*shn Codci Thc Contra.lort Liccnsc kw dcs nol applyio e owncr oftmrcn, *ho blildF or iry,,ovci $creon,
<br />!trd who ontm.ls for slch lmrers *irt a Co Bcro(s) lt nsd,'uruut to rlrCon'idoi. L@nr lts).
<br />,l amcrcmpl lndcr Sdion- B. & P.C. forrhis erson
<br />Del.: Oem.:
<br />uoBsExeglMtENsAIQ!
<br />DECIdBAIII}N
<br />I h€rct y Bfiim hder I,cnalr, ol rdjury orc ol fic aollowinS delMrio.s:
<br />-l
<br />lllvc ,r'd will mindn ! C.flificrtc of Coo*nr ro Sclt lnsoo for erlds @awnsrirn. !s ,Evidcd for by SEtion 1700 ol ltf,
<br />L$or C.d.. for rhc p.rfor@.c of lhc m* for which lh. p.rnil i\ hsucd.
<br />-l
<br />hrw and will nliniain wortcn codncnsalion insrrcc. N rcqlicd b, S<rion lrm otrlE tihor Cod.,lor lhc pcrfommc of
<br />rhc uort Lr pnich rhis p.mir is istud. My *6rkdi ompemdion in\&m.!.eicr ond lolicy numlxr rc:'E6T \r\aJeftNs€'56Evr c-r- tr(-
<br />4.*,o*\s?u-ql>q ]KuB/lra.)-1lr rr
<br />-l
<br />ccnili rh.r in th€ p*formk. of rhc wo.l fr whkh rhis pc.mir is ku.d. I shall nol cnploy lny peson in any tu.no
<br />$ $lo trsm subj.rr ro th. wo*c6'smpenssrion Lws ofc.lifonia.0.d lgEc rhd ifl shduld b.rom suhFl lollf
<br />wolt6.omFn*tion,mvisionsofS.rrionlT00ofllEbtorCodc,lshlll.fonhwnhorl,)lywirhiho*pmvlsions
<br />WARNINC: Frliloe ro scuE wort6 omtEns0tion svcm8. is unlswful. Md slEll subjccl an (q)lo,tr ro aininal p.rEllis and
<br />.ivil [ncs !p x, onc hundrcd rhousNnd dollah ($|fi).UD). i. addirion lo lhc cosl ion. d!ro8.i a pr.vid.d ror $.
<br />irrEl"-'l;::"*X -1
<br />I h.sby .ltum und.r p.dly oa pcrjury rhd I m tenr.d !tutcr povision of Chaptc 9 (otlmEi,8 wilh Sc.rbn 700{)) of Divition 3
<br />of rh. BusiNis and Pref.ssion3 Code, !d ny li.c.s is ii tuU fore rrd .fic|.
<br />k q 21)1 r-^
<br />ll Its
<br />I
<br />I hcruby,mrnrtulcr Fn,lryorp.rjury rh,l thce h. oNrrudhi lcndins {scrcy nn rhe pcnn@Nc orrhc work ior which lhn Pen.it i\
<br />issncd rscc loi)?. Civ C I
<br />AXILICANLIIECITTBAID!
<br />I l&bydinn!tu1$ p.nrlry of F,ijuryotrc oithc ldlowirS dccl,nlnrns:
<br />Dcnm lil ion Pcrnrnv AstEslos Norilic.r ion ,tdcrul Rc8ul bns(lirlc,10. Pan6)
<br />-&cquircd
<br />lxrrc. ol Norifi srion
<br />-,
<br />enif, rhlr rhc tcdenl ,.eoldrions Eglrding .stEsros r.mv m nor applicablc lo this nrcj.u
<br />I ccnili lhd I havc Eld rhis appliclrion uxl sratc thar thc lhovc i.formri.n ir cotuyr. I agre to .o nDlywirh rll (iryand Counry
<br />Cnyand Counry ro cnra upon llr
<br />VlpticM, d Accnr s
<br />Appliances
<br />Metal Fire Place
<br />Evaporative Cooler
<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 Range
<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 />lt
<br />Rough Mech.6lt b'///14(!t)) ilrs llo,.n ^J"hFinal Test tvM Pr cn"1t
<br />Meter Release
<br />FINAL g-<-,f- r%a/-K/1 )
<br />Notes, Remarks, Etc.
<br />APPROVALS DATE
<br />Furnace
<br />Other
<br />Above T-Bar
<br />Lctrdcis N!mr:
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<br />*,", -tlnlt6
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