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ID/SIG.COMMENTS OWNEB BUILDEN DET-CARATION
<br />I n@by afilrn undm p.nalty of ncrlry ln l m cxcm 6om lhc Cnntraclos Ltcns tiw for lh. followi.S rc&$. (Se.7011.5
<br />Busin.ss a Proacsion Codc): Any Cily or Coutrly ehich rcquircs a pcmir lo .oNld.l. all6, imlrovc. d.rclish o, Eprt y '
<br />smci!rc. Iritr lo ils nsuaN, als ftaliEs thc al,Plica for oct l)cmfi ro ,ik 6 siSncd srdcm th.l rE or sh. is li.erEd puBuenl
<br />ro rh. Fovirions of rtl Conrshls Li.cflsd L!* (Chapra 9, Commncin8 *irh Sccljon 7000 ol Division 3 of lhc Busi.css and t
<br />Pof€rsions Codc) or rh lEor she h er€mpi ltEet06and rh. borh lor tlE alk8.n cx.q,lhn. Anyviohtionofselhn7011.5bylny
<br />trppli.d lor e pcmll sbiek llE apl,li.dnt lo a civil pcnalry oa mr mE than file huidr.n douars (t500),
<br />-1.
<br />&{ oq( of lhe l,o!cny. or ny .nplo}t s wirh wagc. d t n sb Nmpcnsrion, will &r lhc wort atn llE enrl@ i! mr
<br />ht&krl or of.rcd lm solc (Sr.?044. Busimss and Pofcssiotrs Codc Tnc Connrcror's Ucene bw do.r noi orply to s owrcr of
<br />rrE tFFny who build. o. inpm6 'h.Nr ed eho dcs sch slt himslf o! hcrclf ., rtNlsh hir o, her ow..mploltc,.
<br />pmlld rhsl such in{mEmnri@ ml i.renH orofl@d forr!h.lf, hovN.llE toildinS or inqmrclEnl is sld wittin onc Fd
<br />.fsnphrion. rls olxrF Build.. *ill tuE tr hr&. of povirS rhlt lr or sn dil mr hild or iqmk dEJ,opdry fttr tlE pqrs of
<br />-t,
<br />Bs ovncr of thc tml'eflr, ad dctusilcly co.r,odins wirh lic€n*d conreloR ro cooslrucr rk lmjd (Se 7044, Burrcrs
<br />,.d Pbftssion C{dq Thc C6nh.!oi s Lic.nsc ljv d@s nol lpply l. m owncr of lropeny *to builds or ihprorci rheie6!.
<br />nnd eno conrrn ts for such pmiccls *irh a Conr8do(, licen*d plrunr ro rh€ Co r.clor's Li.rns tiw).
<br />I lmcrcmd undq S(tntr .B & P.C. forlhFrq$n
<br />IOBf,EIN:.C!]MPJNIAIION
<br />DBcIrllAIlqN
<br />I hcrcby artrm u.dcr rcnalry ol pdjury dft of rh. fdlowinB dNhdrionsl
<br />-l
<br />hrrcnnd *illDtrinrri.!CcnificlrcorCDi{nr t, srli lisurc tur work.rf .onrFnsJrion, rs trovkrcd i hrSecrion.rT00orrhr
<br />Ijh, Codc.lorrhc Ffoirnrnccol rhc{ork turwhichlhc p(nnir hsucd
<br />-l
<br />havc and wall nainki. w.rl.R comp.nslrion insnrc.. $ EquiFd by Sdlion l70O of lhe Lahor Cod., for ih. p.rfomw ol
<br />thc worl 16 whth rhis pemit ir i$u.d. My worlcB otr{Ensaion iffurlm. cei:r ad ,bli.y .odtr e:
<br />P.lhvNn'r'lE Eroidl
<br />Al eaif, thd in rhc Frlmmrc of thc work lnr whkh rhis lErmn h isso.d. I shlll fln.npL, ay Fr$n in lny ,gm.
<br />Iso rn lE.otu sbrc.r ro rlF wnrlds comFnqrDn bwi ol Cjlifomia ard agE rhal if I sl$lld t rom rubirr ro rrE
<br />Mrtoc ontlM{ridn pmaisions ofsetion 3700of th. t bor Cod..I shdl. fo h{iln oq,l, wilh lhos Pmvisioos..
<br />WARNING F.ilurc ro scurc *orkc$'
<br />civil fincs ur lo om hundrcd lfiousand
<br />Ser ion 1071t .f rhc I itnr adtc. inrcft<
<br />l. rnd {hrll suhj..t un.'n lotcr to aimind tlMlics and
<br />rhc (xr .r.omp.ns,riotr. donEBcs as polid.d for rhc
<br />IICENSIITONI&ICIOB
<br />DICTABAIION
<br />t h.rcb, aitntundcr [rcnllrtofpcrjlryrhar I anr lici{rl und.r pmvisbn o{chblrct 9 (.onrnEncin8 *irh S.rrir 7(xx)) ol Divisi('n.1
<br />ol rhc Busincs ind Pn'icsrnrns Codc- Rlnrrli.cns n in tull ntrccdn.fic.r.
<br />t/
<br />a (e,
<br />sNEla!]qrcuuaDlNlilcEll(I
<br />I hcrcby sffiro ud.r lcn lIy oa Fjury thll rhd. is ! 6[(tu rio. lnding ag.Ey fo! rlF p€fre of iE solt for *hih lhh trnn b
<br />hsucd (sf. 1097. cir. c.).
<br />-l
<br />ccnifyrhar rhc fcdcral eSri l. r ions rc$rding usb.slol rcn,v0l,a nor 0mli.ahlc to lhis pDirr
<br />-!.rnily
<br />rhar I havc rcld rhir snplkdion dld srtrh rhor lh. rh,vc irlonMrion n comcl. I Bsrcc ro.odnlyeirh dll Cny trnd County
<br />.rtlinrn..r !fJ Shre lrtrrs rc ro buildinB consh.riotr ald hcr.by,urh.rie rcpr.$fl0livcs ofthis Cily and Countyro enid np.n lh
<br />oL
<br />*.,'1/zc/B-
<br />Appliances
<br />Ivletal 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 7 -ra'/ g Y.ttdtd
<br />Residential Ranoe
<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 />Meter Release /A
<br />FINAL N-"21Y *"w)u
<br />Notes, Remarks, Etc.
<br />MECHANICAL-INSPECTOR RECORD
<br />APPROVALS DATE
<br />l,rro ()nn$
<br />,*"(_--akLllj
<br />Lcndcis A drc\\,rllmr,rNilxiianriroF
<br />I tmhy lirtrruM.r ncnnlryol'pcriu,y onc orrhc nnb*ira dslarurtnN
<br />fx'noliri,,tr Pqnrir\ A\h.nos Norifictrriotr F.dctul R.lul,rio (1'nh 41), Pd6)
<br />Rdlu(d ld$ of Norifilnri,rn
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