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MECHANICAL.INSPECTOR RECORD <br />APPHOVALS DATE ID/SIG.COMMENTS OWNER BUILDER DELCNRATION <br />I heE'by lftirm undd p.nalry of lcr.j!ry rh'l Lm cxcnq lEnrhe Conr.rdm Licc.rc L!* for llE olloqirS ras! (S.c,'7011,5 <br />Buiin.ss r.d Prof.isio. Codc): Ary Cnt or Cou y whi.n rcquircs r Ffl l lo onstru.l. dls. imtmvc dcmll\h o. op.t ey <br />srroctuc Irnr b ils issusnce. rko rcqliEs rhc applicorr for such l,cmir ro filc a sieftd srdcm rhil hc or shc is limnsd prNitril <br />t, the pnvisions of rhc Conrturoa. Lienscd Lqu (Ourt6 9. Conftncin8 wilh Scclion TOOO of Division I oa rn Bu\inc$ snd' <br />PFlcrsions Codc) orrhal h. d sn il ercmrl thccfiom ed ttu blsis for thc lller.d crcmflioo. Aryvioldio.ofsc.lbnr0ll.5bysny <br />appliclnr fo! a Fmil subjcrs thc arplic!fl ro ! civil pculry of nn mrc lhnn fivc hudEd doll.is (3500). <br />-1. <br />as owncr of lhc rmllcny. oi ny cfrplorr.s sirh wlgcs ar $cn eb co@.nurion. vill do tlE wdk !d rh. rrtl@ b ml <br />intend.n or o,fcrn ror {lc {S6.7(x4. Busincs ard Pmf.ssions Cod.: Thc Conrr!.lois Lien* rjw des nol rydy lo e o*tur of <br />rh.popcny *ho hoirds or iqmB rl@.. ,rld whr doca suh *o* hnnsclf or tcrclf or rlmust nir or nd own.'nployccs. <br />,rovid.d rhrr srch impmwnF m nol inlcdcd o. ofreBl for $b. lt howc@. the buaui.E ot nr{,mwmnl is sH snhin orc Fe <br />ol complcrion, rhc Owrr Builds will lErc rlE budcn ol rovi.C thn1 hc or shc did nol build or inprct lhc l,oFny f6r ts puqns ol <br />-1, <br />as owmr ofrh. pfttrErty. !,ncx.l!\iv.ly@nreri.g wnh lken$d conrBcron ro onslru€l ltE l,orc.t (S.c.7044. BNinls <br />dd Pr!ftsrbn Codc: Thc Contmdoas Liccnsc ttw do.s nol ltply to e osncr of pmFny who builds or inprovct lhcrcon. <br />and who o trh for $ch p,!jc.ls qilh d ConrRcro(s) ticcns.d ryBust ro rhc Conui.ror'i Liccn$ L!w). <br />Owrer: <br />&OBTEIN:I:OMTINSAIIAN <br />DDCIABAIIITN <br />I hcrchy afllro und$ p. ltyofpsjuryorcotlhc aolloviu dcclmtions: <br />-l <br />hlvc o,n will minrain 6 C.nitrdc ol Con!.or ro Scll- l.suc fo, wort.u otrrpctrelion. s FDvi&d for by Smtion 3700 ol llE <br />Labor Codc, for ihc perlorw ol rte wort for shich rhc rsdir ir kslcd. <br />_l hulc and will minl:in sorkc* comFnsation insurancc. !s rcqui(d by Sel ion l?U, ol rhc kbor Cod.. lor thc pcrfommc of <br />rhc s6rk lhr which rhi\ pc.mir il n\udl. Mysoikcrs .o rp.ion nrurnncc$ricr u Ix)licy numhcr:m <br />_l.cniryrhn( in !h. p.rrormncc of lhc work for wh rhh permir is ksucd.l shallnot.Eploy uny !.rson inunrhuncr <br />m N ro tBom subirr ro rhc wo*6i cohpcnsurion luwr oa Califomi4 u.d lgN th0t il I should tcc.m slbF.l ro rh. <br />workctr' comp.ns0r ion povniofls of Sc.lion :1700 of lhe l-otnr Gde, I shall, todhwirh .omrly wnh lho* pmvisions. <br />WAnNINC: Failurc to sle *ork ^ snlp.n$rion .ovc,0gc is unl,wtul. snd shall subrcrr d cmplo}lr ro oininal p.@llis und <br />civil fincs up ro onc hlndred rhnued doum ($100.@0). in addilion ro lh. co( of cong*nstior. drdges !s providcd tor lhc <br />sccrinn 3074 ofrhc lrtxtr codc. im.rcsl and dn{ <br />Ulrr,lBlIlQN <br />I h@by srlrm under Fnrly of Fqury rhar I m tie.sd !id.r povirion of ChIlrq 9 (olreGin8 *nh Sc.lion 7{100) ot Divirion l <br />ot rh. Busift.s .nd Profssio.s Co.tc. 3.d 6y li..@ t in tull forq 8rd clfel- <br />?,-:{otqt <br />(IONSTNU(]TION I TI\T)IN(: A(:FIIC-Y <br />I hcEby amrm und.r penalry of pcirlry rlul rhqc is a o.srrud hn lcidile rg.my for lhc pcrformic. of lt. srk for wnich lhh lEmil b <br />h$.d (Scc.l0ir7, Ch C.). <br />A-89,.1(ANLI)I;!L!AAU0! <br />I lkR:lt rllih, untlrr If,nrlrJ ol tErlury onc ol ttu tullo*irS d.cIrdi(nN: <br />I)ctr!riri.tr Pcnnir\ Arti{.\ Norilicrrion licdcBl It.!ulJri,n,s rTirlc.l0. Prn6} <br />Rcqundd I (rsol Norilirxrni <br />_l .enif, lh rhe tedcbl Egrl.tions rc8ardir8 asbc*los emal m rct lpdiabh lo rhh Poirt <br />-l <br />cenify rhd I haE ,ead rhie 0pplhdion . rat. thrl th. 0bor inforrotion k coGr. I {g@ ro omply wnh 3ll City 5nd Co! , <br />ordinlRrs sd Sr.lc La,s ElarinB ro boilding .on$erirn. rBj hercb, aulthrnc rq,rcsntalircs of lhFcnt and Counly to cnlcr utFfl lhc <br />at-vc mnthn.d pmpcny for <br />i, <br />Appliances <br />Metal Fire Place <br />Evaporative Cooler <br />Furnace <br />Compressor <br />I\Iisc. Equipment <br />Duct Work <br />Pre-lnsulation <br />lnsulation <br />Smoke Detectors lnstalled <br />Rouoh Ductwork <br />tA <br />Toilet Room / Clothes Dryer 7-11-)r \,VII,LI <br />Residential Ranqe <br />Hood <br />Type I Hood <br />Type ll Hood <br />Grease Duct <br />Fire Damper <br />Openings <br />lnstallation <br />F.D. Drop Test <br />Above Hard Lid <br />Above T-Bar <br />Rough Mech. <br />Meter Release /r\\ <br />FINAL K-ts {K k-w"an <br />Notes, Remarks, Etc <br />Vents <br />Other <br />Final Test <br />_l m crcopr uodcr SeIion- B. & P.C. for thil Ga$n. <br />,",., z '1/ tllE <br />1-r€ <br />t---+--- <br />tt <br />I